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PubMedDate not supplied

CT appearance of direct leukemic invasion of bowel.

Although leukemic invasion of bowel is frequently seen on pathologic examination, it has rarely been described in the imaging literature. Previous radiographic reports have relied mostly on non-cross-sectional imaging techniques such as barium enema and have detected abnormalities only in the most advanced stages of disease when prognosis is uniformly poor. We describe a case of direct leukemic invasion seen on computed tomography which may offer the advantage of earlier detection and more favorable prognosis.

Aged↗
PubMed2003

Therapy-related leukemia cutis: case study of an aggressive disorder.

Therapy-related leukemia cutis has not yet been described. We report a 55-year-old male who developed aleukemic leukemia cutis 15 months after chemotherapy and radiotherapy for non-Hodgkin's lymphoma. Despite intensive therapy including allogeneic hematopoietic stem cell transplantation, the patient died of progressive disease. Sequence analysis of the TP53 gene and screening for defective DNA mismatch repair revealed no abnormalities. This case demonstrates that therapy-related aleukemic leukemia cutis is an aggressive disorder resistant to conventional antineoplastic treatment approaches. As the number of patients developing therapy-related myelodysplasia or leukemia is increasing, clinicians might be confronted more frequently with atypical, extramedullary presentations of these disorders.

Base Pair Mismatch↗
PubMed2004

Complete molecular remission of chronic eosinophilic leukemia complicated by CNS disease after targeted therapy with imatinib.

Many cases of hypereosinophilia, formerly classified as hypereosinophilic syndrome, can now be characterized as chronic eosinophilic leukemia (CEL) based on the demonstration of characteristic genetic markers indicating clonality of hematopoiesis. Here we report on a 33-year-old male patient with central nervous system manifestations of CEL and an excellent response to low-dose imatinib (Glivec). Molecular analysis demonstrated a constitutive activation of the platelet-derived growth factor receptor-alpha (PDGFR-A) as the mechanism of responsiveness to imatinib.

Adult↗
PubMed2001

Percutaneous core-needle biopsy of enlarged lymph nodes in the diagnosis and subclassification of malignant lymphomas.

The objective of this study was to evaluate the sensitivity and specificity of percutaneous core-needle biopsy of enlarged lymph nodes in the diagnosis and subclassification of malignant lymphomas. In a 1-year period 158 image-guided percutaneous core-needle biopsies of enlarged lymph nodes were performed on 149 consecutive patients using a Tru-cut needle fired by a biopsy gun. In 135 cases the biopsy findings could be confirmed by histologic examination of additional tissue samples (n = 59) or by correlation with the patient's clinical and radiologic course (n = 76). The final diagnoses were malignant lymphoma in 65 cases, leukemic nodal infiltration in 2, nodal metastases from a solid tumor in 37 and benign changes or no evidence of malignancy in 31 cases. The core-needle biopsies correctly diagnosed 58 of 65 malignant lymphomas, corresponding to a sensitivity of 89% and a specificity of 97%. Fifty-five of the 58 (95%) correctly diagnosed malignant lymphomas could be subclassified on the basis of the core-needle biopsy. Image-guided core-needle biopsy of enlarged lymph nodes with a Tru-cut needle is a useful method for the diagnosis and subclassification of malignant lymphomas.

Adolescent↗
PubMed1998

[Acute lymphatic leukemia of the T-cell line. Visual impairment as the initial symptom].

INTRODUCTION: Visual impairment as the initial symptom of leukemia is rare. Although retinal involvement during leukemia is frequent, a leukemic macular lesion is an exception. CASE REPORT: A 5 1/2-year-old female child, pale and with a general feeling of illness complained about bilateral reduced vision for 3 days. Binocular visual acuity in reading distance was 0.4. Anterior segment and optic disc were inconspicuous. The macula in both eyes displayed a preretinal hemorrhage in the form of a spot with red, yellow and clear layers lying on top of one another. After a hematological examination the illness was diagnosed as T-cell-type acute lymphocytic leukemia (ALL). Chemotherapy was given immediately and general improvement of ALL was observed. Eleven months after the first presentation visual acuity of the right eye was 0.7 and of the left eye 0.3. The central lesion was completely resorbed and revealed paramacular pigment clumping. CONCLUSION: Because of the differentiated and improved therapy schemata available now, e.g., the ALL-BFM 95 protocol, ALL can be cured more frequently. The prognosis, however, is essentially dependent on early diagnosis. By being familiar with the corresponding ocular findings, an ophthalmologist can contribute to this.

Child, Preschool↗
PubMed2005

Fatal eosinophilic heart disease in a child with neurofibromatosis-1 complicated by acute lymphoblastic leukemia.

We present a pediatric case of neurofibromatosis-1 (NF-1) complicated by acute lymphoblastic leukemia and hypereosinophilia, which caused multiple end-organ damage. Although clinical symptoms such as fever and coughing were noted only 1 week before admission, the condition deteriorated rapidly with a fatal outcome prior to antileukemic therapy. A postmortem examination demonstrated extensive endomyocardial fibrosis with thrombotic occlusion and recanalization of the coronary arteries. Leukemic cell infiltration was not seen in the cardiac tissue. When eosinophilia is diagnosed in patients with NF-1, eosinophilic end-organ damage, particularly cardiac involvement, in addition to hematological malignancies, should be screened for in order to start medical treatment at the early stage of the disease.

Child, Preschool↗
PubMed2002

Unexplained acute renal failure in a toddler: a rare complication of Epstein-Barr virus.

A previously healthy toddler developed severe acute renal failure with nephromegaly and peripheral atypical lymphocytosis. Profound interstitial nephritis with acute tubular necrosis was diagnosed by renal biopsy, and both the clinical picture and serological evaluation suggested Epstein-Barr virus (EBV) as the etiological agent. The previous reports of EBV-induced renal failure and the clinical and pathological presentations of interstitial nephritis in children are reviewed.

