Carcinocythemia in a patient with rhabdomyosarcoma

Solid tumor cells are rarely seen in peripheral blood smears. When this occurs the term carcinocythemia is used. This report describes an 18 years old female who presented with a painless lump in the labia majora associated with pancytopenia. Tumor cells were identified int he peripheral blood smear and the bone marrow aspirate showed a predominant population of small round vacuolated primitive cells, many of which formed clumps of varying sizes. Biopsies of the vulvar mass and bone marrow were interpreted as alveolar rhabdomyosarcoma. Review of the literature revealed 12 previously reported cases in whom carcinocythemia had been documented; rhabdomyosarcoma was the specific cell type involved in only two of these. The median time between detection of the leukemic phase of the tumor and death was 8.5 weeks, reflecting the fact that carcinocythemia, when it occurs, represents the terminal event of the disease. To our knowledge, our case is the third well documented case of rhabdomyosarcoma in leukemic phase so far reported. The clinical evolution as well as the management of this patient will be described in detail along with a review of the partinent available literature

Adult idiopathic thrombocytopenic purpura

Fifty three adult patients with idiopathic thrombocytopenic purpura (ITP) were diagnosed at the University District Hospital (UDH) during the last 10 years (1976-1986). There were 33 females (62%) and 20 males (38%). All the patients were over 15 years old with a mean age of 3o years. Only 13 patients gave a history of a viral syndrome preceding the onset of symptoms. The most frequent chief complaint was petechiae and/or ecchymotic lesions. The mean initial platelet count was 10,000/mm. Bone marrow aspiration showed an increased number of megakaryocytes without platelet production in 49 patients (86%). Of the fifty three patients, 37 (70%) had a complete response to steroids. Of those not responding to steroids, 15 underwent splenectomy and 11 (73%) achieved a permanent response. Immunosupresion was prescribed in 4 patients with a 50% complete response