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Yee C, Scruggs BA, Flaxel CJ. RETINAL INFILTRATION IN A CASE OF CHRONIC MYELOID LEUKEMIA. Retin Cases Brief Rep 2023; 17:690-693. [PMID: 35385433 PMCID: PMC9525446 DOI: 10.1097/icb.0000000000001281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To describe a case of chronic myeloid leukemia with retinal leukemic infiltration identified by optical coherence tomography (OCT) and OCT angiography. METHODS Case report. RESULTS A 64-year-old man presented with bilateral painless blurred vision and three weeks of fatigue, unintentional weight loss, and complete hearing loss. Dilated fundus examination of both eyes showed peripheral intraretinal hemorrhages with white centers, vascular tortuosity, and peripheral nonperfusion. No macular lesions were identified by slit-lamp examination, fundus photography, fundus autofluorescence, or fluorescein angiography. Optical coherence tomography through the macula revealed multiple hyperreflective lesions throughout the inner retinal layers. Some of these lesions showed intrinsic flow by OCT angiography, but many lesions did not. The bone marrow biopsy confirmed chronic myeloid leukemia, and these intraretinal lesions were deemed to be leukemic infiltrates. The patient regained vision after systemic chemotherapy with resolution of the retinal infiltrates over time. CONCLUSION Primary leukemic retinal involvement can be challenging to diagnose, especially when the macula appears normal clinically. Optical coherence tomography and OCT angiography are useful imaging modalities for the detection of retinal leukemic infiltration. Completing a thorough review of systems and initiating an urgent, systemic work-up are warranted in cases of retinal infiltration.
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Affiliation(s)
- Claudine Yee
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; and
| | - Brittni A Scruggs
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; and
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Christina J Flaxel
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; and
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Abstract
PURPOSE To report combined central arterial and venous occlusions secondary to bilateral leukemic interfascicular optic nerve infiltration in a 56-year-old man. This was the sole presentation of a relapse in T/myeloid mixed-phenotype acute leukemia after 5 months of remission. METHODS Case report with clinical photography. RESULTS A 56-year-old man reported to be in complete remission of T/myeloid mixed-phenotype acute leukemia presented with sudden painless loss of vision in his left eye. Fundoscopy showed unilateral severe optic disk swelling with characteristic findings of a central retinal vein occlusion, namely, intraretinal and preretinal hemorrhages and cotton-wool spots, as well as the features of a central retinal artery occlusion resulting in a pale, edematous retina and a characteristic cherry-red spot. Blood analysis, cerebrospinal fluid evaluation, and bone marrow analysis were performed in combination with medical imaging. No evidence of leukemic relapse was found. An optic nerve biopsy was indicated because of decompensation of the contralateral eye and ultimately confirmed leukemic infiltration. CONCLUSION Regardless of no hematological and nonspecific imaging findings, optic nerve biopsy may be crucial for clinical decision-making in a patient with acute complete vision loss and a history of leukemia.
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Affiliation(s)
- Vincent M De La Porte
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
- Faculty of Health Sciences, University of Antwerp, Edegem, Belgium
| | - Martin Lammens
- Faculty of Health Sciences, University of Antwerp, Edegem, Belgium
- Department of Pathology, Antwerp University Hospital, Edegem, Belgium; and
| | - Sven Dekeyzer
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Michel Van Lint
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
- Department of Pathology, Antwerp University Hospital, Edegem, Belgium; and
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Cotorogea-Simion M, Pavel B, Isac S, Telecan T, Matache IM, Bobirca A, Bobirca FT, Rababoc R, Droc G. What Is Different in Acute Hematologic Malignancy-Associated ARDS? An Overview of the Literature. Medicina (Kaunas) 2022; 58:medicina58091215. [PMID: 36143892 PMCID: PMC9503421 DOI: 10.3390/medicina58091215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Acute hematologic malignancies are a group of heterogeneous blood diseases with a high mortality rate, mostly due to acute respiratory failure (ARF). Acute respiratory distress syndrome (ARDS) is one form of ARF which represents a challenging clinical condition. The paper aims to review current knowledge regarding the variable pathogenic mechanisms, as well as therapeutic options for ARDS in acute hematologic malignancy patients. Data collection: We provide an overview of ARDS in patients with acute hematologic malignancy, from an etiologic perspective. We searched databases such as PubMed or Google Scholar, including articles published until June 2022, using the following keywords: ARDS in hematologic malignancy, pneumonia in hematologic malignancy, drug-induced ARDS, leukostasis, pulmonary leukemic infiltration, pulmonary lysis syndrome, engraftment syndrome, diffuse alveolar hemorrhage, TRALI in hematologic malignancy, hematopoietic stem cell transplant ARDS, radiation pneumonitis. We included relevant research articles, case reports, and reviews published in the last 18 years. Results: The main causes of ARDS in acute hematologic malignancy are: pneumonia-associated ARDS, leukostasis, leukemic infiltration of the lung, pulmonary lysis syndrome, drug-induced ARDS, radiotherapy-induced ARDS, diffuse alveolar hemorrhage, peri-engraftment respiratory distress syndrome, hematopoietic stem cell transplantation-related ARDS, transfusion-related acute lung injury. Conclusions: The short-term prognosis of ARDS in acute hematologic malignancy relies on prompt diagnosis and treatment. Due to its etiological heterogeneity, precision-based strategies should be used to improve overall survival. Future studies should focus on identifying the relevance of such etiologic-based diagnostic strategies in ARDS secondary to acute hematologic malignancy.
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Affiliation(s)
- Mihail Cotorogea-Simion
- Department of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Bogdan Pavel
- Department of Physiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Sebastian Isac
- Department of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Department of Physiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Correspondence:
| | - Teodora Telecan
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Urology, Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Irina-Mihaela Matache
- Department of Physiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Anca Bobirca
- Department of Rheumatology, Dr. I. Cantacuzino Hospital, 073206 Bucharest, Romania
| | - Florin-Teodor Bobirca
- Department of General Surgery, Dr. I. Cantacuzino Hospital, 073206 Bucharest, Romania
| | - Razvan Rababoc
- Department of Internal Medicine II, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Gabriela Droc
- Department of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, Romania
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Palacka P, Slopovsky J, Makovnik M, Kajo K, Obertova J, Mego M. A case report of a patient with inoperable primary diffuse leptomeningeal melanomatosis treated with whole-brain radiotherapy and pembrolizumab. Medicine (Baltimore) 2022; 101:e28613. [PMID: 35060532 PMCID: PMC8772673 DOI: 10.1097/md.0000000000028613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/30/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Primary diffuse leptomeningeal melanomatosis (PDLM) is a rare disease that affects melanocytes in the leptomeninges. There is very limited data on the efficacy of immunotherapy in this setting. PATIENT CONCERNS A patient (23 years old) was diagnosed with PDLM. Histologically, atypical melanocytic cells were also observed. DIAGNOSIS Immunohistochemistry showed positivity for S100 protein, NKiC3, and vimentin, and negativity for Melan-A and HMB-45, with a proliferation index of 30%. Extracranial disease was excluded using dermatological and other examinations, including positron emission tomography/computed tomography with 18F-fluorodeoxyglucose. INTERVENTIONS The patient was treated with whole-brain radiotherapy (10 fractions to a total dose of 30 Gy) concomitantly with pembrolizumab and then continued with immunotherapy until disease progression with a maximum effect of partial remission on magnetic resonance imaging scans. OUTCOMES Progression-free survival was 6.0 months and overall survival 6.5 months. LESSONS This is one of the few case reports of an adult patient with this rare malignancy being treated with a programmed death-1 inhibitor with partial response. Immunotherapy in metastatic PDLM may be a reasonable therapeutic option.
