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Enlarged Abdominal Lymph Node as a Cause of Polyhydramnios in the Course of Congenital Neonatal Leukaemia: A Case Report and Review of the Literature on Foetal Abdominal Tumours with Coexisting Polyhydramnios. J Clin Med 2022; 11:jcm11216598. [PMID: 36362825 PMCID: PMC9656261 DOI: 10.3390/jcm11216598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
Polyhydramnios represents a complication found in 0.2–2% of pregnancies, and it is usually diagnosed between 31 and 36 weeks of pregnancy. Although most cases of polyhydramnios are idiopathic, maternal diabetes or foetal malformations constitute frequent causes of the excessive accumulation of the amniotic fluid. Considering the latter, polyhydramnios may rarely be caused by foetal abdominal tumours, with the incidence rate of 2–14 cases per 100,000 live births. Congenital neonatal leukaemia (CNL) is a rare disease with a reported incidence rate of 5–8.6 cases per million live births. In the prenatal period, the ultrasound abnormalities associated with CNL include hepatomegaly and splenomegaly. In this paper, we presented a case of polyhydramnios caused by mechanical pressure on the foetal gastrointestinal tract by an enlarged lymph node in the course of CNL, as well as reviewing the available literature on foetal abdominal tumours with concurrent polyhydramnios.
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2
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Transient myeloproliferative disorder as the presenting feature for mosaic trisomy 21. Cold Spring Harb Mol Case Stud 2021; 7:mcs.a006126. [PMID: 34789514 PMCID: PMC8751406 DOI: 10.1101/mcs.a006126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022] Open
Abstract
Trisomy 21 is a common congenital disorder with well-documented clinical manifestations, including an increased risk for the transient myeloproliferative disorder as a neonate and leukemia in childhood and adolescence. Transient myeloproliferative disorder is only known to occur in hematopoietic cells with trisomy 21. Children with mosaic trisomy 21 also have a risk for hematological malignancies. We present a nondysmorphic neonate, with a negative noninvasive prenatal screening of maternal blood for trisomy 21, who came to medical attention because of ruddy skin. He was found to have mild polycythemia, thrombocytopenia, and developed peripheral blasts. His clinical presentation was consistent with transient myeloproliferative disorder, which is only seen with trisomy 21. Cytogenetic studies of peripheral blood are positive for mosaic trisomy 21.
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3
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Green K, Tandon S, Ahmed M, Toscano W, O'Connor D, Ancliff P, Vora A, Bartram J, Samarasinghe S, Ghorashian S, Pavasovic V, Rao A. Congenital acute myeloid leukemia: challenges and lessons. A 15-year experience from the UK. Leuk Lymphoma 2021; 62:688-695. [PMID: 33225799 DOI: 10.1080/10428194.2020.1845335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/24/2020] [Indexed: 10/22/2022]
Abstract
Congenital Acute Myeloid leukemia (CAML) is a rare leukemia diagnosed within the first 28 days of life. Dismal survival rates of approximately 25% at two years from diagnosis have not improved despite multiple treatment protocols, and there lacks international consensus for optimal management of these vulnerable patients. We report a retrospective analysis of our fifteen-year experience from a large UK tertiary pediatric center, focusing on treatment modalities and outcomes, including late therapeutic toxicities. To our knowledge, this is the first UK series of congenital leukemia patients reported. Twelve patients with a median age of 16.4 days (1-60) were diagnosed with CAML in fifteen years. All patients presented unwell; 92% demonstrating skin involvement. 10 (83%) received chemotherapy; with 1 death at presentation and 1 spontaneous remission. 5 (42%) received subsequent stem cell transplant. Only 4 (33%) remain alive, with 5 (42%) dying in disease remission with treatment-related mortality. Documented cardiotoxicity was observed in 3 (25%) patients, with a further 2 (17%) suspected but not receiving postmortem. Treatment of congenital AML raises challenging diagnostic, therapeutic and ethical questions and requires multi-center, international collaboration to see improvements.
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Affiliation(s)
- Katherine Green
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Sneha Tandon
- Division of Pediatric Oncology, Department of Pediatrics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mansur Ahmed
- Department of Pharmacy, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Wanda Toscano
- Department of Pharmacy, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - David O'Connor
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Philip Ancliff
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Ajay Vora
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
- University College London, London, UK
| | - Jack Bartram
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Sujith Samarasinghe
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Sara Ghorashian
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Vesna Pavasovic
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Anupama Rao
- Division of Pediatric Oncology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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4
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Taee N, Faraji‐Goodarzi M, Safdari M, Bajelan A. Transient abnormal myelopoiesis in pediatrics with trisomy 21. Clin Case Rep 2021; 9:605-608. [PMID: 33598211 PMCID: PMC7869390 DOI: 10.1002/ccr3.3589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 08/31/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022] Open
Abstract
Transient abnormal myelopoiesis is common among Down syndrome patients. Although no therapeutic measures are required, close monitoring of comorbidities such as gastrointestinal bleeding is required. Long-term follow-up is promising for a healthy future and reduced requirement of unnecessary therapeutic measures including chemotherapy and remission of the pathology.
