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Rustogi D, Khare C. Early onset leukemoid reaction in a micro preemie. Pediatr Neonatol 2024; 65:101-102. [PMID: 37739873 DOI: 10.1016/j.pedneo.2023.05.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/22/2023] [Accepted: 05/19/2023] [Indexed: 09/24/2023] Open
Affiliation(s)
- Deepika Rustogi
- Department of Paediatrics & Neonatology, Yashoda Super Speciality Hospital, Kaushambi, Ghaziabad UP, India.
| | - Chetan Khare
- Department of Neonatology, AIIMS Bhopal, Madhya Pradesh, India
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2
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Hawaka H, Shimokaze T, Yokosuka T, Toyoshima K, Saito T, Goto H. Common Blood Test Indices for Predicting Transient Abnormal Myelopoiesis-Related Mortality in Infants with Down Syndrome. TOHOKU J EXP MED 2023; 261:51-56. [PMID: 37344418 DOI: 10.1620/tjem.2023.j051] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Transient abnormal myelopoiesis (TAM) can cause early death in children with Down syndrome, and liver failure is the most common cause of death. The aim of this single-center retrospective study was to identify a quantitative index for predicting TAM-related mortality at the time of diagnosis. Of the 462 children with Down syndrome admitted to our hospital from 1992 to 2021, we studied 12 infants with TAM-related death and 31 survivors who were diagnosed with TAM. In the death and survival groups, the median gestational ages were 34.9 and 37.1 weeks, respectively (p = 0.12). At diagnosis, the white blood cell (WBC) counts were 99.2 and 36.2 × 109/L (p = 0.011), the hemoglobin concentrations were 131 and 159 g/L (p = 0.009), and the serum albumin concentrations were 23 and 31 g/L (p < 0.001), respectively. The areas under the receiver operating characteristic curve for the abilities of the WBC count, hemoglobin, and serum albumin at diagnosis to predict survival were 0.75, 0.76, and 0.85, respectively. The serum albumin concentration threshold of 28 g/L at diagnosis had sensitivity of 0.79 and specificity of 0.82. Gestational age and serum albumin concentration were entered into a logistic regression model. The serum albumin concentration was an independent indicator of TAM-related death (adjusted odds ratio, 0.78; 95% confidence interval, 0.65-0.93; p = 0.005). In conclusion, a low serum albumin concentration at diagnosis may be a good predictor of TAM-related death.
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Affiliation(s)
- Hideyuki Hawaka
- Department of Neonatology, Kanagawa Children's Medical Center
| | | | - Tomoko Yokosuka
- Department of Hematology/Oncology, Kanagawa Children's Medical Center
| | | | - Tomoko Saito
- Department of Neonatology, Kanagawa Children's Medical Center
| | - Hiroaki Goto
- Department of Hematology/Oncology, Kanagawa Children's Medical Center
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3
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van den Akker TA, Liu YC, Liu H, Chapman J, Levine JM, Weinberg OK, Geyer JT. Myeloid Proliferations Associated with Down Syndrome: Clinicopathologic Characteristics of Forty Cases from Five Large Academic Institutions. Pathobiology 2023; 91:89-98. [PMID: 36996802 PMCID: PMC10857798 DOI: 10.1159/000530431] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/28/2023] [Indexed: 04/01/2023] Open
Abstract
INTRODUCTION The incidence of myelodysplastic syndrome and acute myeloid leukemia is significantly increased in children with Down syndrome (DS). Within the revised 2016 WHO edition, these entities are jointly classified as myeloid leukemia associated with DS (ML-DS). Additionally, infants with DS may develop transient abnormal myelopoiesis (TAM) which is histomorphologically similar to ML-DS. While TAM is self-limiting, it is associated with an increased risk of subsequently developing ML-DS. Differentiating TAM and ML-DS is challenging but clinically critical. METHODS We performed a retrospective review of ML-DS and TAM cases collected from five large academic institutions in the USA. We assessed clinical, pathological, immunophenotypical, and molecular features to identify differentiating criteria. RESULTS Forty cases were identified: 28 ML-DS and 12 TAM. Several features were diagnostically distinct, including younger age in TAM (p < 0.05), as well as presentation with clinically significant anemia and thrombocytopenia in ML-DS (p < 0.001). Dyserythropoiesis was unique to ML-DS, as well as structural cytogenetic abnormalities aside from the constitutional trisomy 21. Immunophenotypic characteristics of TAM and ML-DS were indistinguishable, including the aberrant expression of CD7 and CD56 by the myeloid blasts. DISCUSSION The findings of the study confirm marked biological similarities between TAM and ML-DS. At the same time, several significant clinical, morphological, and genetic differences were observed between TAM and ML-DS. The clinical approach and the differential diagnosis between these entities are discussed in detail.
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Affiliation(s)
| | - Yen-Chun Liu
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Huifei Liu
- Department of Pathology, Nationwide Children’s Hospital, Columbus, OH, USA
| | | | | | - Olga K. Weinberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Pathology, Boston Children’s Hospital, Boston, MA, USA
| | - Julia T. Geyer
- Department of Pathology, Weill Cornell Medicine, New York, NY, USA
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4
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Alenchery AJ, Yeaney NK, Chen CB, Talati R, Vogelius E, Tan C, Radhakrishnan K. A rare case of hepatic sinusoidal occlusive syndrome in a premature neonate with trisomy 21. J Neonatal Perinatal Med 2023; 16:735-740. [PMID: 38073401 DOI: 10.3233/npm-230094] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
Trisomy 21 (Down Syndrome) may lead to multiple hematological and hepatobiliary manifestations including the development of transient abnormal myelopoiesis. While many cases resolve, transient abnormal myelopoiesis may lead to significant morbidity and mortality in a small percentage of patients. This condition may present a diagnostic challenge for physicians and currently there is only limited data on effective treatments, particularly with low blast percent transient abnormal myelopoiesis. We present a case of a neonate with trisomy 21 and multiple congenital anomalies who consequently developed hepatic failure with evidence of non-cirrhotic portal hypertension likely due to transient abnormal myelopoiesis. This clinical scenario highlights the need for additional evaluation for transient abnormal myelopoiesis associated hepatic disorder and possibly hepatic sinusoidal occlusive syndrome among trisomy 21 neonates particularly with low blast percentage.