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Affiliation(s)
- Patrik Palacka
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
- National Cancer Institute, Bratislava, Slovakia
| | - Jan Slopovsky
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
- National Cancer Institute, Bratislava, Slovakia
| | - Marek Makovnik
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
- Department of Radiology, National Cancer Institute, Bratislava, Slovakia
| | - Karol Kajo
- Department of Pathology, St. Elisabeth Cancer Institute, Bratislava, Slovakia
| | - Jana Obertova
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
- National Cancer Institute, Bratislava, Slovakia
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
- National Cancer Institute, Bratislava, Slovakia
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Lee V, Farooq AV, Shah HA. Leukemic and Lymphomatous Optic Neuropathy: A Case Series. J Neuroophthalmol 2021; 41:e796-e802. [PMID: 34629409 DOI: 10.1097/wno.0000000000001365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optic neuropathy in the context of leukemia and lymphoma raises concern for central nervous system involvement or relapse and warrants prompt evaluation and treatment. To date, a gold standard for the diagnosis and management of leukemic optic neuropathy has yet to be established. METHODS Case series and review of the literature. Two illustrative cases were selected to discuss their treatment course and outcome. RESULTS We report 7 cases of patients with leukemia or lymphoma presenting with optic nerve infiltration. All patients received steroid therapy for presumed infiltrative optic neuropathy, and 4 patients underwent radiation therapy. Along with systemic chemotherapy, all patients received intrathecal chemotherapy except one. Three patients received chimeric antigen receptor T-cell therapy. CONCLUSIONS Leukemic and lymphomatous optic neuropathy is difficult to diagnose and treat, and there is no gold standard for diagnosis or treatment in the current literature. We help clarify how this disease should be approached in a multidisciplinary fashion and on an individual basis to correctly diagnose and treat the vision loss, while considering the patient's long-term prognosis based on their systemic disease.
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Affiliation(s)
- Victoria Lee
- Pritzker School of Medicine (VL), University of Chicago, Chicago, Illinois; and Department of Ophthalmology and Visual Science (AVF, HAS), University of Chicago, Chicago, Illinois
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Kassar O, Ben Amor S, Fakhfakh Y, Kharrat R, Maalej R, Feki J, Elloumi M. Isolated optic nerve infiltration as a site of relapse of acute lymphoblastic leukemia. Tunis Med 2019; 97:925-928. [PMID: 31872405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Optic nerve infiltration is relatively rare in acute lymphoblastic leukemia. We present a case of a -53 year-old-man who was diagnosed with T- acute lymphoblastic leukemia (ALL). The patient was treated with ALL national protocol and the central nervous system (CNS) prophylactic management. On treatment, the patient presented with sudden severe vision deterioration of both eyes. Fundoscopic examination of the eye and magnetic resonance imaging of the orbits were in favor of an infiltration of the optical nerve. An isolated extramedullary relapse of the optical nerve was retained. The patient was treated with salvage chemotherapy systematic and intrathecal. Waiting forthe beginning of radiotherapy, the patient presented a bone marrow relapse. He died of a severe hemorrhagic syndrome. Conclusion: Optic nerve leukemic infiltration has a severe prognosis. Ophthalmic assessment is essential in patients with ALL in order to diagnose an early ocular involvement and the patient's vision can be preserved if treatment is initiated promptly.
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Sandre M, Osmond A, Ghazarian D, Ghiasi N. Bullous leukemia cutis: a rare clinical subtype. Dermatol Online J 2019; 25:13030/qt68z1v55d. [PMID: 31329394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023] Open
Abstract
Leukemia cutis represents infiltration of the skin by malignant leukocytes and typically presents as firm, red-brown papules and nodules. The bullous clinical subtype is considered a rare entity and can be a diagnostic challenge. This case describes a patient with bullous leukemia cutis mimicking vesiculobullous skin disease.
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Affiliation(s)
- Matthew Sandre
- Division of Dermatology, University of Toronto, Toronto, Ontario.
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8
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Abdelaal O, Barber H, Atala A, Sadri-Ardekani H. Purging of malignant cell contamination prior to spermatogonia stem cell autotransplantation to preserve fertility: progress & prospects. Curr Opin Endocrinol Diabetes Obes 2019; 26:166-174. [PMID: 30998603 DOI: 10.1097/med.0000000000000481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW This systematic review evaluates the state of the art in terms of strategies used to detect and remove contaminated malignant cells from testicular biopsy prior to spermatogonia stem cells (SSCs) autotransplantation to restore fertility. RECENT FINDINGS Several trials have been done in past two decades to determine the reliable methods of detecting and purging cancer cells prior to SSCs autotransplantation. SUMMARY The success in treating childhood cancer has dramatically increased over the past few decades. This leads to increasing demand for a method of fertility preservation for patients with pediatric cancer, as many cancer therapies can be gonadotoxic. Storing the SSCs prior to chemo- or radiation therapies and transplanting them back has been tested as a method of restoring fertility in rodents and nonhuman primate models. This has promise for restoring fertility in childhood cancer survivors. One of the major concerns is the possibility of malignant cell presence in testicular tissue biopsies that could re-introduce cancer to the patient after SSCs autotransplantation. Non-solid cancers - especially hematologic malignancies - have the risk of being transplanted back into patients after SSCs cryopreservation even if they were only present in small number in the stored testicular tissue biopsy.
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Affiliation(s)
- Omar Abdelaal
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Urology, Faculty of Medicine, Zagazig University, Egypt
| | - Heather Barber
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Hooman Sadri-Ardekani
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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9
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Maxfield L, Gaston Ii DA, Sanghvi A. Chronic lymphocytic leukemia and infiltrates seen during excision of nonmelanoma skin cancer. Cutis 2019; 103:E23-E26. [PMID: 30893395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Luke Maxfield
- Sampson Medical Center/Campbell University, Clinton, North Carolina, USA
| | - David A Gaston Ii
- Dermatology and Laser Center, Medical Center Clinic, Pensacola, Florida, and the Florida State University College of Medicine, Tallahassee, USA
| | - Asmi Sanghvi
- Advanced Dermatology and Cosmetic Surgery of Orlando/Kansas City University, Florida, USA
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Moyer AB, Rembold J, Lee NE, Johnson G, Gardner JM. Leukemia cutis as the presenting symptom of acute myeloid leukemia: report of three cases. Dermatol Online J 2018; 24:13030/qt7238n3r8. [PMID: 30142735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 06/08/2023] Open
Abstract
Leukemia cutis (LC), a rare cutaneous manifestation of leukemia, can precede, follow, occur concurrently with, or present in the absence of (aleukemic) systemic leukemia. Leukemia cutis is especially rare as the presenting symptom of leukemia and is associated with a poor prognosis. Although more commonly seen in acute leukemias of myeloid and monocytic lineage, lymphocytic/lymphoblastic leukemias can also involve the skin. Three cases of LC presented with diverse skin lesions ranging from an erythematous rash to violaceous macules and papules to subcutaneous nodules. One case clinically mimicked fixed drug eruption. All the patients had acute myeloid leukemia (AML). Lesions showed two overarching histologic patterns: atypical perivascular infiltrate or nodular dermal histiocytoid infiltrate. Our cases expressed myeloperoxidase (MPO), a helpful marker to distinguish myeloid from non-myeloid cells, and CD68, a monocytic marker frequently expressed in cutaneous AML. CD14, a marker of monocyte maturity, was negative. In the absence of systemic leukemia, common diagnostic tools for hematologic malignancies such as bone marrow biopsy and flow cytometry are non-contributory, making morphologic and immunohistochemical analysis of the skin lesions key to diagnosis.
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Affiliation(s)
- Amanda B Moyer
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas.
