Subject(s)
Blast Crisis , Dendritic Cells , Hematologic Neoplasms , Spleen/diagnostic imaging , Spleen/injuries , Splenic Rupture , Aged , Blast Crisis/blood , Blast Crisis/diagnostic imaging , Fatal Outcome , Hematologic Neoplasms/blood , Hematologic Neoplasms/diagnostic imaging , Humans , Male , Splenic Rupture/blood , Splenic Rupture/diagnostic imagingSubject(s)
Blast Crisis/complications , Cardiac Tamponade/etiology , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications , Adult , Blast Crisis/blood , Blast Crisis/diagnostic imaging , Cardiac Tamponade/blood , Female , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnostic imaging , Radiography, Abdominal , Splenomegaly/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
We are presenting a case of an adult male patient with monocytic acute myeloid leukemia (AML) who had on presentation brain infarction and bilobed nuclei had been demonstrated in many of the leukemic blasts. There was no laboratory evidence of acute disseminated intravascular coagulopathy, on presentation or later on. Initially the diagnosis of acute promyelocytic leukemia (APL) was considered, so all trans-retinoic acid (ATRA) was added to induction chemo therapy. As the diagnosis of APL was ruled out, based on the flow cytometry, fluorescent in situ hybridization and polymerase chain reaction findings, the ATRA was discontinued and the patient continued on the standard AML chemo therapy induction regimen. Later on chromosomal analysis was also normal. Sever dehydration on presentation, would have contributed to brain infarction. AML particularly monocytic, can mimic APL, especially its microgranular variant. The possible ATRA therapy side effects, can be avoided by early confirmation of the diagnosis.
Subject(s)
Blast Crisis/complications , Brain Infarction/complications , Cell Nucleus/pathology , Leukemia, Myeloid, Acute/diagnosis , Leukemia, Promyelocytic, Acute/diagnosis , Blast Crisis/diagnostic imaging , Blast Crisis/pathology , Bone Marrow/pathology , Brain Infarction/diagnostic imaging , Brain Infarction/pathology , Diagnosis, Differential , Humans , Leukemia, Myeloid, Acute/diagnostic imaging , Leukemia, Myeloid, Acute/pathology , Leukemia, Promyelocytic, Acute/diagnostic imaging , Leukemia, Promyelocytic, Acute/pathology , Male , Middle Aged , Suction , Tomography, X-Ray ComputedSubject(s)
Blast Crisis/diagnostic imaging , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnostic imaging , Magnetic Resonance Imaging , Neoplasms, Second Primary/diagnostic imaging , Optic Nerve Neoplasms/diagnostic imaging , Sarcoma/diagnostic imaging , Adult , Female , Humans , RadiographyABSTRACT
A 22-year-old male with Ph-positive chronic myelogenous leukemia (CML) was started on treatment with imatinib. After 12 months of therapy, he achieved a complete cytogenetic response (CCyR). Although the CCyR persisted in his bone marrow, he developed an isolated CML blast crisis in his central nervous system (CNS) after 29 months of therapy. He underwent allogeneic hematopoietic stem cell transplantation (HSCT) following combination therapy with dasatinib, intrathecal chemotherapy and cranial irradiation. Subsequently, 168 days after allogeneic HSCT, he was started on dasatinib maintenance therapy to prevent a CNS relapse. Thirty-eight months after allogeneic HSCT, he has sustained a complete molecular response in both bone marrow and CNS. We believe dasatinib has the potential to prevent CNS relapse if used for maintenance therapy after allogeneic HSCT.
Subject(s)
Antineoplastic Agents/therapeutic use , Blast Crisis/therapy , Central Nervous System Neoplasms/therapy , Hematopoietic Stem Cell Transplantation , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Pyrimidines/therapeutic use , Thiazoles/therapeutic use , Blast Crisis/diagnostic imaging , Blast Crisis/pathology , Bone Marrow/pathology , Brain/pathology , Central Nervous System Neoplasms/diagnostic imaging , Central Nervous System Neoplasms/pathology , Combined Modality Therapy , Dasatinib , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnostic imaging , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology , Magnetic Resonance Imaging , Male , Radiography , Recurrence , Transplantation, Homologous , Young AdultSubject(s)
Blast Crisis/diagnosis , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology , Lymph Nodes/pathology , Piperazines/therapeutic use , Pyrimidines/therapeutic use , Abdomen , Antineoplastic Agents/therapeutic use , Benzamides , Blast Crisis/diagnostic imaging , Blast Crisis/pathology , Female , Hematopoiesis, Extramedullary/physiology , Humans , Imatinib Mesylate , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnostic imaging , Lymph Nodes/diagnostic imaging , Middle Aged , Tomography, Emission-ComputedSubject(s)
Blast Crisis , Brain Neoplasms , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Leukemic Infiltration/diagnostic imaging , Philadelphia Chromosome , Protein Kinase Inhibitors/administration & dosage , Pyrimidines/administration & dosage , Thiazoles/administration & dosage , Adult , Blast Crisis/diagnostic imaging , Blast Crisis/drug therapy , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/drug therapy , Dasatinib , Female , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnostic imaging , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Leukemic Infiltration/drug therapy , RadiographyABSTRACT
Sacroiliitis is the most pathognomonic and earliest manifestation of ankylosing spondylitis. We herein report a 28-year-old female patient who presented with sacroiliitis as an initial manifestation of acute myelogenous leukemia (AML). She had a 3-month history of anemia and walking difficulty. Bone marrow findings revealed an increase of blasts with trilineage dysplasia. Although she was initially diagnosed with myelodysplastic syndrome (MDS), blasts rapidly increased and AML developed 1 month after the diagnosis of MDS with Sacroiliitis. Induction chemotherapy failed to induce a complete remission of AML, but it did effectively treat the sacroiliitis. However, the sacroiliitis relapsed when the leukemia cells progressed thereafter. Oral corticosteroids helped ameliorate the sacroiliitis. She underwent bone marrow transplantation (BMT) from an HLA-identical sister during a nonremission period; however, the leukemic cells began to rapidly increase from day 30 after BMT. The close relationship between the occurrence of sacroiliitis and AML suggested that autoimmune sacroiliitis was a paraneoplastic phenomenon of AML in this patient. Although autoimmune disorders develop in a substantial number of MDS patients, they are rarely observed in de novo AML. No previous report has described sacroiliitis as the initial manifestation of de novo AML.
