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PubMed2001

CT findings of leukemic pulmonary infiltration with pathologic correlation.

The aim of this study was to demonstrate the characteristic CT findings of leukemic pulmonary infiltration based on the pathologic findings. The CT findings of 11 leukemic patients with leukemic pulmonary infiltration were compared with those of 22 leukemic patients with other diseases as a control group. Evaluated pulmonary parenchymal CT findings included thickening of bronchovascular bundles and interlobular septa, prominence of peripheral pulmonary arteries, ground-glass opacities, air-space consolidation, and nodules. The CT-pathologic correlations for leukemic infiltration were evaluated in 7 patients. Frequent parenchymal CT findings were thickening of bronchovascular bundles (81.8%), prominence of peripheral pulmonary arteries (81.8%), and non-lobular and non-segmental ground-glass opacities (90.9%). The first two findings were significantly more frequently observed in leukemic infiltration than in the control group, had good interobserver agreement, and corresponded pathologically to leukemic cell infiltration around the pulmonary arteries, bronchi, or bronchioles. Non-lobular and non-segmental ground-glass opacity corresponded to leukemic cell infiltration within alveolar spaces and septa adjacent to the pulmonary arteries or bronchi and also corresponded to hemorrhage, edema, or diffuse alveolar damage. Thickening of bronchovascular bundles and prominence of peripheral pulmonary arteries are CT findings suggestive for leukemic infiltration and correspond to peribronchovascular tumor extension.

Adult↗
PubMed2004

Bilateral leukemic orbital infiltration presenting as proptosis and narrow-angle glaucoma.

A 71-year-old man with acute myeloid leukemia presented with bilateral uveal and orbital leukemic infiltration presenting as tense bilateral proptosis, orbital inflammation, and acute-angle closure glaucoma. B-scan ultrasonography revealed uveoscleral thickening and anterior rotation of the ciliary body. Orbital CT and MRI showed bilateral proptosis with streaking of intraconal fat. Temporary pressure lowering occurred after lateral canthotomy and inferior cantholysis. Definitive treatment included systemic chemotherapy and steroids. Over a 2-week period, vision improved and proptosis resolved, and the intraocular pressure returned to normal. The patient died of cerebral complications of his illness after 6 weeks. This is the first reported case of orbital and ocular leukemic infiltration presenting simultaneously as tense proptosis and narrow-angle glaucoma.

Acute Disease↗
PubMed1976

A study of leukemic cell infiltration in the testis and ovary.

The behavior of leukemic cell infiltration in the testis or ovary was examined on 99 autopsy cases of various leukemia, which were performed in the Department of Pathology, Tokyo Medical and Dental University, from 1964 to 1975. The incidence of leukemic cell infiltration was 48.5% in the testis and 58.1% in the ovary. The frequency of leukemic cell infiltration in the testis or ovary itself showed no significant increase in recent years, although median survival time became longer by a more aggressive combination chemotherapy. These findings show that the testis and ovary are essentially a preferred site of leukemic cell infiltration. Especially in acute monocytic leukemia, leukemic cell infiltration was revealed in all cases. In addition, short discussions were made on the role of sex hormones in the infiltration, proliferation, and persistence of leukemic cells of each type of leukemia in the testis or ovary.

Acute Disease↗
PubMedDate not supplied

Leukemic iris infiltration.

Three patients with acute lymphoblastic leukemia and leukemic infiltration of the iris are presented. The clinical features, diagnostic techniques, and treatment of this condition are described.

Acute Disease↗
PubMed1990

Localized leukemic pulmonary infiltrates. Diagnosis by bronchoscopy and resolution with therapy.

Although commonly found at autopsy, leukemic infiltration of the lung is rarely recognized as a cause of respiratory symptoms or roentgenographic densities. Previously reported cases of patients who had symptomatic or roentgenographic acute leukemic lung diseases invariably presented with diffuse pulmonary infiltrates. We describe three patients with leukemic involvement of the lung who presented with cough, fever, and localized roentgenographic infiltrates suggestive of bacterial pneumonia. In each case, the diagnosis was made by transbronchial biopsy specimen and confirmed by complete response to chemotherapy. In common with the other reported cases, all of our patients had peripheral blast counts above 40 percent (greater than 6,000 blasts per ml3) at the time the pulmonary diagnosis was made. Leukemic invasion of the lung should be considered in patients with acute leukemia who develop lung infiltrates--whether diffuse or focal--in association with a high peripheral blast count.

