ABSTRACT
La leucemia Monoblástica o Monocítica Aguda, es similar a otros subtipos de leucemias agudas, algunas peculiaridades que las diferencian son la hiperleucocitosis, infiltración extramedular y coagulación intravascular diseminada. El tratamiento de inducción se basa en drogas antracíclicas combinadas con citarabina; las complicaciones pueden ser fatales y la sobrevida a largo plazo se estima en 25% a 40%. Objetivo: documentar la r espuesta y complicaciones del tratamiento (quimioterapia) de inducción en la leucemia monoblástica aguda. Presentación de caso clínico: mujer de 34 años, acude con cuadr o inicial de congestión nasal bilateral y fiebre; examen físico normal, a excepción de equimosis en sitios de venopunción, el hemograma reveló anemia, leucocitosis y trombocitopenia. El frotis de sangre periférica, la biopsia y aspirado de médula ósea, fueron característicos de leucemia mieloide aguda tipo monocítica. Durante el tratamiento se administró dos ciclos de quimioterapia de inducción y coadyuvantes con base en hemoderivados, factor estimulante de colonias de granulocitos, antieméticos, antibióticos y antimicóticos. Complicaciones: se presentó toxicidad manifiesta por náuseas y vómitos grado II, mucositis, pérdida de peso y alopecia total, alteraciones hematológicas y complicaciones infecciosas grado IV. Se obtuvo remisión hematológica completa. Conclusión: es posible tr atar pacientes que sufr en leucemia monoblástica aguda tipo M5, en nuestro 1Universidad Nacional Autónoma de Honduras, Facultad de Ciencias Médicas, Tegucigalpa, Honduras. 2Laboratorios Molina, Tegucigalpa, Honduras. 3Investigador Independiente, Western International School, San Pedro Sula, Honduras. Autor de correspondencia: José Angel Sánchez N., jose.skiro@gmail.com Recibido: 03/12/2020 Aceptado: 15/05/2021 medio, con quimioterapia agresiva y obtener remisión hematológica completa. La identificación temprana de complicaciones y manejo oportuno es fundamental para evitar consecuencias fatales...(AU)
Subject(s)
Humans , Female , Adult , Leukemia, Monocytic, Acute/diagnosis , Induction Chemotherapy/methods , Physical Examination , Leukemia, Myeloid , FeverABSTRACT
ABSTRACT Objective: To describe the case of a child who presented hemophagocytic lymphohistiocytosis (HLH) associated with acute monocytic leukemia after chemotherapy, with hemophagocytosis caused by leukemic cells. Case description: In a university hospital in Southern Brazil, a 3-year-old female was diagnosed with acute monocytic leukemia with normal karyotype. The chemotherapy regimen was initiated, and she achieved complete remission six months later, relapsing after four months with a complex karyotype involving chromosomes 8p and 16q. The bone marrow showed vacuolated blasts with a monocytic aspect and evidence of hemophagocytosis. The child presented progressive clinical deterioration and died two months after the relapse. Comments: HLH is a rare and aggressive inflammatory condition characterized by cytopenias, hepatosplenomegaly, fever, and hemophagocytosis in the bone marrow, lymph nodes, spleen, and liver. Although rare, malignancy-associated HLH (M-HLH) is fatal. The patient in this case report met five out of the eight established criteria for HLH. The evolution of the patient's karyotype, regardless of the diagnostic profile, seemed secondary to the treatment for acute monocytic leukemia. In this case, the cytogenetic instability might have influenced the abnormal behavior of leukemic cells. This is a rare case of HLH in a child with acute monocytic leukemia.
RESUMO Objetivo: Descrever um caso de um paciente pediátrico que apresentou linfo-histiocitose hemofagocítica (LHH) associada à leucemia monocítica aguda pós-quimioterapia, com hemofagocitose causada pelas próprias células leucêmicas. Descrição do caso: Em um hospital universitário do Sul do Brasil, uma menina de três anos foi diagnosticada com leucemia monocítica aguda com cariótipo normal. Após receber protocolo quimioterápico, atingiu remissão seis meses depois do início do tratamento, recaíndo quatro meses após com um cariótipo complexo envolvendo ambos os cromossomos, 8p e 16q. A medula óssea mostrava-se infiltrada por células blásticas vacuolizadas com aspecto monocítico, com evidências de hemofagocitose. A criança apresentou um declínio clínico progressivo e dois meses após a recaída foi a óbito. Comentários: A LHH é uma condição inflamatória rara e agressiva caracterizada por citopenias, hepatoesplenomegalia, febre e hemofagocitose na medula óssea, linfonodos, baço e fígado. A LHH associada a doenças malignas, embora seja uma condição rara, é potencialmente fatal. A paciente deste caso apresentou cinco dos oito critérios estabelecidos para o diagnóstico de LHH. A evolução do cariótipo do paciente, independentemente do perfil do diagnóstico, pareceu ser secundária ao tratamento da leucemia monocítica aguda, sendo que a instabilidade citogenética pode ter influenciado o comportamento atípico observado nas células leucêmicas. Este é um dos raros casos de LHH em uma criança com leucemia monocítica aguda.
