Gastrointestinal bleeding due to leukemic infiltrate in myelodysplastic syndrome.
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HISTORY: A 70-year-old woman was admitted with the suspected diagnosis of acute leukaemia. She had complained of decreased physical capacity, nonproductive cough and dyspnoea. INVESTIGATIONS: The blood picture showed leukocytosis of 46/nl, anaemia (haemoglobin 8.8 g/dl) and thrombocytopenia (25 platelets/nl). Differential white count: 10% blast cells, 43% monocytes. Bone marrow smear revealed acute monocytic leukaemia. The chest radiogram showed increased interstitial markings and lung function tests indicated moderate restriction. TREATMENT AND COURSE: The atypical pneumonia was treated with erythromycin, but the respiratory functions deteriorated further within 2 days. Cytostatic treatment had been started on the second hospital day, but the patient died a few hours later in respiratory failure. Autopsy revealed numerous alveolar infiltrates by immature myeloid cells. CONCLUSION: In patients with acute leukaemia and respiratory symptoms, pulmonary involvement should be included in the differential diagnosis and, if present, chemotherapy immediately begun.
Surgical procedures and diseases in childhood involving damage to or obstruction of the thoracic duct and related lymphatic channels can cause pleural effusions that are often chylous and can be massive. The morphology of fluid cytology in these cases can prompt a mistaken diagnosis of a hematolymphoid malignancy. We describe 6 infants, aged 3 days to 5 months, in whom thoracoabdominal disease and/or surgical procedures interfered with lymphatic drainage of the thorax and pleural space. In 5 cases, the clinically significant chylous pleural effusion was postoperative; in 1 case, it was related to congenital abnormalities. After chest tube drainage, the effusion resolved in all cases. Fluid cytology revealed a predominant population of small to medium immature-appearing cells with moderate amounts of basophilic cytoplasm without granules. The nuclei were often irregular or slightly lobulated, with evenly dispersed chromatin and occasionally prominent nucleoli. Flow cytometry performed on these cases revealed a heterogeneous population of lymphoid cells, most of which showed phenotypic markers typical for mature T cells. A complete patient history and ancillary studies in such cases can correctly characterize the cells to reach an accurate diagnosis.
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Tc-99m labeled RBC blood-pool and Tc-99m sulfur colloid imaging were performed in a patient with chronic myelogenous leukemia (CML) in blast crisis. Functional asplenia was demonstrated on the sulfur colloid study despite intact organ perfusion as demonstrated by blood-pool imaging. Tc-99m RBC blood-pool imaging appears to be an ideal noninvasive technique to document intact spleen perfusion in functional asplenia.
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Granulocytic sarcoma (GS) is an extramedullary tumor composed of immature cells of the granulocytic series known to occur in patients with myelodysplastic syndrome, chronic myelogenous leukemia, or acute myelogenous leukemia (AML). Involvement of the gastrointestinal tract is relatively rare in GS. We present an extremely rare case of GS of the colon and liver infiltration in a 60-year-old male patient with AML presenting with jaundice and hematochezia and review the literature. It should be kept in mind that hematochezia may be due to colonic involvement of GS besides thrombocytopenia which is usually encountered in patients with AML.
A case of early involvement of the prostate by chronic lymphocytic leukemia first manifested by urinary retention is reported. The patient was prostatectomized without specific findings. Only about 60 similar previous cases have been reported in the literature.
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