Adult↗
PubMed2002

Extensive pulmonary infiltration by leukemic blasts successfully treated with hydroxyurea--a case report.

The initial presentation of acute leukemia as diffuse pulmonary infiltrates, especially with respiratory distress, is relatively infrequent and poses a therapeutic dilemma. Here we report a case of acute myeloid leukemia with diffuse pulmonary infiltration and respiratory distress symptom as the initial presentation that responded to hydroxyurea dramatically. This case demonstrates that hydroxyurea can be used effectively to decrease blast cell count and resolve leukemic infiltration of both lungs in patients with acute myeloblastic leukemia.

Acute Disease↗
PubMed1995

Case of pelvic relapse in a child suffering from acute lymphoblastic leukemia.

We describe here a case of an eight years old child suffering from acute lymphoblastic leukemia. She developed pelvic infiltration of leukemic cells while in bone marrow remission and receiving maintenance chemotherapy. She also developed leukemic infiltration of Central Nervous System and died of complications resulting from massive pelvic relapse. With greater number of children in bone marrow and CNS remission, the issue of possible greater predisposition to extramedullary relapse has been discussed. The need for greater vigilance towards pelvic surveillance has been stressed.

Central Nervous System↗
PubMed1999

Role of radiation therapy to the brain in leukemic patients with cranial nerve palsies in the absence of radiological findings.

The value of brain radiotherapy for leukemic patients with cranial nerve palsies in the absence of radiological evidence of leukemic infiltration is not well defined. This retrospective study was undertaken to evaluate the effectiveness of brain irradiation in reversing the cranial nerve palsies in leukemic patients with no radiological evidence of intracranial leukemic infiltration. Records of leukemic patients who received brain radiotherapy between June 1980 and December 1993 were reviewed. Criteria for inclusion were 1) no evidence of intracranial leukemic infiltration by computed axial tomography (CT) or magnetic resonance imaging scan (MRI), 2) no evidence of leukemic infiltration on ophthalmologic examination, and 3) no previous radiotherapy to the brain. Actuarial survival rates were calculated using the Kaplan-Meier method. Pearson's chi-squared test was used to compare responses. Twenty-eight patients met these criteria. The median age was 38 years (range 3-75 years): Seventeen patients had acute lymphoblastic leukemia, nine had acute myelogenous leukemia, and two had chronic myelogenous leukemia. Four patients had initial presentation with leukemia, and 24 presented with relapse. Twenty-six patients had cerebrospinal fluid cytology that was positive for leukemic cells. Fifteen patients had involvement of more than one cranial nerve, and nine had bilateral involvement. The most commonly involved nerves were the facial (n = 18), oculomotor (n = 9), and abducens nerves (n = 8). Twenty-six patients received whole-brain radiotherapy. Two received radiation to the base of the skull only. The median radiation dose was 24 Gy (range 16-30 Gy) at 2-3 Gy per fraction. Every patient had either concomitant intrathecal (n = 6) or systemic (n = 5) chemotherapy or both (n = 17) with radiation. Fourteen patients had complete reversal of the cranial nerve deficit, eight had partial recovery, and four had no response or progression of the disease. The response was unknown in two patients. Factors associated with complete response were unilateral versus bilateral involvement (72% vs. 13%, P = 0.005) and single versus multiple nerve involvement (75% vs. 36%, P = 0.045). In conclusion, radiation therapy to whole brain was effective in reversing cranial nerve deficits from leukemia, although the leukemic infiltration may not be visualized by CT or MRI. No dose-response relationship was observed in the range we examined.

Adolescent↗
PubMed1998

Squamous cell carcinoma in a patient with chronic lymphocytic leukemia. An intraoperative diagnostic challenge for the Mohs surgeon.