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Affiliation(s)
- Nadereh Taee
- Department of PediatricsFaculty of MedicineLorestan University of Medical SciencesKhorramabadIran
| | - Mojgan Faraji‐Goodarzi
- Department of PediatricsFaculty of MedicineLorestan University of Medical SciencesKhorramabadIran
| | - Mohammad Safdari
- Student of Research CommitteeLorestan University of Medical SciencesKhorramabadIran
| | - Amir Bajelan
- Student of Research CommitteeLorestan University of Medical SciencesKhorramabadIran
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de Gonzalo-Calvo D, Barroeta I, Nan MN, Rives J, Garzón D, Carmona-Iragui M, Benejam B, Videla L, Fernández S, Altuna M, Valldeneu S, Blesa R, Lleó A, Blanco-Vaca F, Fortea J, Tondo M. Evaluation of biochemical and hematological parameters in adults with Down syndrome. Sci Rep 2020; 10:13755. [PMID: 32792619 PMCID: PMC7426851 DOI: 10.1038/s41598-020-70719-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/30/2020] [Indexed: 11/30/2022] Open
Abstract
Down syndrome (DS) is the most common worldwide cause of intellectual disability of genetic origin and the most common chromosomal disorder affecting live-born infants. In addition to intellectual disability, individuals with DS have other comorbidities and complex medical conditions. The increase in the life expectancy of patients with DS requires expanding the knowledge about their clinical characteristics and related laboratory parameters. Several studies exploring laboratory tests in DS patients exist, but their focus is limited to specific areas of metabolism. Therefore, our main goal was to describe the biochemical and hematological findings in a DS cohort and to compare the values to those of a control population. A total of 248 DS individuals and 84 control subjects were enrolled. DS individuals had a higher frequency of several clinical conditions compared to control individuals and presented with significant differences with respect to the controls in both biochemical and hematological parameters. We found age- and sex-related differences in several of the parameters. A good understanding of the differences in our cohort might be of aid in the clinical follow-up of adults with DS, especially considering that the lifespan of DS individuals may reach 60 years of age in developed countries.
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Affiliation(s)
- David de Gonzalo-Calvo
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Institute of Biomedical Research of Barcelona (IIBB), Spanish National Research Council (CSIC), Barcelona, Spain.,Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Isabel Barroeta
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Madalina Nicoleta Nan
- Department of Biochemistry, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - José Rives
- Department of Biochemistry, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - Diana Garzón
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - María Carmona-Iragui
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Bessy Benejam
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Laura Videla
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Susana Fernández
- Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Miren Altuna
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Sílvia Valldeneu
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Rafael Blesa
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Alberto Lleó
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Francisco Blanco-Vaca
- Department of Biochemistry, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain.,Center of Biomedical Investigation Network for Diabetes and Metabolic Diseases (CIBERDEM), Madrid, Spain.,Department of Biochemistry and Molecular Biology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Mireia Tondo
- Department of Biochemistry, Hospital de La Santa Creu i Sant Pau, Biomedical Research Institute (IIB) Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain.
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Desandes E, Guissou S, Ducassou S, Lacour B. Neonatal Solid Tumors: Incidence and Survival in France. Pediatr Blood Cancer 2016; 63:1375-80. [PMID: 27093073 DOI: 10.1002/pbc.26006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/14/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Solid tumors are uncommon in the neonatal period but represent an important cause of mortality and morbidity. PROCEDURE Using the French National Registry of Childhood Solid Tumors database, all children, from birth to 28 days of age inclusive, with a primary malignant solid tumor diagnosed between 2000 and 2009 in mainland France were identified. Tumors were classified according to the third version of the International Classification of Childhood Cancer. RESULTS Of total 285 solid tumors over 10 years, the most common cancer was neuroblastoma (47%), followed by germ cell tumors (29%), central nervous system tumors (10%), and soft tissue sarcomas (8%). The annual incidence was 36.6 per million live births. No statistically significant change in time trends of incidence was observed during 2000-2009. Routine ultrasonography during pregnancy established the diagnosis in 52% of cases. Thirteen neonates (4.5%) had congenital abnormalities associated with their tumors. For all solid tumors combined, overall survival was 84.2% (95% CI, 79.4-87.9) at 1 year and 83.8% (95% CI, 79.0-87.6) at 5 years. More favorable prognosis was significantly associated with neonates treated by surgery (65% of cases) compared to those without tumor excision. However, perioperative and postoperative mortality was 8%. CONCLUSIONS Because of their relative rarity, there is a paucity of objective information on the epidemiology, optimal treatment, and long-term outcome of neonatal solid tumors. But to obtain a clearer picture of the epidemiology of neonatal tumors, it is essential to have some recommendations on the methodological approach used to study them.
