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[Isolated leukemic infiltration of the iris].

A boy 3 1/2 years old with the diagnosis acute lymphoblastic leukemia, in stage of high malignity, came to the Eye clinic in Hradec Králové. The clinical and haematological findings showed the remission of the illness but a leukemic infiltration with hypopyon had arised. The diagnosis has been done selon the clinic image of the eye and selon the ultrasound examination. The histologic finding showed also an infiltration of chorioidea, iris and ciliary body, an infiltration in the nuchal region, in the spleen and in testicles. The isolated leukemic infiltration of the iris can be the first sign of a relapse and is an indication to begin a relevant therapy.

Child, Preschool↗

An unusual instance of leukemic infiltrate. Diagnosis and management of periapical tooth involvement.

The clinical course of an adult patient with relapsed acute myelogenous leukemia and leukemic infiltrate periapical to the dentition is described. While the oral symptoms were indicative of pulpal disease requiring dental therapy to resolve the patient's complaint, roentgenographic, dental pulp testing, and histologic analysis revealed extramedullary infiltrate apical to a mandibular molar. The findings developed coincident with relapse of leukemia; the medical and dental testing described above were essential in establishing an accurate diagnosis. While most oral leukemic infiltrates affect the gingiva, in this patient the infiltrate involved periapical tissue which was not clinically observable.

Adult↗

Leukemic infiltrates of the heart: CT findings.

Although primary cardiac tumors are rare, metastatic disease to the heart is not uncommon. This is particularly true of the leukemias. Because of increased patient survival, cardiac leukemic infiltrates may assume a larger role in the gamut of leukemic complications. We present a case of massive cardiac leukemic infiltrates in which CT was instrumental in diagnosis and patient management. Relevant pathologic and radiologic features are reviewed.

Female↗

[Risk factors of leukemic infiltration in patients with acute myeloblastic leukemia].

On the basis of clinical neuropathological evaluation of 48 patients with acute myeloblastic leukaemias the authors analyse the risk factors of leukemic infiltrations developing in the brain. The investigations revealed that the distinct dissemination of leukemic cells in blood is the most important risk factor of such infiltrations. The risk increases significantly in older patients. Survival time and maintenance of high leukocytosis do not intensify the risk of leukemic infiltrations in the brain.

Adolescent↗

Marked granulocytic proliferation induced by granulocyte colony-stimulating factor in the spleen simulating a myeloid leukemic infiltrate.

The authors describe a patient with a long-standing history of systemic lupus erythematosus and leukopenia who received multiple intermittent doses of recombinant granulocyte colony-stimulating factor (G-CSF) and who underwent splenectomy because of a clinical impression of sequestration of granulocytes by the spleen. Histologic evaluation of the spleen revealed marked granulocytic hyperplasia with an increase in immature myeloid precursors, morphologically indistinguishable from a myeloid leukemic infiltrate. A postsplenectomy bone marrow aspirate and biopsy revealed a normocellular bone marrow with active hematopoiesis and trilineage maturation. The bone marrow aspirate cultured cells showed no numeric or structural chromosomal abnormality. Extramedullary hematopoiesis after receipt of G-CSF was previously reported, but, to our knowledge, ours is the first report of morphologic changes virtually identical to a leukemic infiltrate in spleen after G-CSF treatment. We describe the histologic and immunohistochemical findings in the spleen, compare our observations with those of others reported in the literature, and postulate a possible mechanism for this phenomenon.

Adult↗

Primary hypothyroidism due to leukemic infiltration of the thyroid gland.

We describe a patient with acute B-lymphocyte lymphoblastic leukemia who developed laboratory changes (not detectable free thyroxine, TSH 66 microIU/ml) suggesting severe primary hypothyroidism. Histological examination at autopsy showed massive leukemic infiltration of the thyroid gland: the progressive reduction of thyroid hormone levels with concomitant increase in TSH levels observed over a three-month period from the onset of the hemopathy suggests a cause-effect relationship between leukemic infiltration of the thyroid gland and hypothyroidism.

Acute Disease↗

Acute leukemic infiltration of the prostate. Successful treatment with radiation.