Subject(s)
Leukemia, Myeloid, Acute , Sacroiliac Joint , Spondylitis, Ankylosing , Adrenal Cortex Hormones/therapeutic use , Adult , Blast Crisis/diagnosis , Blast Crisis/diagnostic imaging , Blast Crisis/therapy , Bone Marrow Transplantation , Fatal Outcome , Female , Humans , Leukemia, Myeloid, Acute/diagnosis , Leukemia, Myeloid, Acute/diagnostic imaging , Leukemia, Myeloid, Acute/therapy , Radiography , Recurrence , Sacroiliac Joint/diagnostic imaging , Spondylitis, Ankylosing/diagnosis , Spondylitis, Ankylosing/diagnostic imaging , Spondylitis, Ankylosing/therapy , Transplantation, HomologousABSTRACT
BACKGROUND: A nodular tumor of the spleen in patients with myeloproliferative disease (MPD) is a very rare form of splenic involvement. The aim of the study was to describe the clinical data, sonographic patterns, and prognosis of nodular splenic infiltration in patients with MPD. MATERIALS AND METHODS: During a 20-year period, nodular splenic lesions were found in 10 out of 183 patients with MPD. Retrospectively, splenic size, echomorphology of the lesions, clinical data, sonographic follow-up, and survival were analyzed. RESULTS: In 9 out of 10 patients the lesions were hyperechoic--in one patient hypoechoic. In 3 patients the lesions were solitary. Seven patients had multiple nodular lesions. Low platelet count was seen in 8 patients; blast crisis was seen in 7 patients. The mean survival time was 2.9 months after detection of the splenic lesions. In one patient, autopsy confirmed the diagnosis of myelosarcoma of the spleen. CONCLUSION: The appearance of nodular splenic lesions in MPD is associated with blast crisis and a short survival. Definite histologic or cytologic findings associated with splenic nodules in MPD have not been identified yet. Myelosarcoma of the spleen is the most probable diagnosis suggested.
Subject(s)
Myeloproliferative Disorders/complications , Splenic Diseases/complications , Splenic Diseases/pathology , Aged , Aged, 80 and over , Blast Crisis/complications , Blast Crisis/diagnostic imaging , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myeloproliferative Disorders/blood , Myeloproliferative Disorders/diagnostic imaging , Prognosis , Retrospective Studies , Spleen/diagnostic imaging , Splenic Diseases/diagnostic imaging , Survival Analysis , UltrasonographyABSTRACT
Treatment of Philadelphia (Ph) chromosome-positive chronic myelogenous leukemia (CML) with recombinant interferon-alpha (IFN-A) results in complete disappearance of the Ph chromosome in about 10% to 15% of patients in early chronic phase. This group has a long survival and very low incidence of blast crisis. The first known case is reported of extramedullary blastic transformation in a patient with medullary complete cytogenetic response (0% Ph-positive metaphases) to IFN-A. Four episodes of extramedullary blast crisis have occurred in this patient. The first three episodes were lymphoid by morphology and cytochemical stains. Molecular analysis confirmed breakpoint cluster region rearrangement. The most recent transformation was myeloid in nature and involved bone and pulmonary parenchyma. The patient is currently undergoing a second autologous transplantation with stored bone marrow that is Ph negative. The patient has survived more than 18 months since the first episode of blast crisis, and the bone marrow is normal.
Subject(s)
Blast Crisis/therapy , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Blast Crisis/diagnostic imaging , Bone Marrow Transplantation , Chronic Disease , Combined Modality Therapy , Humans , Interferon Type I/therapeutic use , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnostic imaging , Male , Radionuclide Imaging , Remission Induction , Whole-Body IrradiationABSTRACT
Radiologic, clinical, and pathologic findings are described in 6 young adults with lymphoblastic lymphoma (LBL), an aggressive tumor which has recently become recognized as a serious threat to adults as well as to children. Each patient presented with a mediastinal mass, three of them developing cardiac tamponade and one a superior vena cava syndrome. CT scanning and echocardiography were particularly helpful in defining the lesions. The rapid dissemination of LBL, and its early progression to a leukemic phase call for prompt diagnosis and treatment.