Acute Kidney Injury↗
PubMed2005

Leukemic and lymphomatous meningitis: incidence, prognosis and treatment.

Neoplastic meningitis (NM) is a common problem in neuro-oncology occurring in approximately 5% of all patients with cancer. Notwithstanding frequent focal signs and symptoms in NM, NM is a disease affecting the entire neuraxis and therefore staging and treatment need encompass all cerebrospinal fluid (CSF) compartments. Central nervous system (CNS) staging of NM includes contrast enhanced cranial computerized tomography (CE-CT) or magnetic resonance imaging (MR-Gd), contrast enhanced spine magnetic resonance imaging (MR-S) or computerized tomographic myelography (CT-M) and radionuclide CSF flow study (FS). Treatment of NM involves involved-field radiotherapy of bulky or symptomatic disease sites and intra-CSF drug therapy. The inclusion of concomitant systemic therapy may benefit patients with NM and may obviate the need for intra-CSF chemotherapy. At present, intra-CSF drug therapy is confined to three chemotherapeutic agents (i.e. methotrexate, cytosine arabinoside and thio-TEPA) administered by a variety of schedules either by intralumbar or intraventricular drug delivery. Although treatment of NM is palliative with an expected median patient survival of 4 to 6 months, it often affords stabilization and protection from further neurologic deterioration in patients with NM. In patients with leukemia or lymphoma, prophylaxis of the CNS is used (utilizing a combination of high-dose systemic chemotherapy and intra-CSF chemotherapy) for patients at high risk as defined by specific tumor-related laboratory markers. Using such a risk-stratified approach, the late occurrence of CNS relapse has decreased dramatically attesting to the value of CNS prophylaxis.

Humans↗
PubMed1983

Changes in the compositions of the null cell compartment with murine autoimmunity.

The subpopulations that comprise the null cell compartment were examined sequentially in various strains of autoimmune-prone mice. Different patterns emerged that were consistent within strains but differed from strain to strain. Abnormalities appear earlier in life in short-lived mice, such as male BXSB and MRL/l mice, than in relatively long-lived strains, such as female BXSB and NZB mice. The accumulation of T cells in MRL/l mice was accompanied by null cell changes that contrasted with those that developed in AKR/J mice after their spleens were infiltrated with leukemic T cells. It would seem that lymphocyte perturbations with murine autoimmunity also involve their precursor cells and that these precursor cell changes vary in different strains, perhaps in relation to different genetic factors.

Aging↗
PubMed1995

Unusual specific cutaneous lesions in myelodysplastic syndromes.

BACKGROUND: Early diagnosis of leukemia cutis in myelodysplastic syndrome (MDS) is important because these lesions can precede acute peripheral blood or bone marrow transformation. Leukemia cutis is usually easy to recognize, but atypical lesions are not well described. OBJECTIVE: Our purpose was to describe unusual specific lesions in MDS. METHODS: Data from patients with myeloid malignancies and leukemia cutis were reviewed. Only patients with MDS and cutaneous lesions different from typical tumors were included. Clinical features were analyzed. RESULTS: Four patients with MDS and unusual specific cutaneous lesions were found. They had ecchymoses, necrotic plaques or ulcers, and prurigo-like lesions. In three of four patients appearance of these skin lesions heralded or was concomitant with acute transformation. CONCLUSION: Specific cutaneous lesions can display unusual patterns. Early biopsy of cutaneous lesions in MDS is indicated.

Aged↗
PubMed1995

A method for total skin electron treatment for infants.

Diseases such as mycosis fungoides require the treatment of a patient's total skin surface with superficial radiation. In a unique clinical situation, a 14-month-old child presented with a need for total skin treatment. A typical total skin technique requires overlapping electron beams, using 6 body positions, each with the gantry rotated for 2 angulations, or '6 positions-12 fields'. Adaptation of this technique for infants is complicated by the small diameter of some body parts, and by the necessity to treat while the patient is anesthetized. Even degraded, low energy electrons can easily penetrate fingers and toes. Therefore, dose from 6 positions becomes additive, and the total dose to small circumferences can be 3 to 4 times more than skin dose on the torso, raising concerns about uneven bone growth in the developing child. Special phantoms were designed for extensive dosimetry needed to determine both dose rate and dose summation from the overlapping beams. Computerized electron pencil beam calculations were compared to TLD measurements. Unique compensating techniques were used to deliver uniform dose. A modification of the 6 position-12 field technique will be described; and accessories used to reduce high dose regions will be illustrated.

Bone Development↗
PubMed1995

The oral health of long-term survivors of acute lymphoblastic leukaemia: a comparison of three treatment modalities.

Sixty-eight children who were diagnosed with acute lymphoblastic leukaemia (ALL) prior to age 5 years and treated with chemotherapy alone, chemotherapy plus 1800 cGy cranial irradiation (RT), or chemotherapy plus 2400 cGy RT were assessed clinically for overall dental health. All patients were at least 60 months in continuous remission. Dental caries were assessed by NIDR diagnostic criteria, oral hygiene was assessed by the modified Oral Hygiene Index, and gingival health was assessed by the modified gingival index of Loe and Silness. There was no significant difference in caries experience between the three groups nor with the normal population. Those patients that received 2400 cGy RT had significantly higher plaque and periodontal index scores than patients in the other treatment groups. The results of this study suggest that: (1) children with ALL treated with any of the described modalities are at no greater risk of developing dental caries than the normal population; and (2) patients receiving 2400 cGy prior to age 5 years are at greater risk of developing periodontal disease than patients treated with other central nervous system prophylaxis regimens examined in this study.

Antineoplastic Agents↗