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Affiliation(s)
- A J Alenchery
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Children's, Cleveland, OH, USA
| | - N K Yeaney
- Neonatal Director, Fetal Care Center, Cleveland Clinic Children's, Cleveland, OH, USA
| | - C B Chen
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Children's, Cleveland, OH, USA
| | - R Talati
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - E Vogelius
- Section Head, Pediatric Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - C Tan
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - K Radhakrishnan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Children's, Cleveland, OH, USA
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5
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Wan YY, Miao CL, Liu SB, Zhang T, Luo CH. Epithelioid Inflammatory Myofibroblastic Sarcoma with Leukemoid Reaction. J Coll Physicians Surg Pak 2022; 32:1212-1215. [PMID: 36089724 DOI: 10.29271/jcpsp.2022.09.1212] [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] [Received: 05/22/2020] [Accepted: 11/03/2020] [Indexed: 06/15/2023]
Abstract
Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare and aggressive inflammatory myofibroblastic tumour (IMT) variant. This report identifies the first case of EIMS with leukemoid reaction. This is also the first case in which pancreatic infiltration occurred from the disease onset. A 14-year male patient presented with an 18×18×10 cm mass at the retroperitoneal space and a white blood cell (WBC) count of 85×109/L. The mass and the invaded tissues were surgically removed with tumour-free margins. Histopathology and bone marrow aspiration confirmed the diagnosis of EIMS with leukemoid reaction. The tumour recurred with hepatic and pulmonary metastasis one month after the surgery. WBC count also increased progressively with the tumour recurrence. There is no consensus on the treatment of EIMS. Since ALK rearrangement presents in all the EIMS cases, surgical resection combined with crizotinib or other targeted drugs may improve the prognosis. Key Words: Sarcoma, Soft tissue neoplasms, Leukemoid reaction, Crizotinib.
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Affiliation(s)
- Yuan-Yuan Wan
- Department of Pediatrics, Peking University International Hospital, Beijing, China
| | - Cheng-Li Miao
- Retroperitoneal Tumours Centre, Peking University International Hospital, Beijing, China
| | - Shi-Bo Liu
- Retroperitoneal Tumours Centre, Peking University International Hospital, Beijing, China
| | - Tong Zhang
- Department of Pathology, Peking University International Hospital, Beijing, China
| | - Cheng-Hua Luo
- Retroperitoneal Tumours Centre, Peking University International Hospital, Beijing, China
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6
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Manohar S, Jayakumar N. "TAM"ing of the shrew-challenges in the diagnosis of Neonatal leukemia with Down's syndrome -A case report with literature review. INDIAN J PATHOL MICR 2022; 65:699-701. [PMID: 35900507 DOI: 10.4103/ijpm.ijpm_731_21] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
The latest WHO (2017) classification describes the hematological abnormalities of Down's syndrome as a separate entity under 'Myeloid proliferations associated with Down's syndrome'. It includes Transient Abnormal Myelopoiesis and Myeloid leukemia of Down's syndrome. Here we report a case of a 3 days old neonate with Down's syndrome, presenting with a leukemic blood picture. The baby had icterus, fever and hepatosplenomagaly. Peripheral blood showed megakaryoblasts and giant platelets. A diagnosis of transient abnormal myelopoiesis was made by confirming with karyotyping and immunophenotyping. We attempt to address all the diagnostic challenges faced by a clinician and pathologist same, upon encountering such a case,by following an algorithmic approach. The mandatory need for follow up and cytogenetic studies in identifying high risk cases that will become myeloid leukemia of Down's syndrome are stressed. Our case also throws light upon the significance of identification of GATA1 mutation in diagnosing and prognostication of such cases.
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Affiliation(s)
- Srijanaki Manohar
- Department of Pathology, Government Sivagangai Medical College, Sivagangai, Tamil Nadu, India
| | - Niveditha Jayakumar
- Department of Pathology, Government Sivagangai Medical College, Sivagangai, Tamil Nadu, India
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7
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Tarur SU, Prasanna S. Undifferentiated Nasopharyngeal Carcinoma and Paraneoplastic Leukemoid Reaction. Indian Pediatr 2021; 58:188-189. [PMID: 33632959] [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: 06/12/2023]
Affiliation(s)
| | - Sudhakar Prasanna
- Institute of Child Health and Hospital for Children, Madras Medical College, Chennai, India
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8
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Labuhn M, Perkins K, Matzk S, Varghese L, Garnett C, Papaemmanuil E, Metzner M, Kennedy A, Amstislavskiy V, Risch T, Bhayadia R, Samulowski D, Hernandez DC, Stoilova B, Iotchkova V, Oppermann U, Scheer C, Yoshida K, Schwarzer A, Taub JW, Crispino JD, Weiss MJ, Hayashi Y, Taga T, Ito E, Ogawa S, Reinhardt D, Yaspo ML, Campbell PJ, Roberts I, Constantinescu SN, Vyas P, Heckl D, Klusmann JH. Mechanisms of Progression of Myeloid Preleukemia to Transformed Myeloid Leukemia in Children with Down Syndrome. Cancer Cell 2019; 36:123-138.e10. [PMID: 31303423 PMCID: PMC6863161 DOI: 10.1016/j.ccell.2019.06.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/07/2019] [Accepted: 06/11/2019] [Indexed: 12/22/2022]
Abstract
Myeloid leukemia in Down syndrome (ML-DS) clonally evolves from transient abnormal myelopoiesis (TAM), a preleukemic condition in DS newborns. To define mechanisms of leukemic transformation, we combined exome and targeted resequencing of 111 TAM and 141 ML-DS samples with functional analyses. TAM requires trisomy 21 and truncating mutations in GATA1; additional TAM variants are usually not pathogenic. By contrast, in ML-DS, clonal and subclonal variants are functionally required. We identified a recurrent and oncogenic hotspot gain-of-function mutation in myeloid cytokine receptor CSF2RB. By a multiplex CRISPR/Cas9 screen in an in vivo murine TAM model, we tested loss-of-function of 22 recurrently mutated ML-DS genes. Loss of 18 different genes produced leukemias that phenotypically, genetically, and transcriptionally mirrored ML-DS.
