Chronic eosinophilic leukemia complicated by epidural myeloblastoma

The role of trisomy 8 in the pathogenesis of chronic eosinophilic leukemia

A case of chronic eosinophilic leukemia (CEL) manifesting as spinal cord compression by an extradural eosinophilic chloroma in a 32-year-old Chinese man was presented, who subsequently developed extramedullary transformation at the skin and then peritoneal cavity. Cytogenetic study of bone marrow cells at diagnosis showed a clonal karyotypic abnormality of trisomy 8 (+8), which on fluorescence in situ hybridization (FISH) was shown to be present in a clone of abnormal eosinophils, hence showing the neoplastic nature of the eosinophilic proliferation. There was another population of abnormal eosinophils that did not show +8. At blastic transformation, all blast cells in ascitic fluid were shown by FISH to harbor +8. These findings suggest that +8 in this case may have arisen from clonal evolution and is not the primary genetic event in leukemogenesis, but +8 most probably imparts a further survival advantage to the clone responsible for subsequent blastic transformation.

Spinal cord involvement in leukemia: a review of the literature and a case of Ph1+ acute myeloid leukemia presenting with a conus medullaris syndrome

A 21-year-old male with Ph1 positive acute myeloid leukemia (AML) became constipated, experienced pain in the sacral area and retained urine. These were the principle presenting complaints of his disease. With local radiotherapy and systemic chemotherapy, all neurologic symptoms and signs disappeared within three days. A conus medullaris syndrome is uncommon in leukemia, as we were able to find only three other such patients in the literature and three others with the closely related cauda equina syndrome. A literature review of spinal cord involvement in leukemia in general revealed 67 reasonably well-described cases. Compilation of data from these suggests it is most often seen in patients with AML and that it is most common in the second decade of life. Tumors extrinsic to but compressing the cord are the most common finding and the thoracic cord is the most common site of involvement.

Eosinophilic leukaemia: morphological, cytochemical, and electron microscopic studies

The eosinophils of a patient with eosinophilic leukaemia were studied with 13 different cytochemical methods using light and electron microscopy. Apart from the 'left shift' of the eosinophils in bone marrow and peripheral blood, the following morphological changes were noted: uncoordinated maturation of the nucleus and cytoplasm, changes in size of the specific granules, and hypogranulation to such an extent that some of the cells bore only very few granules. The cytochemical studies showed a strongly positive periodic acid Schiff reaction in the eosinophils, caused by a high content of glycogen, and a relatively strong positive acid-phosphatase reaction. These cells were also tested for aryl sulphatase and coenzyme Q. Electron microscopy confirmed the presence of a high-content glycogen and a strong acid phosphatase response in the cells. Peroxidase reaction, detected in electron microscopy as well, enabled us to trace the maturation of the eosinophil cell line.

Granulocytic sarcoma of the central nervous system: inital presentation of leukemia

Granulocytic sarcoma as the presenting feature of leukemia is rare. Although it has been reported in various sites such as the retrobulbar area, mastoid region, iliac bone, and breast, this appears to be the first recorded case presenting as an intracranial tumor.