Subject(s)
Humans , Female , Child, Preschool , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Leukemia, Monocytic, Acute/drug therapy , Lymphohistiocytosis, Hemophagocytic/etiology , Brazil , Leukemia, Monocytic, Acute/diagnosis , Leukemia, Monocytic, Acute/genetics , Leukemia, Monocytic, Acute/pathology , Fatal Outcome , Lymphohistiocytosis, Hemophagocytic/diagnosis , Lymphohistiocytosis, Hemophagocytic/immunology , Lymphohistiocytosis, Hemophagocytic/pathologyABSTRACT
A 1.6-year-old male domestic short hair cat was brought to the Veterinary Medical Teaching Hospital, Kasetsart University, with signs of severe anemia, depression, and general lymph node enlargement. Complete blood count revealed leukocytosis and massive undifferentiated blasts. Testing for antibodies specific to feline leukemia virus (FeLV) was positive, and FeLV nucleic acid was confirmed by nested polymerase chain reaction. Base on cytochemistry and ultrastructure, the cat was diagnosed with acute monoblastic leukemia.
Subject(s)
Animals , Cats , Male , Cat Diseases/diagnosis , Leukemia Virus, Feline/isolation & purification , Leukemia, Monocytic, Acute/diagnosis , Osteoblasts/ultrastructureABSTRACT
Trisomy 8 is one of the most frequent numerical chromosomal abnormalities observed in hematological malignancies, whereas tetrasomy 8 is a clonal aberration seen mainly in myeloid disorders such as acute myelod leukemia (AML) and myelodysplastic syndromes. In contrast to trisomy 8, tetrasomy 8 is a rare chromosomal aberration, in that only 17 reported AML cases with isolated tetrasomy 8 have been documented. Interestingly, the majority of reported cases were associated with monocytic-lineage leukemias. According to recent reports, tetrasomy 8 is regarded as a poor prognostic factor, and most patients having this abnormality relapsed and died within 1 yr. Here, we report a patient with acute monoblastic leukemia having tetrasomy 8 and a very aggressive disease course.
Subject(s)
Humans , Male , Middle Aged , Aneuploidy , Chromosomes, Human, Pair 8 , In Situ Hybridization, Fluorescence , Karyotyping , Leukemia, Monocytic, Acute/diagnosisABSTRACT
Severe aplastic anemia (AA) is a life-threatening condition wherein bone marrow transplantation (BMT) is the therapy of choice in a young patient who has a matched sibling donor. Here, we report an 11-year-old boy with severe AA who was referred for BMT late in its course when he had developed acute myeloid leukemia following two courses of immunosuppressive therapy with antithymocyte globulin and cyclosporin. He was then treated with induction therapy using cytosine arabinoside and daunomycin for acute myeloid leukemia, but he succumbed due to infection and refractory leukemia. We discuss the relevance of early referral for BMT in severe AA.
Subject(s)
Anemia, Aplastic/etiology , Antineoplastic Agents/therapeutic use , Bone Marrow Transplantation , Child , Fatal Outcome , Humans , Immunosuppressive Agents/therapeutic use , Leukemia, Monocytic, Acute/diagnosis , Male , Sepsis/etiologyABSTRACT
We report on an 18-year-old man who had both acute monoblastic leukemia and Marfan syndrome. A diagnosis of Marfan syndrome was established by those characteristics of arachnodactyly, ectopia lentis, mitral valve prolapse, and mitral regurgitation. Findings on bone marrow examination of the patient showed that most of nucleated cells were monoblasts and immunophenotype of those cells showed CD13+, CD33+, CD56+, and HLA-DR+. To our knowledge, this is the second report of leukemia in Marfan syndrome in the world.
Subject(s)
Humans , Male , Adolescent , Biopsy, Needle , Bone Marrow/pathology , Diagnosis, Differential , Echocardiography , Electrocardiography , Leukemia, Monocytic, Acute/diagnosis , Leukemia, Monocytic, Acute/complications , Marfan Syndrome/diagnosis , Marfan Syndrome/complicationsABSTRACT
La discusión clínica se basará en el análisis de las principales causas de hepatoesplenomegalia en el período neonatal y en lactactes menores de tres meses de edad. Intentaré excluír rápidamente las afecciones menos frecuentes que cursan con hepatoesplenomegalia, para luego circunscribirme a los diagnósticos diferenciales más probables.