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MESH Headings
- Animals
- Biomarkers, Tumor/genetics
- Cell Transformation, Neoplastic/genetics
- Chromosomes, Human, Pair 21
- Cytokine Receptor Common beta Subunit/genetics
- Disease Models, Animal
- Disease Progression
- Down Syndrome/diagnosis
- Down Syndrome/genetics
- GATA1 Transcription Factor/genetics
- GATA1 Transcription Factor/metabolism
- Gene Expression Regulation, Leukemic
- Genetic Predisposition to Disease
- HEK293 Cells
- Humans
- Leukemia, Myeloid/diagnosis
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/pathology
- Leukemoid Reaction/diagnosis
- Leukemoid Reaction/genetics
- Mice, Inbred C57BL
- Mice, Inbred NOD
- Mice, Transgenic
- Mutation
- Phenotype
- Transcription, Genetic
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Affiliation(s)
- Maurice Labuhn
- Pediatric Hematology and Oncology, Hannover Medical School, 30625 Hannover, Germany
| | - Kelly Perkins
- MRC MHU, BRC Hematology Theme, Oxford Biomedical Research Centre, Oxford Centre for Haematology, WIMM, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Sören Matzk
- Pediatric Hematology and Oncology, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany; Max Planck Institute for Molecular Genetics, 14195 Berlin, Germany
| | - Leila Varghese
- Ludwig Institute for Cancer Research Brussels Branch, 1200 Brussels, Belgium
| | - Catherine Garnett
- MRC MHU, BRC Hematology Theme, Oxford Biomedical Research Centre, Oxford Centre for Haematology, WIMM, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Elli Papaemmanuil
- Departments of Epidemiology and Biostatistics and Cancer Biology, MSKCC, New York, NY 10065, USA
| | - Marlen Metzner
- MRC MHU, BRC Hematology Theme, Oxford Biomedical Research Centre, Oxford Centre for Haematology, WIMM, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Alison Kennedy
- MRC MHU, BRC Hematology Theme, Oxford Biomedical Research Centre, Oxford Centre for Haematology, WIMM, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | | | - Thomas Risch
- Max Planck Institute for Molecular Genetics, 14195 Berlin, Germany
| | - Raj Bhayadia
- Pediatric Hematology and Oncology, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany
| | - David Samulowski
- Pediatric Hematology and Oncology, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany
| | - David Cruz Hernandez
- MRC MHU, BRC Hematology Theme, Oxford Biomedical Research Centre, Oxford Centre for Haematology, WIMM, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Bilyana Stoilova
- MRC MHU, BRC Hematology Theme, Oxford Biomedical Research Centre, Oxford Centre for Haematology, WIMM, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Valentina Iotchkova
- MRC MHU, BRC Hematology Theme, Oxford Biomedical Research Centre, Oxford Centre for Haematology, WIMM, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Udo Oppermann
- Botnar Research Centre, NDORMS, Oxford NIHR BRC and Structural Genomics Consortium, UK University of Oxford, Oxford OX3 7LD, UK
| | - Carina Scheer
- Pediatric Hematology and Oncology, Hannover Medical School, 30625 Hannover, Germany
| | - Kenichi Yoshida
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8315 Japan
| | - Adrian Schwarzer
- Pediatric Hematology and Oncology, Hannover Medical School, 30625 Hannover, Germany
| | - Jeffrey W Taub
- Division of Pediatric Hematology/Oncology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - John D Crispino
- Division of Hematology/Oncology, Northwestern University, Chicago, IL 60611, USA
| | - Mitchell J Weiss
- Hematology Department, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Yasuhide Hayashi
- Institute of Physiology and Medicine, Jobu University, Takasaki-shi, Gunma 370-0033, Japan
| | - Takashi Taga
- Department of Pediatrics, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Etsuro Ito
- Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8315 Japan; Center for Hematology and Regenerative Medicine, Karolinska Institute, 171 77 Stockholm, Sweden
| | - Dirk Reinhardt
- Pediatric Hematology and Oncology, Pediatrics III, University Hospital Essen, 45122 Essen, Germany
| | | | - Peter J Campbell
- Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
| | - Irene Roberts
- MRC MHU, BRC Hematology Theme, Oxford Biomedical Research Centre, Oxford Centre for Haematology, WIMM, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK; Department of Paediatrics, University of Oxford, Oxford OX3 9DS, UK
| | | | - Paresh Vyas
- MRC MHU, BRC Hematology Theme, Oxford Biomedical Research Centre, Oxford Centre for Haematology, WIMM, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK; Department of Haematology, Oxford University Hospitals NHS Trust, Oxford OX3 7LE, UK.
| | - Dirk Heckl
- Pediatric Hematology and Oncology, Hannover Medical School, 30625 Hannover, Germany; Pediatric Hematology and Oncology, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany.
| | - Jan-Henning Klusmann
- Pediatric Hematology and Oncology, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany.
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9
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Abstract
INTRODUCTION Childhood immune thrombocytopenia (ITP) remains a diagnosis of exclusion when isolated thrombocytopenia is not part of another disease process. In practice, the diagnosis of ITP can only be confirmed when thrombocytopenia resolves or is excluded after the recognition of a primary cause. METHODS The records of 87 consecutive children with isolated thrombocytopenia seen over a nine-year period in a private paediatric haematology practice were reviewed retrospectively. Children in whom a primary cause was eventually found were the subjects of a further descriptive study. RESULTS 9 (10%) children with isolated thrombocytopenia were not diagnosed with ITP because a primary disease was found. Of these nine cases, four had thrombocytopenia recognised during the neonatal period, consisting of perinatal cytomegalovirus infection (n = 2), meconium aspiration pneumonia (n = 1) and transient abnormal myelopoiesis associated with Down syndrome (n = 1). The remaining five children were each found to have familial thrombocytopenia, portal hypertension, cutaneous mastocytosis, May-Hegglin anomaly and systemic lupus erythematosus. Two of them had a history of failure of response to corticosteroid therapy. CONCLUSION Secondary thrombocytopenia is not uncommon in a tertiary paediatric specialty practice with adequate evaluation. Thrombocytopenia occurring during the newborn period and failure of steroid therapy are predictive of secondary cases.
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MESH Headings
- Adolescent
- Child
- Child, Preschool
- Cytomegalovirus Infections/complications
- Cytomegalovirus Infections/diagnosis
- Diagnosis, Differential
- Down Syndrome/complications
- Down Syndrome/diagnosis
- Hearing Loss, Sensorineural/complications
- Hearing Loss, Sensorineural/diagnosis
- Hematology
- Humans
- Hypertension, Portal/complications
- Hypertension, Portal/diagnosis
- Infant
- Infant, Newborn
- Leukemoid Reaction/complications
- Leukemoid Reaction/diagnosis
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/diagnosis
- Mastocytosis, Cutaneous/complications
- Mastocytosis, Cutaneous/diagnosis
- Meconium Aspiration Syndrome/complications
- Meconium Aspiration Syndrome/diagnosis
- Pneumonia/complications
- Pneumonia/diagnosis
- Purpura, Thrombocytopenic, Idiopathic/diagnosis
- Purpura, Thrombocytopenic, Idiopathic/etiology
- Retrospective Studies
- Thrombocytopenia/complications
- Thrombocytopenia/congenital
- Thrombocytopenia/diagnosis
- Thrombocytopenia/etiology
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Affiliation(s)
- Anselm Chi-wai Lee
- Correspondence: Dr Anselm Lee, Senior Consultant, Children’s Haematology and Cancer Centre, Mount Elizabeth Hospital, Level 4, 3 Mount Elizabeth, Singapore 228510.
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10
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Lee WY, Weinberg OK, Evans AG, Pinkus GS. Loss of Full-Length GATA1 Expression in Megakaryocytes Is a Sensitive and Specific Immunohistochemical Marker for the Diagnosis of Myeloid Proliferative Disorder Related to Down Syndrome. Am J Clin Pathol 2018; 149:300-309. [PMID: 29481579 PMCID: PMC5848381 DOI: 10.1093/ajcp/aqy001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 12/18/2022] Open
Abstract
OBJECTIVES Myeloid proliferative disorders associated with Down syndrome (MPD-DS), including transient abnormal myelopoiesis and myeloid leukemia associated with Down syndrome (DS), harbor mutations of GATA1, a transcription factor essential for erythroid and megakaryocytic development. These mutations result in a N-terminally truncated GATA1 (GATA1s) and prohibit the production of the full-length GATA1 (GATA1f). Here, we demonstrate the utility of immunohistochemical GATA1f reactivity in diagnosing MPD-DS. METHODS Immunohistochemical studies for GATA1f expression were performed on bone marrow biopsy specimens. RESULTS In all cases of MPD-DS, megakaryocytes lacked GATA1f expression. In contrast, GATA1f expression was detected in megakaryocytes in all specimen types from patients without DS (normal bone marrows, pediatric myelodysplastic syndrome, juvenile myelomonocytic leukemia, adult acute megakaryocytic leukemia [pediatric and adult; without trisomy 2]), as well as normal bone marrows from patients with DS. CONCLUSIONS The lack of GATA1f expression is a sensitive and specific immunohistochemical marker for MPD-DS.