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Abstract
RATIONALE Neurolymphomatosis (NL) is a rare syndrome of lymphoma and leukemic infiltration of cranial or peripheral nerves. PATIENT CONCERNS We report a case of non-Hodgkin Lymphoma (NHL) in a 24-year-old man presented with difficulty in swallowing, hypersalivation, hoarseness, ptosis, facial paralysis, and facial hypoesthesia associated with NL. DIAGNOSIS NL was diagnosed based upon cranial magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) examination. INTERVENTIONS The patient was treated with intrathecal methotreaxate (12.5 mg) and cytosine arabinoside (70 mg), systemic high-dose methotrexate therapy, and cranial radiotherapy. OUTCOME Due to the deterioration of general condition of the patient, he was admitted to intensive care unit, but died 22 days after the onset of symptoms in spite of aggressive treatment. LESSONS In this case, we present a patient with T cell lymphoma and multineuritis of NL diagnosed by MRI and as far as we know, this is the first reported case in which so many cranial nerves (3, 5, 7, 8, 9, and 10 th) were involved. Briefly, in a patient with hematologic malignancy and neurological complaints, NL should be considered. Early and effective use of imaging modalities such as positron emission tomography (PET-CT), MRI, and aggressive therapies are important for prolonged survival.
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Affiliation(s)
| | - Ahmet Mete
- Department of Radiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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Abstract
BACKGROUND Myeloid leukemia cutis is the terminology used for cutaneous manifestations of myeloid leukemia. OBJECTIVE The purpose of this study was to study the clinical, histopathological and immunohistochemical features of myeloid leukemia cutis. METHODS This was a retrospective study of clinical and pathological features of 10 patients with myeloid leukemia cutis. RESULTS One patient developed skin lesions before the onset of leukemia, seven patients developed skin infiltration within 4-72 months after the onset of leukemia, and two patients developed skin lesions and systemic leukemia simultaneously. Of these patients, five presented with generalized papules or nodules, and five with localized masses. The biopsy of skin lesions showed a large number of tumor cells within the dermis and subcutaneous fat layer. Immunohistochemical analysis showed strong reactivity to myeloperoxidase (MPO), CD15, CD43 and CD45 (LCA) in most cases. NPM1 (nucleophosmin I) and FLT3-ITD (Fms-like tyrosine kinase 3-internal tandem duplication) mutations were identified in one case. Five patients with acute myelogenous leukemia and one patient with chronic myelomonocytic leukemia died within two months to one year after the onset of skin lesions. STUDY LIMITATIONS This was a retrospective and small sample study. CONCLUSIONS In patients with myelogenous leukemia, skin infiltration usually occurs after, but occasionally before, the appearance of hemogram and myelogram abnormalities, and the presence of skin infiltration is often associated with a poor prognosis and short survival time. myeloid leukemia cutis often presents as generalized or localized nodules or masses with characteristic pathological and histochemical findings.
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Affiliation(s)
- Li Li
- Department of Dermatology, Peking Union Medical College Hospital,
Chinese Academy Medical Sciences - Beijing, China
| | - Yanan Wang
- Department of Dermatology, Peking Union Medical College Hospital,
Chinese Academy Medical Sciences - Beijing, China
| | - Christine Guo Lian
- Department of Pathology, Brigham & Women's Hospital, Harvard
Medical School - Boston, USA
| | - Nina Hu
- Department of Pathology, Brigham & Women's Hospital, Harvard
Medical School - Boston, USA
| | - Hongzhong Jin
- Department of Dermatology, Peking Union Medical College Hospital,
Chinese Academy Medical Sciences - Beijing, China
| | - Yuehua Liu
- Department of Dermatology, Peking Union Medical College Hospital,
Chinese Academy Medical Sciences - Beijing, China
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England CG, Jiang D, Ehlerding EB, Rekoske BT, Ellison PA, Hernandez R, Barnhart TE, McNeel DG, Huang P, Cai W. 89Zr-labeled nivolumab for imaging of T-cell infiltration in a humanized murine model of lung cancer. Eur J Nucl Med Mol Imaging 2018; 45:110-120. [PMID: 28821924 PMCID: PMC5700850 DOI: 10.1007/s00259-017-3803-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/04/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE Nivolumab is a human monoclonal antibody specific for programmed cell death-1 (PD-1), a negative regulator of T-cell activation and response. Acting as an immune checkpoint inhibitor, nivolumab binds to PD-1 expressed on the surface of many immune cells and prevents ligation by its natural ligands. Nivolumab is only effective in a subset of patients, and there is limited evidence supporting its use for diagnostic, monitoring, or stratification purposes. METHODS 89Zr-Df-nivolumab was synthesized to map the biodistribution of PD-1-expressing tumor infiltrating T-cells in vivo using a humanized murine model of lung cancer. The tracer was developed by radiolabeling the antibody with the positron emitter zirconium-89 (89Zr). Imaging results were validated by ex vivo biodistribution studies, and PD-1 expression was validated by immunohistochemistry. Data obtained from PET imaging were used to determine human dosimetry estimations. RESULTS The tracer showed elevated binding to stimulated PD-1 expressing T-cells in vitro and in vivo. PET imaging of 89Zr-Df-nivolumab allowed for clear delineation of subcutaneous tumors through targeting of localized activated T-cells expressing PD-1 in the tumors and salivary glands of humanized A549 tumor-bearing mice. In addition to tumor uptake, salivary and lacrimal gland infiltration of T-cells was noticeably visible and confirmed via histological analysis. CONCLUSIONS These data support our claim that PD-1-targeted agents allow for tumor imaging in vivo, which may assist in the design and development of new immunotherapies. In the future, noninvasive imaging of immunotherapy biomarkers may assist in disease diagnostics, disease monitoring, and patient stratification.
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Affiliation(s)
- Christopher G England
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, 53705, USA
| | - Dawei Jiang
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Nanhai Ave 3688, Shenzhen, Guangzhou, 518060, People's Republic of China
- Department of Radiology, University of Wisconsin - Madison, 1111 Highland Avenue, Room 7137, Madison, WI, 53705-2275, USA
| | - Emily B Ehlerding
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, 53705, USA
| | - Brian T Rekoske
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, 53792, USA
| | - Paul A Ellison
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, 53705, USA
| | - Reinier Hernandez
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, 53705, USA
| | - Todd E Barnhart
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, 53705, USA
| | - Douglas G McNeel
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, 53792, USA
- University of Wisconsin Carbone Cancer Center, Madison, WI, 53792, USA
| | - Peng Huang
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Nanhai Ave 3688, Shenzhen, Guangzhou, 518060, People's Republic of China.
| | - Weibo Cai
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, 53705, USA.
- Department of Radiology, University of Wisconsin - Madison, 1111 Highland Avenue, Room 7137, Madison, WI, 53705-2275, USA.
- University of Wisconsin Carbone Cancer Center, Madison, WI, 53792, USA.
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Min M, Bi Y, Liu Y, Xu Y. Extramedullary gastric relapse of acute lymphoblastic leukemia in an adolescent. Gastrointest Endosc 2017; 86:565-567. [PMID: 28322772 DOI: 10.1016/j.gie.2017.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/11/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Min Min
- Department of Gastroenterology and Hepatology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China
| | - Yiliang Bi
- Department of Gastroenterology and Hepatology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China
| | - Yan Liu
- Department of Gastroenterology and Hepatology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China
| | - Yang Xu
- Department of Gastroenterology and Hepatology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China
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Ben Khelil M, Chkirbene Y, Mlika M, Haouet S, Hamdoun M. Unexpected infant death secondary to a pulmonary infiltration due to acute myelocytic leukaemia. Malays J Pathol 2017; 39:193-196. [PMID: 28866704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Acute myeloid leukaemia (AML) often presents with non-specific symptoms such as fatigue, anaemia or infection. Pulmonary involvement is uncommon in AML during the course of the disease and is usually caused by infection, haemorrhage, leukaemic pulmonary infiltrates and leukostasis. Lung localization of AML is very uncommon and potentially life threatening if not diagnosed and treated rapidly. The authors describe the sudden death of an asymptomatic five-month-infant because of a misdiagnosed lung localization of AML. Autopsy examination followed by histopathological studies showed an extensive leukostasis and extramedullary leukaemic infiltrating the lungs. Special stains and immunohistochemical studies revealed findings consistent with acute myelogenous leukaemia. This case suggests that underlying acute leukaemia should be considered as a cause of flu-like symptoms in infants. Medical personnel are urged to be alert to fever, sore throat, weakness and dyspnea that may be characteristic of serious systemic diseases.