Infiltration of the prostate by acute granulocytic leukemia can cause diagnostic and therapeutic difficulties. After stabilization of hematologic findings, the diagnosis can be made safely by needle biopsy of the prostate. The prostate may be one of the so-called sanctuary areas where chemotherapy does not affect the leukemic infiltrate. This process may be a source of reactivation of leukemia in patients who had achieved a hematologic remission. This report describes a patient who had successful eradication of acute myelomonocytic leukemia from the prostate by radiation therapy while in hematologic remission. Better surveillance for leukemic infiltrate of the prostate is needed, including needle biopsy when appropriate. Radiation may be an effective therapy for this manifestation of leukemia.

Adult↗

The neurologic complications in pediatric acute lymphoblastic leukemia patients excluding leukemic infiltration.

This study presents retrospective analyses of 20 acute lymphoblastic leukemia (ALL) patients who developed neurologic complications (except leukemic infiltration). These subjects represent 9.9% of 203 ALL patients aged 16 years or younger followed in our hospital between March 1991 and January 2003. Fourteen male and six female patients, whose ages ranged between 6 and 168 months, developed 24 episodes of neurologic complications after the diagnosis of ALL. The most common complication was meningitis, which developed in six (25%) episodes, and two thirds of the patients who had meningitis were evaluated to be iatrogenic. Cerebral infarct and venous thrombosis were detected in five (21%) of the episodes. In two (8%) episodes progressive cerebral dysfunction developed after radiotherapy. The remaining 11 (45%) episodes are due to varying types of complications. Interestingly, one patient had abundant histiocytes exhibiting hemophagocytosis in the cerebrospinal fluid (CSF) examination and this patient was subsequently diagnosed with fungal meningoencephalitis, by further investigation. Six (30%) patients died; epilepsia developed in five (25%) patients in the follow-up period and the remaining nine (45%) are healthy. By close follow-up and effective treatment of thrombosis and, especially, of infections including iatrogenic meningitis in developing countries, the morbidities and mortalities of these complications can be decreased.

Adolescent↗

[Leukemic infiltration and adenocarcinoma of the prostate gland (author's transl)].

The appearance of a leukemic infiltration of the prostate gland as the first manifestation of a chronic lymphocytic leukemia, followed by an adenocarcinoma of the prostate gland, is exceptional, since only one case has been previously documented. For this reason the authors wish to signal the possibility of a prostatic infiltration in the course of chronic lymphocytic leukemia and insist on the association of this type of leukemia and cancer.

Adenocarcinoma↗

[Leukemic infiltration of the mastoid bone--cytologic examination of exudate in the tympanic cavity as a useful diagnostic method].

Although otologic involvement by leukemic infiltration was supposed to be unusual, increasing number of cases have been reported in recent years, probably due to the advance of chemotherapy, improved remission rate and longer survival of leukemic patients. Two cases of myelogenous leukemia with infiltration of mastoid bone were reported. One is 15-year-old girl with acute myelogenous leukemia, which had been well controlled for 1 year, developed a sudden onset of facial nerve palsy. The other is 30-year-old female with chronic myelogenous leukemia and blastic crisis, complained hearing loss. As both cases had exudate in the tympanic cavity, the punctures were carried out through the eardrum. The pathological study of these exudate cells revealed the involvement of mastoid bone by leukemia. The cytologic examination of exudate in the tympanic cavity is simple, time-sparing and of little burden to the patient. This technique is very useful and supposed to take the place of the exploratory surgery of mastoid cavity which is previously considered necessary for the correct diagnosis.

Adolescent↗

Experimental model of leukemic infiltrative pericarditis reflecting a human disease.

In human leukemias, pericarditis may be associated with leukemic pericardial infiltration. In order to obtain more information about the pathogenesis of the leukemic involvement of the pericardium, sterile talc-induced pericarditis was produced in acute lymphoid leukemic male hybrid mice. The animals invariable showed leukemic pericardial infiltration within 14 days. In leukemic mice without any treatment or with intrapericardial physiological NaCl injection (instead of talc), leukemic involvement of the pericardium did not occur.

Animals↗

Can renal leukemic infiltration cause hypertension in children?