BACKGROUND: Chronic lymphocytic leukemia (CLL) is the most common form of chronic leukemia in the US. CLL patients have an increased risk of developing other malignant neoplasms, especially skin cancer. Lymphoma-associated squamous cell carcinomas (SCCs) tend to behave more aggressively and therefore are often treated with Mohs micrographic surgery (MMS). OBJECTIVE: To elucidate the potential difficulty of distinguishing perineural infiltrates as leukemic infiltrates versus inflammatory infiltrates associated with SCC on frozen tissue sections during MMS. METHODS: This is a case report illustrating a patient with CLL who develops a SCC on the posterior ear. MMS was employed to treat the patient. Special immunohistochemical stains were performed to help distinguish the type of perineural infiltrate present. RESULTS: The perineural infiltrate was shown by immunohistochemistry to be leukemic in origin. Special stains for keratin revealed no residual SCC hidden in the infiltrate. CONCLUSION: CLL is a malignancy that primarily effects the elderly population and markedly increases their risk of developing skin cancers, especially SCC. An intense infiltrate may be present surrounding the tumor. This case report demonstrates one of the potential challenges the Mohs surgeon may face in interpreting histologic frozen section. Immunohistochemistry may be helpful in providing a more definitive answer to this problem.

Aged↗
PubMed2005

[Renal insufficiency caused by leukemic cell infiltration in Sézary syndrome].

A 77-year-old woman was admitted to our hospital because of pneumonia and heart failure in July 2002. She had been diagnosed as having with Sézary syndrome in 1993, and had been treated with a combination of prednisolone, methotrexate, and cyclosporin A with subsequent stable disease but persistent generalized erythroderma. On admission, the white blood count was 23.9 X 10(9)/L with 28% Sézary cells, and serum creatinine levels were within normal limits. One month after admission, the pneumonia and heart failure improved remarkably with antibiotics and diuretics. However, at the same time, her renal function deteriorated with increasingly high serum creatinine levels. She died of anuria in September, 2002. An autopsy showed marked perivascular and peritubular infiltration of abnormal lymphocytes with degenerative nephrotubuli in the kidneys. This patient may be the first reported case of Sézary syndrome with renal failure caused by leukemic infiltration.

Aged↗
PubMedDate not supplied

Leukemic dermal infiltrate at the exit site of a central venous catheter.

This report describes the case of a minimally differentiated acute myeloid leukemia (FAB M0) diagnosed in a 55-year-old woman. During a second chemotherapy-induced complete remission, a subcutaneous nodule appeared at the scar of a recently removed Hickman catheter, which when biopsied revealed leukemic infiltration of the dermis and hypodermis. The patient had a bone marrow relapse three weeks later. The authors review similar recent reports and emphasize the importance of recognizing this particular type of cutaneous leukemic relapse.

Acute Disease↗
PubMed2003

Leukemic gingival infiltrate as an indicator of chemotherapeutic failure following monoclonal antibody therapy: a case report.

Treatment options are limited for patients with relapsed acute myelogenous leukemia (AML), particularly when the disease is refractory to standard cytotoxic chemotherapy. Targeted drug therapy offers the advantage of delivering higher doses of non-cross resistant chemotherapy with potentially less systemic toxicity. Gemtuzumab ozogamicin (Mylotarg, Wyeth-Ayerst Laboratories) is an immunoconjugate that consists of humanized anti-CD 33 antibody linked to the potent anti-tumor antibiotic calicheamicin and has been an effective therapy for some patients with relapsed AML. However, the overall utility of gemtuzumab ozogamicin is not well defined. For instance, it is not known how well this antibody will target extramedullary disease. This article reports gemtuzumab treatment of refractory AML in a 32-year-old man. At the time of recurrence, his bone marrow was hypoplastic and without leukemia, but the condition progressed resulting in marked leukemic infiltration of the oral mucosa. This case history raises the possibility that leukemic sanctuary sites may exist, and that monoclonal antibody therapy may have sub-optimal activity in non-medullary sites of disease.

Adult↗
PubMed1993

Adult T-cell leukemia with leukemic cell infiltration in the conjunctiva. A case report.

A 77-year-old Japanese woman who had suffered from skin eruptions since 1986 was admitted in January, 1990. A diagnosis of adult T-cell leukemia/lymphoma (ATL) was made on the basis of clinical and laboratory data. On admission, erythematous lesions were present in both eyelids. Yellowish-white elevated lesions were found along the limbal conjunctiva, and extended segmentally into the cornea of both eyes. Microscopically, leukemic infiltration into the subepithelial layer of the conjunctiva was observed. Ophthalmic manifestations in ATL have not been well described, because of a little attention paid to them.

Aged↗
PubMed1991

Leukemic dermal infiltrates at permanent indwelling central venous catheter insertion sites.