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Affiliation(s)
- Winston Y Lee
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Olga K Weinberg
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Department of Pathology, Boston Children’s Hospital, Boston, MA
| | - Andrew G Evans
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Geraldine S Pinkus
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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11
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Affiliation(s)
- Piali Mandal
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India.
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12
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Zhang Y. [Alcoholic liver cirrhosis combined leukemoid reaction: a case report]. Zhonghua Gan Zang Bing Za Zhi 2016; 24:312. [PMID: 27470634 DOI: 10.3760/cma.j.issn.1007-3418.2016.04.015] [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: 06/06/2023]
Affiliation(s)
- Y Zhang
- No.3 People's Hospital in Taiyuan City, Taiyuan 030012, China
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13
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Yamaguchi H, Kosugiyama K, Honda S, Tadao O, Taketomi A, Iwata S. Down Syndrome with Patent Ductus Venosus and Hepato-Biliary-Pancreatic Abnormalities. Indian J Pediatr 2016; 83:78-80. [PMID: 26096864 DOI: 10.1007/s12098-015-1797-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 05/18/2015] [Indexed: 11/27/2022]
Abstract
The association between Down syndrome and congenital portosystemic shunts, most commonly caused by patent ductus venosus, remains relatively unknown. The authors present a girl with Down syndrome with patent ductus venosus, pancreaticobiliary maljunction and paucity of interlobular bile ducts, presenting with neonatal cholestasis and transient abnormal myeloproliferative disorder. To the best of authors' knowledge, no report of the concurrent presence of the above in Down syndrome has been published.
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Affiliation(s)
- Hiroshi Yamaguchi
- Department of Pediatrics, Teine Keijinkai Hospital, 1 Jo 12-1-40, Maeda, Teine-ku, Sapporo, Japan.
| | - Kiyotaka Kosugiyama
- Department of Pediatrics, Teine Keijinkai Hospital, 1 Jo 12-1-40, Maeda, Teine-ku, Sapporo, Japan
| | - Shohei Honda
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Japan
| | - Okada Tadao
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Japan
| | - Seido Iwata
- Department of Pediatrics, Teine Keijinkai Hospital, 1 Jo 12-1-40, Maeda, Teine-ku, Sapporo, Japan
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14
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Saldir M, Polat A, Babacan O, Keskin U, Gursel O, Gulgun M, Zeybek C, Tunc T. A Newborn with Down Syndrome, Developing Hydrops Fetalis Due to Transient Myeloproliferative Disorder and Liver Hamartoma. Genet Couns 2016; 27:243-246. [PMID: 29485829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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15
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Abstract
Transient myeloproliferative disorder (TMD) is a unique form of acute megakaryocytic leukemia (AMKL) that spontaneously regresses and is found in 3% to 10% of neonates with Down syndrome (DS). We report the case of a neonate with DS who presented with a widespread vesiculopustular eruption as an initial sign of TMD. Complete blood count was normal but peripheral smear revealed circulating megakaryoblasts. The severity of skin lesions correlated with the blast count. By age 2 months the TMD resolved and the patient remains disease-free after 18 months of follow-up. Several important features of TMD are highlighted: skin findings may provide an important clinical clue to TMD diagnosis; manual review of the peripheral smear is necessary when TMD is suspected; and patients with a history of TMD have a very high (∼30%) risk of recurrence with a persistent AMKL within the first 3 years of life.
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16
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Rozen L, Huybrechts S, Dedeken L, Heijmans C, Dessars B, Heimann P, Lambert F, Noubouossie DF, Ferster A, Demulder A. Transient leukemia in a newborn without Down syndrome: case report and review of the literature. Eur J Pediatr 2014; 173:1643-7. [PMID: 24253371 DOI: 10.1007/s00431-013-2163-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 07/04/2013] [Accepted: 09/18/2013] [Indexed: 12/20/2022]
Abstract
UNLABELLED Transient neonatal leukemia occurs almost exclusively in Down syndrome babies. We report here the unusual case of a newborn without Down syndrome who presented neonatal transient leukemia and who achieved spontaneously complete remission. Trisomy 21 and GATA1 mutation were both present in leukemic cells. While close follow-up is advised since true leukemia may develop later, the patient is still in remission for 2.5 years. We performed a literature review of 15 other similar cases. CONCLUSION Our case of transient leukemia without Down syndrome and the literature review highlight the important role of trisomy 21 and GATA1 mutation in the development of transient neonatal leukemia.
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Affiliation(s)
- Laurence Rozen
- Laboratory of Hematology and Haemostasis, CHU-Brugmann, Université Libre de Bruxelles (ULB), Place Van Gehuchten 4, 1020, Brussels, Belgium,
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17
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Ito E. [Abnormal hematopoiesis in Down syndrome]. Rinsho Ketsueki 2014; 55:1738-1747. [PMID: 25297735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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18
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Kuş AB, Şahin P, Uğuz AH, Tanyeli A, Küpeli S. Leukemoid reaction associated with pediatric nasopharyngeal carcinoma: An unusual presentation. Int J Pediatr Otorhinolaryngol 2014; 78:885-7. [PMID: 24646685 DOI: 10.1016/j.ijporl.2014.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/06/2014] [Accepted: 02/07/2014] [Indexed: 02/07/2023]
Abstract
Nasopharyngeal carcinoma is a tumor originating from the surface epithelial cells of nasopharynx. It is rare in children and adolescents. Most common physical finding is a neck mass. Most children with nasopharyngeal carcinoma present with advanced stage disease. The presentation with hematological abnormalities in patients without systemic metastasis is extremely rare. We reported a 14-year-old boy presenting with a mass at the right side of the pharynx and leukemoid reaction. To our knowledge, this is the first report of leukemoid reaction associated with pediatric nasopharyngeal carcinoma in English literature.
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Affiliation(s)
- Asiye Burcu Kuş
- Çukurova University, Faculty of Medicine, Department of Pediatrics, Turkey
| | - Poyraz Şahin
- Çukurova University, Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Aysun Hatice Uğuz
- Çukurova University, Faculty of Medicine, Department of Pathology, Turkey
| | - Atila Tanyeli
- Çukurova University, Faculty of Medicine, Department of Pediatric Oncology/Pediatric BMT Units, Turkey
| | - Serhan Küpeli
- Çukurova University, Faculty of Medicine, Department of Pediatric Oncology/Pediatric BMT Units, Turkey.