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Affiliation(s)
- M Ben Khelil
- University Tunis-Elmanar, Faculty of Medicine, Tunis, Tunisia.
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Huang YYM, Liu M, Ruth JS, Potenziani S, Hsu S. Precursor-B-cell-ALL leukemia cutis resembling lipomas: an atypical presentation of a rare entity and a review of the literature. Dermatol Online J 2017; 23:13030/qt6bs2d542. [PMID: 28329516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/21/2017] [Indexed: 06/06/2023] Open
Abstract
Leukemia cutis (LC) is an extramedullary manifestationof leukemia owing to cutaneous infiltration ofneoplastic cells resulting in characteristic firm,erythematous nodules. Most cases of LC occur inpatients with acute myelogenous leukemia andchronic myelogenous leukemia. However in rarecases, LC has presented in patients with acutelymphoblastic leukemia (ALL). In these rare ALLassociatedcases, only 10 cases of precursor-B-ALL(pre-B-ALL) have been described in the literature.We report a case of a 22-year-old man with relapsingpre-B-ALL who presented with a 4-day history ofmultiple asymptomatic, soft, dome-shaped, lipomalikemounds on his scalp and chin, which exhibitedcutaneous involvement by leukemic cells. To date, thisis the first case of pre-B-ALL associated leukemia cutispresenting as soft, dome-shaped mounds resemblinglipomas.
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Nascimbeni C, Chantepie S, Brugiere C, Comoz F, Salaun V, Verneuil L. [Cutaneous involvement in T-lymphoblastic lymphoma]. Ann Dermatol Venereol 2017; 144:268-274. [PMID: 28242092 DOI: 10.1016/j.annder.2017.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/27/2016] [Accepted: 01/13/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lymphoblastic lymphoma (LBL) is a rare form of non-Hodgkin's lymphoma (NHL). Cutaneous LBL is seen in less than 20% of patients. PATIENTS AND METHODS Herein, we report the case of a 66-year-old male patient without any previous disease history of note and who was presenting a gradually spreading tumoral lesion of the scalp, several purplish macules and nodules on the trunk, and a single spinal adenopathy. A thoracic-abdominal-pelvic CT scan performed for acute renal failure, revealed extensive infiltration of retroperitoneal tissue. Skin biopsies and staging tests indicated LBL-T with associated cutaneous, bone and lymph node retroperitoneal lesions with no mediastinal mass. After two months of treatment with CHOP (four courses), the cutaneous lesions and abdominal tumoral mass had regressed and renal function had returned to normal. DISCUSSION There have been 13 reported cases of LBL with cutaneous involvement; most of these patients were young (under 30 years) and presented multiple cutaneous lesions (nodules or tumors) associated with numerous peripheral adenopathies, invasion of the bone marrow, and in many cases, a mediastinal mass. The clinical presentation of LBL-T in our case is novel on account of the cutaneous sites, associated with abdominal tumoral syndrome, without mediastinal infiltration, and with a single peripheral adenopathy, in an elderly subject.
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Affiliation(s)
- C Nascimbeni
- Service de dermatologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France; Université de Caen Normandie, 14000 Caen, France.
| | - S Chantepie
- Service d'hématologie clinique, CHU de Caen, 14033 Caen, France; Université de Caen Normandie, 14000 Caen, France
| | - C Brugiere
- Service de dermatologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France; Université de Caen Normandie, 14000 Caen, France
| | - F Comoz
- Service d'anatomie pathologique, CHU de Caen, 14033 Caen, France; Université de Caen Normandie, 14000 Caen, France
| | - V Salaun
- Service d'hématologie biologique, CHU de Caen, 14033 Caen, France; Université de Caen Normandie, 14000 Caen, France
| | - L Verneuil
- Service de dermatologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France; Université de Caen Normandie, 14000 Caen, France
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Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare myeloid malignancy with no defined standard of care. BPDCN presents most commonly with skin lesions with or without extramedullary organ involvement before leukemic dissemination. As a result of its clinical ambiguity, differentiating BPDCN from benign skin lesions or those of acute myeloid leukemia with leukemia cutis is challenging. BPDCN is most easily defined by the phenotype CD4+CD56+CD123+lineage-MPO-, although many patients will present with variable expression of CD4, CD56, or alternate plasmacytoid markers, which compounds the difficulty in differentiating BPDCN from other myeloid or lymphoid malignancies. Chromosomal aberrations are frequent, and the mutational landscape of BPDCN is being rapidly characterized although no obvious molecular target for chemoimmunotherapy has been identified. Chemotherapy regimens developed for acute myeloid leukemia, acute lymphoid leukemia, and myelodysplastic syndrome have all been used to treat BPDCN. Relapse is frequent, and overall survival is quite poor. Allogeneic transplantation offers a chance at prolonged remission and possible cure for those who are eligible; unfortunately, relapse remains high ranging from 30% to 40%. Novel therapies such as SL-401, a diphtheria toxin conjugated to interleukin-3 (IL-3) is commonly overexpressed in BPDCN and other aggressive myeloid malignancies and has shown considerable promise in ongoing clinical trials. Future work with SL-401 will define its place in treating relapsed or refractory disease as well as its role as a first-line therapy or bridge to transplantation.
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Peña-Romero AG, Domínguez-Cherit J, Méndez-Flores S. [Leukemia cutis: clinical features of 27 mexican patients and a review of the literature]. GAC MED MEX 2016; 152:439-443. [PMID: 27792708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Leukemia Cutis (LC) consists in neoplastic leukocytic infiltration of the skin and is strongly associated with the presence of extramedullary disease and poor prognosis. However, there are few studies in the literature regarding this entity. We perform a retrospective study of 27 mexican patients in order to analyze the clinical features and prognosis of LC in Mexico, and a brief review of the literature. METHODS Cases diagnosed as LC by skin biopsy were selected from the database of the Department of Dermatology of National Institute of Medical Science and Nutrition Salvador Zubirán. Cases were searched between the dates of January 1993 and December 2013. RESULTS Twenty-seven cases which were histologically confirmed with cutaneous leukemic infiltrate were included. Of these patients 60% were male and the mean age at diagnosis was 42 yr (19 to 80 yr). The predominant tipe of LC was acute myeloid leukemia (AML) with 48% of the cases. Nodular neoformations were the main clinical manifestation with 63% of the cases. The mean interval between the diagnosis of LC and death was 10 months (CI 95%). CONCLUSIONS The presence of LC is a marker of poor prognosis and can precede the relapse of systemic leukemia. Cutaneous infiltration may be the first or the only sign of progression, so doctors should be familiar with the clinical manifestations of this disease.
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Affiliation(s)
- Adriana Guadalupe Peña-Romero
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Judith Domínguez-Cherit
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Silvia Méndez-Flores
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
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20
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Reddy S, Shashikiran AR, Basavaraj R, Shamanur M. Leukemia cutis in a patient of relapsed leprosy- Coincidence or predisposition? LEPROSY REV 2016; 87:252-259. [PMID: 30212171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Leprosy, a disease of skin and peripheral nerves has varied manifestations which principally affect the immune status of the host. Leukemic skin infiltrations in patients with leukemia are referred to as leukemia cutis. It can be seen in all types of leukemia, especially in patients with acute myelomonocytic leukemia (AML). In majority of cases, the cutaneous lesions are nonspecific manifestations associated with an impaired immune system.1 Though various malignancies have been documented with leprosy, no case of borderline-tuberculoid (BT) Hansen’s disease with coexisting leukemia cutis has ever been reported in literature to the best of our knowledge.