Three cases of leukemic dermal infiltrates at permanent indwelling central venous catheter insertion sites in patients with acute myelogenous leukemia are reported. Two patients had a localized soft tissue mass at the previous permanent indwelling catheter insertion site as the sole initial manifestation of relapse after achieving complete remission and undergoing bone marrow transplantation. The third patient had catheter tunnel sepsis preceding leukemic dermal infiltration. A review of the English language literature showed that this condition is rare with no specific pathogenetic mechanisms identified. Patients with unresolved catheter tunnel infections in acute leukemia and persistent chest wall masses that appear after a previous permanent indwelling catheter should have a biopsy done and be treated promptly.

Adult↗
PubMedDate not supplied

Cutaneous infiltration by leukemic cells in acute promyelocytic leukemia of a child after treatment with all-trans retinoic acid.

We describe here the first case of childhood acute promyelocytic leukemia (APL) with cutaneous infiltration of leukemic cells following treatment with all-trans retinoic acid (ATRA) confirmed by immunostaining and polymerase chain reaction for PML/RAR alpha. An 11-year-old girl was diagnosed as having APL. Chromosomal analysis demonstrated the characteristic karyotype of t(15;17). ATRA therapy was begun at a dose of 45 mg/m2 daily. During ATRA therapy, leukocytosis and retinoic acid syndrome were observed but were resolved by dexamethasone. Two months after commencement of ATRA therapy, complete remission was achieved. During the course of consolidation chemotherapy, however, multiple cutaneous nodules developed in her trunk, the size and number of which increased despite intensive chemotherapy. Histological and immunological studies of the cutaneous nodules showed infiltration of leukemic cells. PML/RAR alpha mRNA was detected in both the cutaneous nodules and bone marrow by means of polymerase chain reaction. ATRA treatment for APL may be associated with an increased incidence of extramedullary disease such as cutaneous lesions. The best available therapy for APL may be a combination of ATRA and chemotherapy, especially when a marked leukocytosis occurs during ATRA therapy.

Antineoplastic Agents↗
PubMed2003

Hairy cell leukemia: an autopsy study.

Autopsy study from 21 patients with hairy cell leukemia was performed. All patients had the expected widespread involvement of the hematopoietic system. Leukemic infiltration of lymph nodes was detected in 12 cases. Liver involvement was present in 19 patients, leukemic infiltration ranged from focal portal and sinusoidal infiltration to massive infiltration that effaced the hepatic architecture. Twelve patients showed leukemic infiltration of the spleen, remaining 9 patients underwent previous splenectomy for massive splenomegaly. We also found leukemic infiltration of kidneys in four cases, two patients showed leukemic involvement of the lungs. The cause of death was related to impaired immunity (sepsis, bronchopneumonia, etc.) in the majority (73%) of cases.

Adolescent↗
PubMed1999

Identification of an adhesion molecule expressed on adult T cell leukemia cells derived from a patient with gastrointestinal involvement: implication for a possible role of integrin beta 7 in leukemic cell infiltration into intestinal mucosa.

Patients with adult T cell leukemia (ATL) often manifest leukemic cell infiltration into various organs such as lung, liver, skin, and gut. To analyze the mechanism of intestinal infiltration of ATL cells, we made mAbs against ATL-43T, a human T cell line derived from an ATL patient with severe intestinal mucosal infiltration. One of the mAbs, named H920, was noted for a high and relatively specific reactivity with ATL-43T. Molecular cloning was done to identify this molecule and disclosed that the Ag molecule was identical to integrin beta 7. Since integrin beta 7 and its ligand MAdCAM-1 had been reported to mediate homing of lymphocytes to endothelial cells in intestinal mucosa, we next examined wither ATL-43T cells could adhere to MAdCAM-1+ cells. Human MAdCAM-1 transfectants of MMCE, a mouse epithelial cell line, were made and used to evaluate cell adhesion mediated by integrin beta 7 and MAdCAM-1. Considerable levels of cell adhesion were observed between ATL-43T and the transfectant cells, which was inhibited by H920 mAb in a dose-dependent manner. Furthermore, peripheral blood leukemic cells or lymphoma cells from 10 ATL patients were examined for expression of integrin beta 7 with regard to organ involvement. Samples from three patients with gastrointestinal tract involvement showed considerably higher expression of integrin beta 7. These results suggest that integrin beta 7 may play a role in adhesion and subsequent infiltration of a certain type of ATL cells into intestinal mucosa.

Adult↗