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19
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Salagre KD, Sahay RN, Patil A, Joshi A, Shukla A. Leukemoid reaction, a rare manifestation of autoimmune hemolytic anemia in a case of small duct primary sclerosing cholangitis. J Assoc Physicians India 2013; 61:760-762. [PMID: 24772740] [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: 06/03/2023]
Abstract
A 48 year old lady presented with jaundice and exertional breathlesness. Her laboratory reports showed anaemia, reticulocytosis, leucocytosis, elevated Lactate Dehydrogenase (LDH), alkaline phosphatase levels, hyperbillirubinemia and positive direct Coomb's test. After ruling out all the other causes of autoimmunity and hemolytic anemia, she was diagnosed as leukemoid reaction due to autoimmune hemolytic anemia with primary sclerosing cholangitis. Patient showed immediate improvement after corticosteroids.
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MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Anemia, Hemolytic, Autoimmune/complications
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/drug therapy
- Cholangitis, Sclerosing/complications
- Cholangitis, Sclerosing/diagnosis
- Cholangitis, Sclerosing/drug therapy
- Diagnosis, Differential
- Female
- Humans
- Leukemoid Reaction/diagnosis
- Leukemoid Reaction/drug therapy
- Leukemoid Reaction/etiology
- Middle Aged
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20
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Eshel E, Sharabi-Nov A, Dally N. Leukocyte alkaline phosphatase (LAP) by flow cytometry. MLO Med Lab Obs 2013; 45:22-26. [PMID: 24205536] [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]
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21
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Raby S, Greaves D, Padayatty J, Huntly B. An unexpected finding after a fall from a horse. BMJ 2013; 346:f724. [PMID: 23403830 DOI: 10.1136/bmj.f724] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sophie Raby
- Haematology Department, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
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22
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Ma X, Li G, Cai Z, Sun W, Liu J, Zhang F. Leukemoid reaction in malignant bone tumor patients - a retrospective, single-institution study. Eur Rev Med Pharmacol Sci 2012; 16:1895-1899. [PMID: 23242713] [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: 06/01/2023]
Abstract
BACKGROUND To the Authors' knowledge, the literature regarding leukemoid reaction in patients with malignant bone tumor is sparse, and most of patients with leukemoid reaction have poor prognosis. AIM To study the leukemoid reaction in malignant bone tumor patients. MATERIALS AND METHODS A total of 105 consecutive malignant bone tumor patients with a white blood cell count > 50,000/microL were retrospectively identified over a 4-years period (2007-2010). Those patients without a secondary cause of their leukocytosis were defined as having a paraneoplastic leukemoid reaction. RESULTS Three etiologies of the leukocytosis were found in those 105 patients: the major one was paraneoplastic leukemoid reaction which accounted for 56%; the second one was hematopoietic growth factors defect accounting for 30%; 14% patients were caused by infection and Tumor bone marrow involvement. The patients diagnosed with a paraneoplastic leukemoid reaction typically had neutrophil predominance (94.8%) and radiographic evidence of metastatic diseases (78%). They were clinically stable, but had a poor prognosis. 95% either died or were discharged to hospice within 12 weeks of their initial extreme leukocyte count. Both of the 2 (2%) patients who survived over 12 weeks received effective antineoplastic therapy. CONCLUSIONS Patients with typical paraneoplastic leukemoid reaction were clinically stable despite having large tumor burdens. However, clinical outcomes were poor unless receiving an effective antineoplastic treatment.
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Affiliation(s)
- X Ma
- Department of Orthopedics, Tongji University School of Medicine, Shanghai, China
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23
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Abstract
The Pelger-Huët anomaly (PHA) is a recognized morphologic variant affecting all granulocytes but is most evident in polymorphonuclear neutrophils (PMNs). PHA is caused by a decreased amount of the lamin B receptor (LBR). Recognition of PHA morphologic features serves as a marker for mutations in the LBR gene. This review summarizes the history of PHA and the current knowledge of the functions of the LBR. Guidance is given for distinguishing PHA from other hematologic disorders in which granulocytes may show similar changes. Recognition of PHA in the laboratory should prompt communication to the patient's physician about the possible clinical significance of this finding and the recommended screening for the anomaly in other family members by CBC and review of a peripheral blood smear.
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Affiliation(s)
- Rita Colella
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY 40292, USA
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24
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Granger JM, Kontoyiannis DP. Etiology and outcome of extreme leukocytosis in 758 nonhematologic cancer patients: a retrospective, single-institution study. Cancer 2009; 115:3919-23. [PMID: 19551882 DOI: 10.1002/cncr.24480] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [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: 01/09/2023]
Abstract
BACKGROUND To the authors' knowledge, the literature regarding extreme leukocytosis in solid tumor patients is sparse, consisting of a few case reports and small case series. METHODS A total of 3770 consecutive solid tumor patients with a white blood cell count>40,000/microL were retrospectively identified over a 3-year period (2005-2008). Those patients without a secondary cause of their leukocytosis were defined as having a paraneoplastic leukemoid reaction. RESULTS A total of 758 (20%) patients with solid tumors and extreme leukocytosis were identified. The etiology of the leukocytosis was hematopoietic growth factors in 522 (69%) patients, infection in 112 (15%) patients, high-dose corticosteroids in 38 (5%) patients, newly diagnosed leukemia in 9 (1%) patients, and paraneoplastic leukemoid reaction in 77 (10%) patients. The patients diagnosed with a paraneoplastic leukemoid reaction typically had neutrophil predominance (96%) and radiographic evidence of metastatic disease (78%), were clinically stable, and had a poor prognosis; 78% either died or were discharged to hospice within 12 weeks of their initial extreme leukocyte count. All of the 8 (10%) patients who survived>1 year received effective antineoplastic therapy. CONCLUSIONS Infection was an uncommon cause of extreme leukocytosis in patients with solid tumors. Patients with paraneoplastic leukemoid reactions typically were clinically stable despite having large tumor burdens. However, clinical outcomes were poor unless effective antineoplastic treatment was received.
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Affiliation(s)
- John M Granger
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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25
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Boşoteanu C, Boşoteanu M, Aşchie M. Differential diagnosis issues in a case of gastric carcinoma associated with leukemoid reaction. Rom J Morphol Embryol 2009; 50:701-705. [PMID: 19942969] [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: 05/28/2023]
Abstract
Gastric tumors share many characteristics, making a definitive diagnosis challenging. Gastric adenocarcinomas represent 90% of malignant stomach tumors, meanwhile the frequency of gastric lymphoma range between 1-5% of all gastric cancers. Gastric carcinoma bears resemblance with particular forms of non-Hodgkin's lymphoma of the stomach, not only in morphological presentation, but also in clinical configuration and laboratory tests. We report a case of gastric carcinoma with abnormal hematological picture dominated by leukemoid reaction and peculiar histopathological aspect. Pleomorphism of neoplastic cells and distinct arrangement of these give rise to the need of differentiation between a carcinoma and a non-Hodgkin's lymphoma of the stomach. On immnohistochemical grounds, we succeeded in our action of segregation between the two lesional entities and we establish as definitive diagnosis that of poorly differentiated gastric adenocarcinoma. Additionally, leukemoid reaction proved to be a manifestation of a bone marrow metastasis from gastric cancer.