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Tuma J. [Ultrasound diagnosis 69: Acute lower abdominal pain. Diagnosis: leukemic infiltration of the sigmoid colon]. Praxis (Bern 1994) 2016; 105:476-478. [PMID: 27078736 DOI: 10.1024/1661-8157/a002337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Jan Tuma
- 1 Institut für Sonographie, Uster
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von Altrock A, Ganter M, Schwittlick U, Beineke A. Multicentric T-cell lymphoma accompa- nied by infiltration of the peripheral and central nervous system in a fattening pig. Berl Munch Tierarztl Wochenschr 2015; 128:350-354. [PMID: 26591379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Multicentric lymphomas, usually of B-cell origin, are rather common neoplasms in pigs, which usually affect lymph nodes and different organ systems. An uncommon manifestation of malignant lymphoma represents neoplastic peripheral nerve involvement, which has been reported in human medicine. So far, only single cases of lymphoma with manifestation in peripheral nerves (known as neurolymphomatosis) without leukemic conversion have been mentioned in different animal species others than swine. The present case report describes the occurrence of a multicentric T-cell lymphoma in a fattening pig with marked leukocytosis. The pig was presented with symptoms of lethargy, weight loss, and fever. Bone marrow aspirate contained all stages of granulocytic and erythrocytic precursors, and a remarkable large number of eosinophiles and undifferentiated blasts. At necropsy, the carcass showed generalized lymphadenopathy and severe hepatosplenomegaly. Histological findings included neoplastic round cell infiltrations in lymph nodes, bone marrow, tonsils, lung, spleen, liver, kidneys, urinary bladder, small and large intestine, and meninges. Additionally, neoplastic cells were present in the sciatic and medial plantar nerve of the left hind leg. The diagnosis T-cell lymphoma was confirmed immunohistochemically. To the author's knowledge, this work represents the first report of peripheral nerve involvement in a pig with multicentric T-cell lymphoma accompanied by CNS involvement and leukemia.
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Obiozor C, Ganguly S, Fraga GR. Leukemia cutis with lymphoglandular bodies: a clue to acute lymphoblastic leukemia cutis. Dermatol Online J 2015; 21:13030/qt6m18g35f. [PMID: 26437164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 08/14/2015] [Indexed: 06/05/2023] Open
Abstract
Leukemia cutis describes cutaneous lesions produced by infiltrates of leukemic cells. It usually manifests contemporaneously with the initial diagnosis of systemic leukemia, but may also precede or follow systemic leukemia. Most cases are associated with acute myeloid leukemia. Adult B-cell lymphoblastic leukemia cutis is very rare. We report a 59-year-old woman with a history of B-cell acute lymphoblastic leukemia who relapsed with aleukemic lymphoblastic leukemia cutis. Lymphoglandular bodies were conspicuous on biopsy and may serve as a morphologic clue to lymphocytic differentiation while molecular and immunophenotypic studies are pending. The patient was successfully treated with local radiation therapy and oral ponatinib.
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Walker JL, Cohen LM, Kroumpouzos G. Bilateral auricular involvement: a rare presenting sign of chronic lymphocytic leukemia, and successful treatment with electron beam therapy. Acta Derm Venereol 2015; 95:616-7. [PMID: 25394716 DOI: 10.2340/00015555-2012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
MESH Headings
- Adult
- Biopsy, Needle
- Ear Auricle/pathology
- Ear Auricle/radiation effects
- Follow-Up Studies
- Humans
- Immunohistochemistry
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/radiotherapy
- Leukemic Infiltration/pathology
- Leukemic Infiltration/radiotherapy
- Male
- Proton Therapy/methods
- Rare Diseases
- Risk Assessment
- Skin/pathology
- Treatment Outcome
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Affiliation(s)
- Joanna L Walker
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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25
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Esposito P, Libetta C, Rampino T, Gregorini M, Margiotta E, Dal Canton A. Huge kidneys in a patient with chronic lymphocytic leukaemia. Br J Haematol 2015; 168:470. [PMID: 25384540 DOI: 10.1111/bjh.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
MESH Headings
- Acute Kidney Injury/etiology
- Acute Kidney Injury/therapy
- Antineoplastic Agents, Alkylating/therapeutic use
- Bendamustine Hydrochloride
- Biopsy
- Humans
- Kidney/diagnostic imaging
- Kidney/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemic Infiltration/diagnostic imaging
- Leukemic Infiltration/pathology
- Male
- Middle Aged
- Nitrogen Mustard Compounds/therapeutic use
- Remission Induction
- Renal Dialysis
- Tomography, X-Ray Computed
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Affiliation(s)
- Pasquale Esposito
- Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Pavia, Italy.
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26
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Pulido-Díaz N, Medina G, Palomino N, Peralta F. [Cutaneous manifestations of leukemia]. Rev Med Inst Mex Seguro Soc 2015; 53 Suppl 1:S30-S35. [PMID: 26020660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION To describe the type and frequency of cutaneous manifestations of leukemia. METHODS Observational, descriptive study. We included patients over 16 years of age, with confirmed diagnosis of leukemia from the Hematology and Dermatology Departments of the outpatient clinic and from in-patients. Patients with bone marrow transplantation were excluded. A complete history and physical examination of the skin and appendages was performed, with biopsy and cultures if required. The cutaneous manifestations were classified as infection or drug-related, leukemic infiltration, associated dermatosis to leukemia and non-specific lesions. Descriptive statistics was employed. RESULTS We included 142 patients (62 females, 80 males) with the following diagnoses: acute myeloid leukemia (n=36), acute lymphoblastic leukemia (n=52), chronic myeloid leukemia (n=21), chronic lymphocitic leukemia (n=30) and hairy cells leukemia (n=3). 42% of patients (n=60) presented some dermatoses. There were 36 non-specific dermatoses, 21 drug-related, 20 infectious, 3 infiltrative and none associated. CONCLUSIONS Cutaneous manifestations directly related to leukemia are frequent, being the non-specific ones, the most commonly observed. However, a thorough dermatologic examination is important in these patients as part of an overall evaluation.
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Affiliation(s)
- Nancy Pulido-Díaz
- Departamento de Dermatología, Hospital de Especialidades, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Distrito Federal.
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27
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Prada Garcia C, Sanchez Sambucety P, Rodriguez Prieto MÁ. [Cutaneous infiltratiton by chronic myelononocytic leukemia: presentation of three cases]. Dermatol Online J 2013; 19:20408. [PMID: 24314783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 11/15/2013] [Indexed: 06/02/2023] Open
Abstract
Leukemia cutis refers to cutaneous infiltration by malignant hematopoietic cells. Its clinical manifestations are highly variable and biopsy is required for confirmation. We present three cases of patients with persistent monocytosis and skin lesions whose diagnosis was chronic myelomonocytic leukemia. The biopsy of skin lesions showed a dermal infiltration by atypical myelocytes and monocytes. Immunohistochemical study was positive for CD68. These findings were compatible with cutaneous infiltration by chronic myelomonocytic leukemic cells.