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Affiliation(s)
- Emmanuel Desandes
- CHU Nancy, Registre National des Cancers de l'Enfant, Registre National des Tumeurs Solides de l'Enfant, Faculté de médecine, Vandoeuvre-lès-Nancy F-54500, France.,Université Paris-Sorbonne, CRESS équipe 7, Inserm UMRS-1153, Paris, F-75006, France
| | - Sandra Guissou
- CHU Nancy, Registre National des Cancers de l'Enfant, Registre National des Tumeurs Solides de l'Enfant, Faculté de médecine, Vandoeuvre-lès-Nancy F-54500, France
| | - Stéphane Ducassou
- CHU Bordeaux, Service d'onco-hématologie pédiatrique, Bordeaux F-33000, France
| | - Brigitte Lacour
- CHU Nancy, Registre National des Cancers de l'Enfant, Registre National des Tumeurs Solides de l'Enfant, Faculté de médecine, Vandoeuvre-lès-Nancy F-54500, France.,Université Paris-Sorbonne, CRESS équipe 7, Inserm UMRS-1153, Paris, F-75006, France
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8
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Neonatal Acute Megakaryoblastic Leukemia Presenting with Leukemia Cutis and Multiple Intracranial Lesions Successfully Treated with Unrelated Cord Blood Transplantation. Case Rep Hematol 2015; 2015:610581. [PMID: 26229698 PMCID: PMC4502332 DOI: 10.1155/2015/610581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/18/2015] [Accepted: 06/18/2015] [Indexed: 11/17/2022] Open
Abstract
Neonatal acute megakaryoblastic leukemia (AMKL) without Down syndrome (DS) is an extremely rare disorder. We report of a one-day-old male infant without DS who developed AMKL with leukemia cutis and right facial nerve palsy. Magnetic resonance imaging of the patient's brain revealed multiple intracranial tumors. A biopsy specimen of the skin lesion was suggestive of AMKL, but the bone marrow leukemic cells were less than 5% of the marrow nucleated cells. The skin and intracranial lesions had spontaneously regressed within one and a half months, but the patient's anemia and thrombocytopenia gradually worsened and the leukemic cells in the bone marrow gradually increased to more than 20% of the nucleated cells. In addition, multiple intracranial lesions reappeared at 72 days of life. We diagnosed the patient with AMKL, and chemotherapy followed by unrelated cord blood transplantation after a reduced-intensity conditioning regimen resulted in sustained complete remission. At present, the patient is well, and he has demonstrated normal development for five years.
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9
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Handler MZ, Schwartz RA. Neonatal leukaemia cutis. J Eur Acad Dermatol Venereol 2015; 29:1884-9. [PMID: 25851143 DOI: 10.1111/jdv.13049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
Neonatal leukaemia cutis is a significant neoplasm that may represent a cutaneous manifestation of systemic leukaemia, usually of myeloblastic type. Rarely, it may be or appear to be limited to skin, in which case it is called neonatal aleukaemic leukaemia cutis. By definition, it presents within the first 4 weeks of life and often has a 'blueberry muffin baby' appearance of magenta coloured nodules affecting almost any area of the skin, usually sparing mucous membranes, palms and soles. This clinical pattern is more commonly associated with neonatal infections such rubella and toxoplasmosis, and may be evident with other neonatal neoplasms such as neuroblastoma. Due to the morbidity associated with chemotherapy and reported cases of spontaneous remission without systemic progression in those with neonatal aleukaemic leukaemia cutis without 11q23 translocation, the authors not treating the child with chemotherapy, but to simply monitor for fading of the violaceous nodules, and watch for possible signs of systemic leukaemia.