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Affiliation(s)
- C Boşoteanu
- Service of Pathology, Emergency County Hospital, Constanta, Romania.
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26
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Tilak V, Rai M, Singh VP, Rai AK, Raman R. Hepatocellular carcinoma presenting as neutrophilic leukaemoid reaction--a rare entity. J Indian Med Assoc 2007; 105:462-465. [PMID: 18236911] [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: 05/25/2023]
Abstract
Leukaemoid reaction is a rare, growth factor-driven, paraneoplastic manifestation of hepatocellular carcinoma. It may masquerade as the neutrophilic chronic myeloid leukaemia or as chronic neutrophilic leukaemia. A 52-year-old male presented with hepatosplenomegaly and severe leucocytosis. He had progressive leucocytosis, neutrophil alkaline phosphatase score elevated, liver function tests altered. FNAC from the mass in the liver revealed features of moderately differentiated hepatocellular carcinoma. The patient deteriorated within two weeks and died thereafter.
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Affiliation(s)
- Vijai Tilak
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005
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27
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Liu HC, Chen SH, Wang LY, Yeh TC, Chai IJ, Liang DC. In vitro cell growth stimulated by recombinant human cytokines can help to diagnose transient leukemia in neonates. J Formos Med Assoc 2007; 106:365-71. [PMID: 17561471 DOI: 10.1016/s0929-6646(09)60321-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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] Open
Abstract
BACKGROUND/PURPOSE In a previous study, we demonstrated that in vitro cell growth stimulated by human placental conditioned medium distinguished between transient leukemia (TL) and congenital acute myeloid leukemia (AML) in neonates. We then sought to determine whether the application can be expanded if in vitro cell growths are stimulated by recombinant human cytokines including granulocyte-macrophage colony-stimulating factor (rhGM-CSF), interleukin-3 (rhIL-3), stem cell factor (rhSCF) and thrombopoietin (rhTPO). METHODS Eight neonates with features indistinguishable from AML were studied. Seven patients had Down syndrome and the eighth a normal phenotype. Bone marrow or peripheral blood mononuclear cells (MNC) were cultured in the presence of rhGM-CSF+rhIL-3+rhSCF or of rhTPO alone. After incubation, granulocyte-macrophage colony-forming units (CFU-GM)-derived colonies and clusters were scored on an inverted microscope. Colony-forming units-megakaryocyte (CFU-MK)-derived colonies were counted with an in situ CD61 immunostained dish. Liquid suspension cultures of MNC were stimulated by rhGM-CSF and/or rhTPO. RESULTS CFU-GM-derived colonies and clusters from bone marrow and peripheral blood MNC revealed normal patterns in seven patients. RhTPO-stimulated megakaryocyte colony formation was normal in one patient. Cytospin smears of liquid suspension cultures all showed good myeloid or megakaryocytic maturation consistent with TL rather than AML. One neonate died on the 2nd day of life, but in the seven remaining patients, blasts disappeared from the peripheral blood within 10 months. Among four patients followed long-term, one developed myelodysplastic syndrome at 21 months. This child was given tailored chemotherapy and had a disease-free survival>20 months. CONCLUSION In vitro cell growth stimulated by recombinant human cytokines can help to diagnose TL in neonates.
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Affiliation(s)
- Hsi-Che Liu
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Memorial Hospital, and Mackay Medicine, Nursing and Management College, Taipei, Taiwan
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28
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Kanegae MP, Ximenes VF, Falcão RP, Colturato VA, de Mattos ÉR, Brunetti IL, da Fonseca LM. Chemiluminescent determination of leukocyte alkaline phosphatase: an advantageous alternative to the cytochemical assay. J Clin Lab Anal 2007; 21:91-6. [PMID: 17385676 PMCID: PMC6649205 DOI: 10.1002/jcla.20140] [Citation(s) in RCA: 5] [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] [Indexed: 11/07/2022] Open
Abstract
The determination of leukocyte alkaline phosphatase (LAP) is used as an aid to diagnose many diseases in the laboratory. For example, it can be used to distinguish chronic myeloid leukemia (CML) from other myeloproliferative disorders (particularly myelofibrosis and polycythemia) and leukemoid reactions (LR). Traditionally, this test is performed with the use of subjective cytochemical assays that assign a score to the level of LAP. Here we present a nonsubjective, quantitative, sensitive, and inexpensive chemiluminescent technique that determines LAP based on the commercial reagent Immulite (AMPPD). To validate this methodology, intact leukocytes obtained from 32 healthy subjects, nine CML patients, and nine LR patients were submitted to the optimized protocol. By measuring the light emission elicited by four concentrations of neutrophils, we were able to estimate the activity of LAP per cell (the slope of the curve obtained by linear regression). A high linear correlation was found between the chemiluminescent result (slope) and the cytochemical score. The slope for healthy individuals ranged between 0.61 and 8.49 (10(-5) mV.s/cell), with a median of 2.04 (10(-5) mV.s/cell). These results were statistically different from those of CML patients (range=0.07-1.75, median=0.79) and LR patients (range= 3.84-47.24, median=9.58; P<0.05).
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Affiliation(s)
- Marília P.P. Kanegae
- Departamento de Análises Clínicas, Faculdade de Ciências Farmacêuticas, Universidade Estadual Paulista, Araraquara, Brasil
| | - Valdecir F. Ximenes
- Departamento de Química, Faculdade de Ciências, Universidade Estadual Paulista, Bauru, Brasil
| | - Roberto P. Falcão
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
| | | | | | - Iguatemy L. Brunetti
- Departamento de Análises Clínicas, Faculdade de Ciências Farmacêuticas, Universidade Estadual Paulista, Araraquara, Brasil
| | - Luiz Marcos da Fonseca
- Departamento de Análises Clínicas, Faculdade de Ciências Farmacêuticas, Universidade Estadual Paulista, Araraquara, Brasil
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29
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Dhanya NB, Shanmuga Sundaram V, Rai R, Surendran P, Kumar PN, Matthai J, Srinivas CR. Dapsone syndrome with leukemoid reaction. Indian J Lepr 2006; 78:359-63. [PMID: 17402348] [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: 05/14/2023]
Affiliation(s)
- N B Dhanya
- Department of Dermatology, Venereology and Leprology, PSG Hospitals, Peelamedu, Coimbatore 641 004, Tamil Nadu, India
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30
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Abstract
Renal inflammatory malignant fibrous histiocytoma (MFH) is an extremely rare lesion and is a great masquerader of common benign renal inflammatory lesions, especially xanthogranulomatous pyelonephritis (XGPN). The clinical presentation of mass with fever and peripheral leucocytosis (marked at times), and marked inflammatory, predominantly neutrophilic, infiltrate obscuring the malignant cells on histopathology, can lead to delay in the diagnosis of this poor prognostic malignant tumor. We present the case of a patient who underwent radical nephrectomy with a clinical diagnosis of renal malignancy, but histopathology showing XGPN. The patient showed an initial clinical response, only to recur two times, ultimately leading to a histological and immunohistochemical diagnosis of inflammatory MFH. The diagnosis, histology, therapeutic options and prognosis of this rare lesion are discussed.