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28
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Hato A, Murayama T, Nishikawa S, Kajimoto K, Gomyo H, Sugimoto T, Mizuno I, Koizumi T. Philadelphia chromosome positive acute lymphoblastic leukemia showing normal karyotype in G-banding chromosomal examination before chemotherapy. Hematology 2013; 10:379-81. [PMID: 16273725 DOI: 10.1080/10245330500226787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
A 29-year-old male was admitted because of thrombocytopenia. A diagnosis of acute lymphoblastic leukaemia was made on the basis of a 61.6% infiltration of leukemic cells in his bone marrow. Standard G-binding chromosome analysis of bone marrow cells revealed a normal karyotype. He received combination chemotherapy, and achieved hematological complete remission. However, chromosomal analysis of bone marrow cells after 2 courses of consolidation therapy showed the Philadelphia (Ph) chromosome in two cells out of 20 analysed. We retrospectively examined the sample of bone marrow cells before chemotherapy; It showed minor BCR/ABL positivity with FISH and RT-PCR methods. The Ph chromosome disappeared after consolidation chemotherapy and allogeneic bone marrow transplantation, but the Ph chromosome reappeared at relapse. We postulated that there were two clones, both a Ph-positive clone and Ph-negative clone. At the initial diagnosis, Ph chromosome was not detected because the G-banding method analyzed only metaphase cells, which contained few Ph-positive clones. In order to offer effective therapy with molecular targeting agents, in this poor prognostic disease, it is necessary to detect Ph chromosome before the first chemotherapy and BCR/ABL detection with FISH or RT-PCR methods appears more useful than G-banding chromosome analysis.
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Affiliation(s)
- Akio Hato
- Hematology/Oncology Division, Department of Medicine, Hyogo Medical Center for Adults, Akashi, Hyogo, Japan
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Abstract
Breast lump as a presenting manifestation of acute lymphoblastic lymphoma (ALL) leukemia is extremely rare. We report a case of a young female who presented with a breast lump clinically suggestive of fibroadenoma. On fine needle aspiration cytology, it was diagnosed as lymphoid malignancy, later confirmed as ALL using hematological investigations.
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Affiliation(s)
- Shramana Mandal
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
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30
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Koca E, Goker H, Guven GS, Cetiner D, Haznedaroglu IC, Buyukasik Y, Uner A, Ozcebe OI. Unusual extramedullary recurrences and breast relapse despite hepatic GVHD after allografting in Ph+-ALL. Hematology 2013; 11:105-7. [PMID: 16753850 DOI: 10.1080/10245330600574177] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Extramedullary recurrences with or without bone marrow involvement are reported in up to a half of leukemic relapses after BMT. Our report describes a case of an extramedullary recurrence and breast relapse after second-allografting in a female patient with Ph+-acute lymphoblastic leukemia (ALL), occurring when there was active hepatic GHVD. This case illustrates the complex relationship between graft-versus-host disease (GVHD) and graft-versus-leukemia since she had no evidence of leukemia in her marrow demonstrating 100% full-donor chimerism while she had ALL relapse in her breast.
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Affiliation(s)
- Ebru Koca
- Hacettepe University, Division of Hematology, Department of Internal Medicine, Ankara, Turkey.
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31
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Salihoglu A, Hatemi I, Senel TE, Aki H, Ferhanoglu B. Massive gastrointestinal bleeding during the course of chronic myelomonocytic leukemia. J Gastrointestin Liver Dis 2013; 22:7. [PMID: 23539404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Ayse Salihoglu
- Department of Internal Medicine, Division of Hematology, Istanbul, Turkey.
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32
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Pulgar F, Vélez D, Valdeolivas N, García J, Cabrera A, Pericet L, Trasobares L, Medina S, García M. Post-bone-marrow-transplant leukemia cutis. Dermatol Online J 2013; 19:6. [PMID: 23473276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Granulocytic sarcoma or chloroma is a tumor of immature cells from the granulocyte line that is generally associated with acute myeloid leukemia. The skin is one of the most affected organs. This lesion may complicate hematological dyscrasias, which is generally indicative of a poor prognosis. We present a case of a 51-year-old patient who was diagnosed with acute myeloid leukemia with a complex karyotype that debuted with a post-transplant cutaneous and hematological relapse, a very rare occurrence in the literature given that no extramedullary involvement was present prior to the transplant.
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Ramakrishna R, Sarathy K, Sarathy T. Rituximab therapy in cutaneous infiltration of chronic lymphocytic leukaemia. Acta Haematol 2013; 130:47-51. [PMID: 23406682 DOI: 10.1159/000346072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 11/08/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Raj Ramakrishna
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia.
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Abdou AG, Seleit I, Bakry OA, Abdel-Wahed MM. Leukemia cutis from CD56 positive, myeloperoxidase negative acute myeloid leukemia. Acta Dermatovenerol Croat 2013; 21:189-192. [PMID: 24183224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Acute myeloid leukemia (AML) is a clonal expansion of myeloid blasts in peripheral blood, bone marrow, or other tissues. Cutaneous manifestations of leukemia are either specific or nonspecific. Specific lesions result from direct infiltration of the skin by leukemic cells. We present a case of myeloid leukemia cutis manifested by erythematous asymptomatic nodules and plaques distributed on the chest, abdomen and back. The clinical and histopathologic features of the cutaneous infiltrate were suggestive of hematolymphoid malignancy, more towards lymphoma. However, the immunohistochemical features were against the diagnosis of lymphoma and were highly suspicious of myeloid leukemia, which were concomitantly confirmed by bone marrow biopsy and blood smear. In any poorly differentiated malignant skin infiltrate of confirmed hematopoietic lineage, myeloid differentiation should be considered and excluded by an appropriate panel. CD56+ AML is a rare type of AML that has special features like the great liability of extramedullary involvement including skin, monocytic characteristic of leukemia cells, and absence of myeloperoxidase expression.
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Affiliation(s)
- Asmaa Gaber Abdou
- Dr. Asmaa Gaber Abdou , Department of Pathology, Faculty of medicine, Menofiya University, Shebein Elkom, Egypt;
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35
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Sahin NM, Avci Z, Malbora B, Abaci A, Kinik ST, Ozbek NY. Cushing syndrome related to leukemic infiltration of the central nervous system: a case report and a possible role of LIF. J Pediatr Endocrinol Metab 2013; 26:967-70. [PMID: 23729555 DOI: 10.1515/jpem-2012-0401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 04/01/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome (CS) in the presence of leukemic central nervous system infiltration is very rare. CASE A 3.8-year-old girl who had been treated for B-cell acute lymphoblastic leukemia (ALL) for 1.5 years was admitted to our hospital with excessive weight gain and depression for the last 2 months. Prior to her admission, she was on maintenance with the ALL-BFM95 study protocol for 10 months that does not contain corticosteroids. On physical examination, central obesity and moon face appearance were determined. Laboratory tests revealed high morning ACTH, cortisol level, and 24-h urinary free cortisol level. Morning cortisol level was 33.94 nmol/L after a 2-day (4 × 0.5 mg) dexamethasone suppression test. A lumbar puncture revealed leukemic cells in the cerebrospinal fluid. No pituitary adenoma was detected on magnetic resonance imaging. We diagnosed the patient with ACTH-dependent CS related to leukemic infiltration of the central nervous system. CONCLUSION Central nervous system infiltration should be considered in leukemic patients who have developed CS. We believe increased leukemia inhibitory factor levels may be a factor for CS in our patient with ALL.
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36
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Jiang L, Yu G, Meng W, Wang Z, Meng F, Ma W. Overexpression of amyloid precursor protein in acute myeloid leukemia enhances extramedullary infiltration by MMP-2. Tumour Biol 2012. [PMID: 23179400 DOI: 10.1007/s13277-012-0589-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
It is known that leukemia patients with extramedullary infiltration (EMI) have a worse prognosis than patients without it. Recent data indicate that the amyloid precursor protein (APP) is involved in cell adhesion, motility, and proliferation. The expression of APP and its prognostic significance in acute myeloid leukemia (AML) have not been studied. Our study shows that AML/ETO(+) leukemia patients that overexpress APP easily get EMI and that their long-term survival rate is lower than patients without overexpression of APP. In an in vitro study, we knocked down APP in Kasumi-1 cells using small interfering RNA (siRNA). Transwell data show that siRNA/APP substantially impairs cell migration, but it does not inhibit cell proliferation. Furthermore, by quantitative real-time polymerase chain reaction and Western blot, we found that siRNA/APP decreases MMP-2 expression in vitro. Our study provides a novel clue that APP is involved in the extramedullary infiltration of leukemia by MMP-2.