Out of 334 children with acute lymphoblastic leukemia who were treated with St Jude Total XI and Total XIII chemotherapy protocols were investigated and 21 (6.3%) were hypertensive. The incidence of tumor lysis syndrome was higher in the hypertensive group than in the nonhypertensive group (28.6% vs. 11.5%) (P = 0.035). There were no differences between patients treated with high-dose methylprednisolone and prednisolone St Jude Total XI and Total XIII, St Jude Total XIII LR and St Jude Total XIII HR groups in respect of the above-mentioned parameters. Central nervous system involvement, skeletal system involvement, abdominal lymphadenopathy, elevated lactate dehydrogenase and leukocyte count, French-American-British types and immunophenotypes were not found to be statistically significant to the development of hypertension (P > 0.05). We found that renal leukemic infiltration is a risk factor in hypertension development (P = 0.04) and hypertension is a risk factor for renal parenchymal disorder in the follow-up period (P = 0.0001). Six patients presenting with hypertension in the first week of disease therapy were evaluated for renal parenchymal disorder and glomerular filtration rate abnormality in the follow-up period. Glomerular filtration rate abnormality was found in 1 and renal scintigraphic dimercaptosuccinic acid abnormalities (reduced uptake and dilated hypoactivity) were found in 4 patients. Hypertension was also found to be a risk factor for renal parenchymal disorder in the follow-up period.

Adolescent↗

Leukemic infiltration of the cerebellum in acute myelomonocytic leukemia.

A 31-year-old woman with acute myelomonocytic leukemia presented with meningeal signs and a cerebellar mass attributed to leukemic infiltration. The mass disappeared with radiation therapy and intraventricular chemotherapy, but the patient subsequently suffered several spinal nerve root recurrences, disseminated herpes zoster, and progressive multifocal leukoencephalopathy. At autopsy, there was no trace of the meningeal leukemia or cerebellar infiltrate. This case illustrates several of the neurologic complications of acute nonlymphocytic leukemia, and raises the question whether patients with the myelomonocytic form of this disease might benefit from prophylactic central nervous system treatment.

Adult↗

[Testicular leukemic infiltration].

OBJECTIVES: To remind that despite its low incidence, leukemic relapse in the testicles worsens the prognosis of this haematopoietic neoplasia. METHODS/RESULTS: We report the case of a 20-year-old male suffering from acute lymphoblastic leukemia in complete remission after induction and maintenance treatment, who suffered a leukemic relapse in both testicles. Diagnosis was made by ultrasound and confirmed after bilateral testicular biopsies. The patient died due to fungal infection after new treatment with systemic chemotherapy and bone marrow transplantation. CONCLUSIONS: It is necessary to suspect the existence of leukemic cells within the testicles in patients with this disease, mainly acute lymphoblastic leukemia, who present with acute testicular symptoms. Testicular biopsy confirms the diagnosis. Treatment is systemic, with testicular radiation to eradicate the leukemic reservoir. Despite the achievement of local disease control, this situation worsens the prognosis.

Adult↗

[Acute abdomen caused by phlegmonous appendicitis and leukemic infiltration of the cecum in a patient with acute lymphatic leukosis in relapse: clinico-therapeutic aspects].

We report a case of eleven years old child with an acute lymphoblastic leukemia who developed an acute abdomen while in haematological relapse. He had an acute appendicitis with leukemic infiltration of the coecum. The early surgical intervention and the coecum irradiation were successful: the following chemiotherapy achieved remission. A more aggressive surgical approach to the acute abdomen, combined with careful supportive measures, might improve the usually grim prognosis in patient whose leukemia offers a chance for remission.

Abdomen, Acute↗

Forearm compartment syndrome secondary to leukemic infiltrates.

A 20-year-old white man with leukemia was recently treated with chemotherapy and was admitted to the Massachusetts General Hospital with a fever and a swollen and painful left forearm that worsened despite intravenous antibiotics. The flexor forearm compartment pressures were elevated; therefore, surgical decompression of the flexor compartments was done. All the wound cultures were negative, and biopsy specimens of tissue showed leukemic infiltrates in the muscle and subcutaneous tissue. Tumor infiltrates may result in increased compartmental pressures, and the treatment of these lesions includes chemotherapy and/or radiation therapy to provide local control of the tumor.

Adult↗