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Affiliation(s)
- Shrawan K Singh
- Department of Urology, Postgraduate Instiute of Medical Education and Research, Chandigarh, India.
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31
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Mukhopadhyay S, Mukhopadhyay S, Banki K, Mahajan S. Leukemoid reaction: a diagnostic clue in metastatic carcinoma mimicking classic Hodgkin lymphoma. Arch Pathol Lab Med 2005; 128:1445-7. [PMID: 15578894 DOI: 10.5858/2004-128-1445-lradci] [Citation(s) in RCA: 5] [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] [Indexed: 11/06/2022]
Abstract
We report on 2 patients who were initially suspected to have classic Hodgkin lymphoma because of lymphadenopathy and the presence of Reed-Sternberg-like cells. Both patients had an associated leukemoid reaction (using a threshold leukocyte count of 50 000/microL) and were eventually diagnosed with metastatic carcinoma. Disseminated carcinoma can mimic Hodgkin lymphoma clinically, radiologically, and histologically. Reed-Sternberg-like cells may be found in carcinomas, and they represent a particularly challenging diagnostic pitfall for the unwary. When these cells lead to a suspicion of Hodgkin lymphoma, the presence of a leukemoid reaction should prompt the pathologist to question the diagnosis. Misdiagnosis can be avoided by the use of cytokeratin whenever a leukemoid reaction is present in a suspected case of Hodgkin lymphoma.
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Affiliation(s)
- Sanjay Mukhopadhyay
- Department of Pathology, State University of New York Upstate Medical University, Syracuse 13210, USA.
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32
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Ho MHK, Ha SY, Chan GCF, Ma ESK. Leukemia or leukemoid, Down syndrome or not? Haematologica 2004; 89:ECR33. [PMID: 15377485] [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: 04/30/2023] Open
Affiliation(s)
- Marco H K Ho
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong.
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33
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Sai P, Kalavar M, Raval M, Sipot CR, Steier W. A case of chronic neutrophilic leukemia with novel chromosomal abnormalities. Clin Adv Hematol Oncol 2004; 2:543-5; discussion 545. [PMID: 16163234] [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: 05/04/2023]
MESH Headings
- Aged
- Aged, 80 and over
- Bone Marrow/pathology
- Chromosome Aberrations
- Chromosome Deletion
- Chromosomes, Human, Pair 12/ultrastructure
- Chromosomes, Human, Pair 18/ultrastructure
- Chromosomes, Human, Pair 3/ultrastructure
- Chromosomes, Human, Pair 4
- Clone Cells/ultrastructure
- Diagnostic Errors
- Erythema/diagnosis
- Erythema/etiology
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Neutrophilic, Chronic/diagnosis
- Leukemia, Neutrophilic, Chronic/genetics
- Leukemoid Reaction/diagnosis
- Leukocyte Count
- Neutrophils/ultrastructure
- Translocation, Genetic
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Affiliation(s)
- Padmaja Sai
- Department of Medicine, Division of Hematology-Oncology, Brookdale Hospital Medical Center, Brooklyn, NY 11212, USA.
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Olipitz W, Strunk D, Beham-Schmid C, Sill H. Neutrophilic leukemoid reaction as the presenting feature of de novo and therapy-related acute leukemias. Acta Haematol 2004; 111:233-4. [PMID: 15153719 DOI: 10.1159/000077574] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 12/16/2003] [Accepted: 12/22/2003] [Indexed: 11/19/2022]
Affiliation(s)
- Werner Olipitz
- Division of Hematology, Department of Medicine, Karl Franzens University, Graz, Austria
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35
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Mañas García MD, Marchán Carranza E, Galiana Gómez del Pulgar J, Ceres Alabau F. [Hepatocarcinoma with leukemoid reaction]. An Med Interna 2004; 21:197-8. [PMID: 15109291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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36
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Egorov IV, Kotina LN. [Differential diagnosis of eosinophilia in combination with intoxication syndrome]. Klin Med (Mosk) 2004; 82:70-2. [PMID: 15468731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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37
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Yang JJ, Chen H, Li Y. [A case clinic analysis of leukemoid reaction]. Zhonghua Er Ke Za Zhi 2003; 41:787-8. [PMID: 14731371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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Abstract
BACKGROUND Chronic neutrophilic leukaemia (CNL) is a rare myeloproliferative disorder of elderly patients characterised by sustained neutrophilia and splenomegaly. The diagnosis of CNL requires the exclusion of BCR/ABL positive chronic myelogenous leukaemia (CML) and of leukaemoid reactions (LRs). The differentiation between CNL and LR is problematic because both conditions share similar morphological features; it is also important because patients with CNL generally have a poor prognosis. AIMS To determine whether CNL and LR could be distinguished on the basis of different clonality patterns. METHODS Blood samples from 52 women were studied using the human androgen receptor gene assay (HUMARA). RESULTS Monoclonality was found in the neutrophils in all 17 patients with different myeloproliferative syndromes (MPSs), including those with CNL. In four of the patients with CNL, autologous T cells were also monoclonal, suggesting that they belonged to the neoplastic clone. This finding was in contrast to other MPSs in which T cells were almost always polyclonal. Of nine patients with clinically suspected LR, the neutrophils of five were polyclonal, whereas three patients had monoclonal neutrophils, suggesting that they might be in the process of developing an MPS. Among 26 healthy blood donors, 20 had polyclonal neutrophils and five showed skewed clonality patterns. One case of LR and one normal blood donor were scored "not informative" at the HUMARA locus. CONCLUSIONS Clonality studies of blood neutrophils using HUMARA aid in distinguishing female patients with monoclonal CNL from those with LR. For the diagnosis of CNL, monoclonality of the neutrophils should be demonstrated whenever possible.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Diagnosis, Differential
- Dosage Compensation, Genetic
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Neutrophilic, Chronic/diagnosis
- Leukemia, Neutrophilic, Chronic/genetics
- Leukemoid Reaction/diagnosis
- Leukemoid Reaction/genetics
- Middle Aged
- Neoplastic Stem Cells/pathology
- Neutrophils/pathology
- Receptors, Androgen/genetics
- Receptors, Androgen/metabolism
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Affiliation(s)
- J Böhm
- Department of Pathology, University of Freiburg, Medical School, D-79002 Freiburg, Germany.