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MESH Headings
- Adult
- Amyloid beta-Protein Precursor/antagonists & inhibitors
- Amyloid beta-Protein Precursor/genetics
- Amyloid beta-Protein Precursor/metabolism
- Blotting, Western
- Cell Adhesion
- Cell Movement
- Cell Proliferation
- Core Binding Factor Alpha 2 Subunit/genetics
- Female
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/pathology
- Leukemic Infiltration/pathology
- Male
- Matrix Metalloproteinase 2/genetics
- Matrix Metalloproteinase 2/metabolism
- Neoplasm Invasiveness
- Oncogene Proteins, Fusion/genetics
- Prognosis
- RNA, Messenger/genetics
- RNA, Small Interfering/genetics
- RUNX1 Translocation Partner 1 Protein
- Real-Time Polymerase Chain Reaction
- Reverse Transcriptase Polymerase Chain Reaction
- Tumor Cells, Cultured
- Young Adult
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Affiliation(s)
- Ling Jiang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Affiliation(s)
- Nilay Kumar
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-0012, USA.
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38
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Obi C, Holler P, Pugliese D, Abraham R, Xu X, Sobanko J, Rosenbach M, Wanat KA. Leukemia labialis: a rare presentation of leukemia cutis limited to the lips. J Am Acad Dermatol 2012; 67:e146-7. [PMID: 22980271 DOI: 10.1016/j.jaad.2011.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 12/02/2011] [Accepted: 12/04/2011] [Indexed: 11/15/2022]
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39
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Uprety D, Peterson A, Shah BK. Renal failure secondary to leukemic infiltration of kidneys in CLL--a case report and review of literature. Ann Hematol 2012; 92:271-3. [PMID: 22875063 DOI: 10.1007/s00277-012-1547-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 07/28/2012] [Indexed: 12/31/2022]
MESH Headings
- Acute Kidney Injury/etiology
- Acute Kidney Injury/therapy
- Aged
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Delayed Diagnosis
- Humans
- Kidney/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemic Infiltration/pathology
- Lymph Nodes/pathology
- Male
- Renal Dialysis
- Rituximab
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
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Latrofa F, Ricci D, Montanelli L, Rocchi R, Piaggi P, Sisti E, Grasso L, Basolo F, Ugolini C, Pinchera A, Vitti P. Lymphocytic thyroiditis on histology correlates with serum thyroglobulin autoantibodies in patients with papillary thyroid carcinoma: impact on detection of serum thyroglobulin. J Clin Endocrinol Metab 2012; 97:2380-7. [PMID: 22539585 DOI: 10.1210/jc.2011-2812] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Serum thyroglobulin (Tg), the marker of residual tumor in papillary thyroid carcinoma, can be underestimated in patients with Tg autoantibodies (TgAb). TgAb are due to a coexistent lymphocytic thyroiditis (LT) or the papillary thyroid carcinoma per se. TgAb assays are highly discordant. DESIGN We evaluated 141 patients with a clinical diagnosis of nodular thyroid disease, 32 of Hashimoto's thyroiditis, and four of Graves' disease, who underwent total thyroidectomy for an associated papillary thyroid carcinoma. Patients were classified as papillary thyroid carcinoma-lymphocytic thyroiditis (PTC-T) and papillary thyroid carcinoma (PTC) according to the presence or absence of LT on histology. Tg was measured before thyroid remnant ablation, when it is expectedly detectable, by an immunometric assay (IMA) and TgAb by three noncompetitive IMA and three competitive radioimmunoassays (RIA). The number of lymphocytes was compared with TgAb concentration. RESULTS Seventy-two of 177 patients (40.7%) were classified as PTC-T and 105 (59.3%) as PTC. Although the tumor stage was similar in the two groups, Tg was undetectable in more PTC-T (37 of 72) than PTC (12 of 105) (P < 0.01), and Tg values were lower in the former (0; 0-4.7 ng/ml) (median; 25th to 75th percentiles) than in the latter group (9.7; 2.7-24.2) (P < 0.01). Accordingly, the percent of positive TgAb by the six assays resulted in higher PTC-T (29.2-50.0%) than PTC (1.9-6.7%) (P < 0.01). Among 49 patients with undetectable Tg, TgAb were more frequently positive by IMA (57.1-63.3%) than RIA (30.6-42.9%). The number of lymphocytes correlated with TgAb concentration in all six assays (0.34 < Rho < 0.46) (all P < 0.01). CONCLUSIONS In papillary thyroid carcinoma, LT on histology must be carefully searched for because it is frequently associated with TgAb and therefore mistakenly low or undetectable Tg. TgAb can be missed by some assays. In absence of LT, TgAb are rare.
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Affiliation(s)
- Francesco Latrofa
- Department of Endocrinology, University Hospital of Pisa, Via Cisanello 2, 56124, Pisa, Italy.
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41
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Fino P, Fioramonti P, Onesti MG, Passaretti D, Scuderi N. Skin metastasis in patient with hairy cell leukemia: case report and review of literature. In Vivo 2012; 26:311-314. [PMID: 22351675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The reported case of Hairy cell leukemia (HCL) refers to a 47-year-old man with pancytopenia, splenomegaly, a month and a half history of dyspnea on mild effort and in common daily activities and a purplish-brown cutaneous node on the back of the left hand at the time of hospital admission. Bone marrow aspiration showed an infiltration by a lymphoproliferative malignancy and the following cytochemical studies on bone marrow sample led to diagnosis of HCL. The biopsy of the skin lesion revealed a infiltrate of medium and large-size cells in the dermis with the the same cytologic features of leukemic blasts appearing in the bone marrow, upon which the diagnosis of Leukemia cutis was established. The differential diagnosis of leukemia includes other neoplastic hematopoietic disorders, such as lymphoma, myelodysplastic syndromes, multiple myeloma, aplastic anemia, severe megaloblastic anemia, severe lymphocytosis, severe monocytosis, and bone marrow failure. In our case, the skin lesion was surgically removed and then left to heal by secondary intention due to the presence of bacterial infection by Staphylococcus aureus and Streptococcus pyogenes. The wound was finally medicated to total healing with Promogran®, an advanced dressings which consists of a sterile, freeze-dried matrix composed of collagen and oxidised regenerated cellulose. The importance of our case lies in the fact that cases with association of HCL with leukemia cutis are very rare, and furthermore that after the excision of the skin lesion of the left hand, the surgeons heal to let the wound close by secondary intention.
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Affiliation(s)
- Pasquale Fino
- Department of Dermatology and Plastic, Reconstructive and Aesthetic Surgery, La Sapienza University of Rome, Umberto I Polyclinics, Rome, Italy.