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Affiliation(s)
- M Z Handler
- Dermatology, Pediatrics, Preventive Medicine, Community Health, and School of Public Affairs and Administration, Rutgers University New Jersey Medical School, Newark, NJ, USA
| | - R A Schwartz
- Dermatology, Pediatrics, Preventive Medicine, Community Health, and School of Public Affairs and Administration, Rutgers University New Jersey Medical School, Newark, NJ, USA
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10
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Park MJ, Sotomatsu M, Ohki K, Arai K, Maruyama K, Kobayashi T, Nishi A, Sameshima K, Takagi T, Hayashi Y. Liver disease is frequently observed in Down syndrome patients with transient abnormal myelopoiesis. Int J Hematol 2013; 99:154-61. [DOI: 10.1007/s12185-013-1487-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/26/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
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11
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Roehm CE, Salazar JC, Hagstrom N, Valdez TA. Phoma and Acremonium invasive fungal rhinosinusitis in congenital acute lymphocytic leukemia and literature review. Int J Pediatr Otorhinolaryngol 2012; 76:1387-91. [PMID: 22818128 DOI: 10.1016/j.ijporl.2012.06.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 06/19/2012] [Accepted: 06/24/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Invasive rhinocerebral fungal infections are a difficult and often fatal problem in children with hematologic malignancies, with increasing reports of rare pathogens. We describe a case of congenital acute lymphoblastic leukemia (ALL) and invasive fungal rhinosinusitis involving Acremonium and Phoma species, not previously reported in invasive pediatric fungal rhinosinusitis, and review all published cases of human Phoma infections. METHODS A literature and institutional review for Phoma spp. was completed including patient demographics, infection site, immune status, treatment and outcome. RESULTS A female neonate with acute lymphoblastic leukemia presented with hyperleukocytosis and advanced invasive Phoma and Acremonium spp. rhinosinusitis. Despite aggressive medical and surgical therapy, the disease progressed to a rhinocerebral infection with a fatal outcome. Twenty cases of Phoma spp. were found in a complete literature search, including 6 females and 14 males from 18 months to 77 years old. Infections were superficial in fifteen patients and involved deeper tissue in five patients, with sites including cutaneous, subcutaneous and deep tissue sites (eye, lung, extremity deep tissue compartments). CONCLUSIONS This case highlights the risks and grave prognosis of fulminant invasive fungal rhinosinusitis in the context of congenital leukemia, and the potential for rare fungal species in neonates with immunosuppression.
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Affiliation(s)
- Corrie E Roehm
- University of Connecticut Health Center, Otolaryngology - Head and Neck Surgery, 263 Farmington Avenue, Farmington, CT 06030-6228, United States.
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12
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Roy A, Roberts I, Vyas P. Biology and management of transient abnormal myelopoiesis (TAM) in children with Down syndrome. Semin Fetal Neonatal Med 2012; 17:196-201. [PMID: 22421527 DOI: 10.1016/j.siny.2012.02.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Children with Down syndrome (DS) have an increased risk of Acute Myeloid Leukaemia (ML-DS), particularly megakaryoblastic leukaemia, which is clonally -related to the neonatal myeloproliferative syndrome, Transient Abnormal Myelopoiesis (TAM) unique to infants with DS. Molecular, biological, and clinical data indicate that TAM is initiated before birth when fetal liver haematopoietic cells trisomic for chromosome 21 acquire mutations in GATA1. TAM usually resolves spontaneously by 6 months; however 20-30% subsequently develop ML-DS harbouring the same GATA1 mutation(s). This review focuses on recent studies describing haematological, clinical and biological features of TAM and discusses approaches to diagnose, treat and monitor minimal residual disease in TAM. An important unanswered question is whether ML-DS is always preceded by TAM as it may be clinically and possibly haematologically 'silent'. We have briefly discussed the role of population-based screening for TAM and development of treatment strategies to eliminate the preleukaemic TAM clone, thereby preventing ML-DS.
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Affiliation(s)
- Anindita Roy
- Centre for Haematology, Imperial College London, United Kingdom
| | - Irene Roberts
- Centre for Haematology, Imperial College London, United Kingdom.
| | - Paresh Vyas
- MRC Molecular Haematology Unit and Department of Haematology, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, United Kingdom.