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Ganti AK, Potti A, Mehdi S. Uncommon syndromes and treatment manifestations of malignancy: Case 2. Metastatic non-small-cell lung cancer presenting with leukocytosis. J Clin Oncol 2003; 21:168-70. [PMID: 12506187 DOI: 10.1200/jco.2003.21.1.168] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Apar Kishor Ganti
- Department of Internal Medicine, University of North Dakota School of Medicine, USA
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40
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Zanardo V, Savio V, Giacomin C, Rinaldi A, Marzari F, Chiarelli S. Relationship between neonatal leukemoid reaction and bronchopulmonary dysplasia in low-birth-weight infants: a cross-sectional study. Am J Perinatol 2002; 19:379-86. [PMID: 12442227 DOI: 10.1055/s-2002-35612] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [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: 10/27/2022]
Abstract
Leukemoid reaction in low-birth-weight (LBW) infants is a rare, recently documented phenomenon, implicated in the sequence of multiorgan inflammatory diseases of preterm infants. The aim of the present paper is to establish whether a neonatal leukemoid reaction is related to bronchopulmonary dysplasia (BPD) development in LBW infants. The design was a case-controlled, retrospective study of all premature infants (born </=31 weeks' gestation) admitted to the neonatal intensive care unit (NICU) over a period of 3 years, from January 1998 to December 2000. The infants who developed BPD formed the study group, while the remainder without pulmonary sequelae, matched for gestational age formed the control group. Leukemoid reaction was considered a white blood cell (WBC) count >40,000/mm 3. The relation between BPD occurrence and WBC counts was studied by Bayesian analysis, dividing WBC counts in 5 progressive bands of 10,000 WBC/mm 3, starting from <10,000 to >40,000/mm 3. Five of 50 BPD infants studied demonstrated WBC counts >40,000/mm 3, with an incidence of 10%, while no control preterm infants presented neonatal leukemoid reaction; the estimated number difference is statistically significant ( p <0.001). There was no other significant association demonstrated between maternal or neonatal variables and leukemoid reaction, including chorioamnionitis, sepsis, and the use of antenatal steroids. Our findings provide further data for the identification of prematures exposed to pro-inflammatory cytokines in utero; the injury responsible for BPD in a subset of prematures may begin with a transient leukemoid reaction.
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Au WY, Ma SK, Kwong YL. Disseminated hepatosplenic mycobacterial infection masking myeloproliferative diseases as leukemoid reaction: a diagnostic pitfall. Leuk Lymphoma 2001; 42:805-8. [PMID: 11697512 DOI: 10.3109/10428190109099344] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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: 11/13/2022]
Abstract
The distinction of myeloproliferative disease (MPD) from leukemoid reactions due to reactive causes can be difficult. In the presence of simultaneous occurrence of MPD and an established infection, only the demonstration of a clonal marker or prolonged observation can substantiate the diagnosis. We present three cases of MPD presenting as leukemoid reaction due to disseminated hepatosplenic mycobacterial sepsis. There appeared to be an association between MPD and reduced resistance to mycobacterial infection. Clinicians and hematologist should be aware of such a predisposition and possible dual pathology for proper diagnosis, therapy and monitoring of both the infection and the myeloproliferation.
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Affiliation(s)
- W Y Au
- Department of Medicine, University Department of Medicine, Queen Mary Hospital, Hong Kong.
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42
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Mironova VG, Plakhuta TG, Soskov GI. [Differential diagnosis of leukemoid reaction in pediatric patients]. Klin Lab Diagn 2000:48-9. [PMID: 10878906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
MESH Headings
- Diagnosis, Differential
- Female
- Humans
- Infant
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/physiopathology
- Leukemoid Reaction/diagnosis
- Leukemoid Reaction/pathology
- Leukemoid Reaction/physiopathology
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43
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Le Guen Y, Lebeau B. [Chemically-induced paraneoplastic hyperleukocytic lung]. Rev Mal Respir 1999; 16:1139-41. [PMID: 10637912] [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: 02/15/2023]
Abstract
Dyspnea is the principal clinical feature of pulmonary leukostasis, a syndrome called "poumon hyperleucocytaire" in French. It is a common complication of chronic myeloid leukemia. In the course of pulmonary carcinoma, leukocytosis is frequently noted. One of the etiologies is a paraneoplastic syndrome with production of colony stimulating factor. We report a case of pulmonary hyperleukostasis following antineoplastic chemotherapy for pulmonary carcinoma.
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Affiliation(s)
- Y Le Guen
- Service de Pneumologie, Hôpital Saint-Antoine, Paris
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44
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Singh ZN, Kotwal J, Choudhry VP, Bhargava M. Leukemoid reaction simulating acute promyelocytic leukemia. J Assoc Physicians India 1999; 47:1031-2. [PMID: 10778706] [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: 02/16/2023]
Affiliation(s)
- Z N Singh
- Dept. of Hematology, All India Institute of Medical Sciences, New Delhi
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45
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De Vega Santos T, Méndez Batán MA, Pérez Rojo A, Romón Alonso I. [Laryngeal cancer and the leukemoid reaction]. An Med Interna 1999; 16:382-3. [PMID: 10481345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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46
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Motoyoshi K. [Monocytic leukemoid reaction]. Ryoikibetsu Shokogun Shirizu 1998:146-8. [PMID: 9833456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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47
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Sakamoto S. [Leukemoid reaction]. Ryoikibetsu Shokogun Shirizu 1998:5-11. [PMID: 9833409] [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: 02/09/2023]
Affiliation(s)
- S Sakamoto
- Sakamoto Medical Clinic of Internal medicine
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48
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Sakamoto S. [Megakaryoblastic leukemoid reaction]. Ryoikibetsu Shokogun Shirizu 1998:12-4. [PMID: 9833410] [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: 04/11/2023]
Affiliation(s)
- S Sakamoto
- Sakamoto Medical Clinic of Internal Medicine
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49
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Hoff DS, Mammel MC. Suspected betamethasone-induced leukemoid reaction in a premature infant. Pharmacotherapy 1997; 17:1031-4. [PMID: 9324194] [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: 02/05/2023]
Abstract
The use of antenatal corticosteroids in threatened pregnancies of less than 34 weeks' duration is a valuable tool for assisting fetal lung maturation. Although this practice has existed for over 20 years, little is known about a rare extreme elevation of the newborn's white blood cell count, called a leukemoid reaction. A case of leukemoid reaction is discussed to assist the clinician with the current thought processes and diagnostic differential behind this benign condition.
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Affiliation(s)
- D S Hoff
- Children's Healthcare-Minneapolis, Minnesota 55404, USA
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50
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Wright JJ, Hoffmeister KJ, Cotelingam JD, Allegra CJ. Neutrophilia and organomegaly in two patients with cancer. Hosp Pract (1995) 1997; 32:135-142. [PMID: 9064302 DOI: 10.1080/21548331.1997.11443411] [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: 05/22/2023]
Affiliation(s)
- J J Wright
- NCI-Navy Medical Oncology Branch, Bethesda, MD, USA
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