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Babina T, Miller L, Thomas B. Leukemia cutis. J Drugs Dermatol 2012; 11:416-417. [PMID: 22395597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Tatyana Babina
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD, USA
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Kim PS, Sheth PB. Asymptomatic cauliflower ears in a 73-year-old man. Diagnosis: Leukemia cutis in the setting of indolent B-cell chronic lymphocytic leukemia (B-CLL). ACTA ACUST UNITED AC 2012; 147:1443, 1448. [PMID: 22184770 DOI: 10.1001/archderm.147.12.1443-a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Sonoi N, Soga Y, Maeda H, Ichimura K, Yoshino T, Aoyama K, Fujii N, Maeda Y, Tanimoto M, Logan R, Raber-Durlacher J, Takashiba S. Histological and immunohistochemical features of gingival enlargement in a patient with AML. Odontology 2011; 100:254-7. [PMID: 22075755 DOI: 10.1007/s10266-011-0051-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 10/30/2011] [Indexed: 11/26/2022]
Abstract
Here, we discuss the pathophysiology of leukemia-associated gingival enlargement based on a case of acute myelomonocytic leukemia (AML-M4) with typical gingival enlargement. Uniquely, this patient was well enough to allow full periodontal examination and incisional gingival biopsy to be performed both before and after chemotherapy. The patient was a 39-year-old Japanese woman with AML-M4 showing gingival enlargement. Histological and immunohistochemical features of gingiva and bacterial counts in the periodontal pockets were examined before and after chemotherapy. The results were as follows: (1) infiltration of myelomonocytic blasts in enlarged gingiva; (2) resolution of gingival enlargement with complete remission of AML by anticancer chemotherapy; and (3) the numbers of bacteria in the periodontal pockets were not high and were not altered before or after chemotherapy. In patients with AML-M4, remarkable mucosal enlargement is not generally observed in the body except in the gingiva. We hypothesized that antigens derived from periodontal bacteria, even if they are not present in large numbers, could act as chemoattractants for myelomonocytic leukemic cells.
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Affiliation(s)
- Norihiro Sonoi
- Department of Patho-physiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Brachtl G, Sahakyan K, Denk U, Girbl T, Alinger B, Hofbauer SW, Neureiter D, Hofbauer JP, Egle A, Greil R, Hartmann TN. Differential bone marrow homing capacity of VLA-4 and CD38 high expressing chronic lymphocytic leukemia cells. PLoS One 2011; 6:e23758. [PMID: 21876768 PMCID: PMC3158106 DOI: 10.1371/journal.pone.0023758] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 07/24/2011] [Indexed: 01/12/2023] Open
Abstract
Background VLA-4 and CD38 predict a poor clinical outcome in chronic lymphocytic leukemia (CLL). We used CLL samples with discordant VLA-4/CD38 risk to address their individual roles in human bone marrow infiltration (BM), CLL cell homing to murine BM, and in supportive CLL cell-stromal cell interactions. Methods VLA-4, CD38, and Ki-67 expression was measured in CLL cells from peripheral blood (PB) and bone marrow (BM) aspirates. CLL BM infiltration rates, routinely determined by Pathology, were correlated to VLA-4 and CD38 expression. Short-term homing capacity of CLL cells was evaluated by adoptive transfer experiments. CLL cell viability and adhesion in stromal cell co-culture was determined. Results About 20% of CLL samples in our cohort displayed discordant VLA-4 and CD38 risk, with either high VLA-4 and low CD38 risk or vice versa. Using particularly such samples, we observed that VLA-4, and not CD38, was responsible for recirculation of CLL cells to murine BM. Human BM infiltration was also significantly higher in patients with high VLA-4 risk but not high CD38 risk. However, both molecules acted as independent prognostic markers. While both VLA-4 and CD38 expression were increased in BM-derived CLL cells, and VLA-4+ and CD38+ subpopulations showed enriched Ki-67 expression, VLA-4 did not contribute to CLL cell protection by stromal cells in vitro. Conclusions Our data argue for a prominent role of VLA-4 but not CD38 expression in the homing of CLL cells to BM niches and in human BM infiltration,but only a limited role in their protection by stromal cells.
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Affiliation(s)
- Gabriele Brachtl
- Laboratory for Immunological and Molecular Cancer Research, Third Medical Department with Hematology, Oncology, Hemostaseology, Infectiology and Rheumatology, Private Medical University Hospital, Salzburg, Austria
| | - Karine Sahakyan
- Laboratory for Immunological and Molecular Cancer Research, Third Medical Department with Hematology, Oncology, Hemostaseology, Infectiology and Rheumatology, Private Medical University Hospital, Salzburg, Austria
| | - Ursula Denk
- Laboratory for Immunological and Molecular Cancer Research, Third Medical Department with Hematology, Oncology, Hemostaseology, Infectiology and Rheumatology, Private Medical University Hospital, Salzburg, Austria
| | - Tamara Girbl
- Laboratory for Immunological and Molecular Cancer Research, Third Medical Department with Hematology, Oncology, Hemostaseology, Infectiology and Rheumatology, Private Medical University Hospital, Salzburg, Austria
| | - Beate Alinger
- Institute of Pathology, Paracelsus Medical University, Salzburg, Austria
| | - Sebastian W. Hofbauer
- Laboratory for Immunological and Molecular Cancer Research, Third Medical Department with Hematology, Oncology, Hemostaseology, Infectiology and Rheumatology, Private Medical University Hospital, Salzburg, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University, Salzburg, Austria
| | - Josefina Piñón Hofbauer
- Laboratory for Immunological and Molecular Cancer Research, Third Medical Department with Hematology, Oncology, Hemostaseology, Infectiology and Rheumatology, Private Medical University Hospital, Salzburg, Austria
| | - Alexander Egle
- Laboratory for Immunological and Molecular Cancer Research, Third Medical Department with Hematology, Oncology, Hemostaseology, Infectiology and Rheumatology, Private Medical University Hospital, Salzburg, Austria
| | - Richard Greil
- Laboratory for Immunological and Molecular Cancer Research, Third Medical Department with Hematology, Oncology, Hemostaseology, Infectiology and Rheumatology, Private Medical University Hospital, Salzburg, Austria
| | - Tanja Nicole Hartmann
- Laboratory for Immunological and Molecular Cancer Research, Third Medical Department with Hematology, Oncology, Hemostaseology, Infectiology and Rheumatology, Private Medical University Hospital, Salzburg, Austria
- * E-mail:
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Pastorczak A, Stolarska M, Trelińska J, Zawitkowska J, Kowalczyk J, Mlynarski W. Nijmegen breakage syndrome (NBS) as a risk factor for CNS involvement in childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2011; 57:160-2. [PMID: 21557461 DOI: 10.1002/pbc.23073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 01/13/2011] [Indexed: 11/07/2022]
Abstract
Central nervous system (CNS) involvement is an independent risk factor for poor event-free survival and relapse confined to the CNS. Knock-out mice deprived of RAG2, the protein involved in DNA repair, developed leukemic infiltration within leptomeninges. Therefore, we hypothesized that DNA repair deficiencies in humans, such as Nijmegen breakage syndrome (NBS), may constitute a risk factor for CNS dissemination of acute lymphoblastic leukemia (ALL). Having analyzed the incidence of CNS2/CNS3 status at diagnosis of ALL in two independent cohorts from the Polish Pediatric Leukemia/Lymphoma Study Group, we noticed that among children with NBS CNS involvement was significantly frequent.
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Affiliation(s)
- Agata Pastorczak
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland.
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Waller WL, Hughes SR, Boh E. Leukemia cutis masquerading as a chemical burn. J Am Acad Dermatol 2011; 64:1003-4. [PMID: 21496715 DOI: 10.1016/j.jaad.2009.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 12/01/2009] [Accepted: 12/09/2009] [Indexed: 11/19/2022]
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49
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Sotiriou E, Manousari A, Apalla Z, Papagarifallou I, Ioannides D. Aleukaemic congenital leukaemia cutis: a critical primary sign of systemic disease. Acta Derm Venereol 2011; 91:203-4. [PMID: 21103839 DOI: 10.2340/00015555-1005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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50
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Hodel J, Dupuis J, Rahmouni A, Lefaucheur JP, Decq P, Créange A, Authier FJ. Leukemic infiltrative plexopathy: diagnosis and follow-up with diffusion tensor imaging. AJNR Am J Neuroradiol 2011; 32:E35-6. [PMID: 21233232 DOI: 10.3174/ajnr.a2347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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