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Natural history of transient myeloproliferative disorder clinically diagnosed in Down syndrome neonates: a report from the Children's Oncology Group Study A2971. Blood 2011; 118:6752-9; quiz 6996. [PMID: 21849481 DOI: 10.1182/blood-2011-04-350017] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Transient myeloproliferative disorder (TMD), restricted to newborns with trisomy 21, is a megakaryocytic leukemia that although lethal in some is distinguished by its spontaneous resolution. Later development of acute myeloid leukemia (AML) occurs in some. Prospective enrollment (n = 135) elucidated the natural history in Down syndrome (DS) patients diagnosed with TMD via the use of uniform monitoring and intervention guidelines. Prevalent at diagnosis were leukocytosis, peripheral blast exceeding marrow blast percentage, and hepatomegaly. Among those with life-threatening symptoms, most (n = 29/38; 76%) received intervention therapy until symptoms abated and then were monitored similarly. Organomegaly with cardiopulmonary compromise most frequently led to intervention (43%). Death occurred in 21% but only 10% were attributable to TMD (intervention vs observation patients: 13/14 vs 1/15 because of TMD). Among those solely observed, peripheral blasts and all other TMD symptoms cleared at a median of 36 and 49 days from diagnosis, respectively. On the basis of the diagnostic clinical findings of hepatomegaly with or without life-threatening symptoms, 3 groups were identified with differing survival: low risk with neither finding (38%), intermediate risk with hepatomegaly alone (40%), and high risk with both (21%; overall survival: 92% ± 8%, 77% ± 12%, and 51% ± 19%, respectively; P ≤ .001). Among all, AML subsequently occurred in 16% at a median of 441 days (range, 118-1085 days). The trial is registered at http://www.clinicaltrials.gov as NCT00003593.
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Abstract
Congenital leukemia (CL) is an extremely rare disorder in the newborn, significant proportion of which is of myeloid origin, primarily of M4 or M5 morphology. As compared to pediatric leukemia, CL is a more aggressive disease. Acute myeloid leukemia (AML-M7) or acute megakaryocytic leukemia is a rare type of AML with an incidence of 0.5 per million per year. Median age of presentation is 6 years, and children may present with a broad variety of symptoms including low-grade fever, diarrhea, easy bruising, failure to gain weight and life-threatening conditions.
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Affiliation(s)
- N. B. Mathur
- Department of Pediatrics, Maulana Azad Medical College, Delhi, India
| | - Neha Joshi
- Department of Pediatrics, Maulana Azad Medical College, Delhi, India
| | - T. Singh
- Department of Pathology, Maulana Azad Medical College, Delhi, India
| | - Meeta Singh
- Department of Pathology, Maulana Azad Medical College, Delhi, India
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15
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Congenital acute lymphoblastic leukemia: a two-case report and a review of the literature. Eur J Pediatr 2011; 170:531-4. [PMID: 21046414 DOI: 10.1007/s00431-010-1339-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 10/20/2010] [Indexed: 09/29/2022]
Abstract
Congenital leukemia is a rare disease with particular biological and clinical characteristics which differs from those of older children and adults. Here, we describe two cases of congenital acute lymphoblastic leukemia in two newborns with different clinical presentations (leukemia cutis vs. splenomegaly and respiratory distress) and fatal outcome. Both cases shared the expression of myeloid antigens (CD65) and cytogenetic disorders involving the MLL gene (location 11q23) which are associated to extremely poor prognosis.
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16
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A case of fetal leukemia with intracranial hemorrhage and early-onset jaundice. Arch Gynecol Obstet 2008; 279:599-601. [DOI: 10.1007/s00404-008-0784-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Accepted: 08/21/2008] [Indexed: 10/21/2022]
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Ferguson EC, Talley P, Vora A. Translocation (6;17)(q23;q11.2): a novel cytogenetic abnormality in congenital acute myeloid leukemia? ACTA ACUST UNITED AC 2005; 163:71-3. [PMID: 16271959 DOI: 10.1016/j.cancergencyto.2005.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Revised: 03/07/2005] [Accepted: 03/15/2005] [Indexed: 11/29/2022]
Abstract
Congenital leukemia occurring within 4 weeks of birth is extremely rare and, excluding transient neonatal myeloproliferation associated with Down syndrome, makes up approximately 1% of childhood leukemias. It is usually seen as acute myeloid leukemia (AML), most frequently French-American-British (FAB) types M4 and M5. Recurrent cytogenetic abnormalities have been reported in this group, and in approximately one third of cases the MLL gene at 11q23 is involved. These patients generally have a poor prognosis. We present a case of congenital leukemia (AML FAB type M1) with an acquired translocation between chromosomes 6 and 17.
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MESH Headings
- Chromosome Mapping
- Chromosomes, Human, Pair 17
- Chromosomes, Human, Pair 6
- Fatal Outcome
- Humans
- Infant, Newborn
- Infant, Premature
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/congenital
- Leukemia, Myeloid, Acute/genetics
- Male
- Translocation, Genetic
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Affiliation(s)
- Elspeth C Ferguson
- Department of Pediatric Haematology and North Trent Cytogenetics Service, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, United Kingdom
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