Child ; Humans ; Kidney Diseases ; etiology ; pathology ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; complications ; diagnosis

Adolescent ; Blood Glucose ; analysis ; Diabetes Complications ; Diabetes Mellitus ; diagnosis ; Female ; Humans ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; complications ; Treatment Outcome

Child, Preschool ; Female ; Humans ; Magnetic Resonance Imaging ; Posterior Leukoencephalopathy Syndrome ; diagnosis ; etiology ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; complications

This study was aimed to explore the clinical diagnostic significance of cerebrospinal fluid detection with flow cytometry (FCM) in children acute lymphoblastic leukemia (ALL) accompanied by central nervous system leukemia (CNSL). The 75 cerebrospinal fluid (CSF) samples of children with de novo ALL were detected by FCM, conventional cytology (CC), CSF routine tests and cytochemical examination. The results showed that among 75 de novo ALL, median age of onset was 5 (1 - 14) years old, ratio of male/female was 1.3:1. According to CCLG2008-ALL risk group protocol, there were 38 cases of standard risk (50.7%), 22 cases of intermedia risk (29.3%), 15 cases of high risk (20%). The results of CSF detection showed FCM(+)CC(+) 5 cases (6.7%), FCM(+)CC(-) 8 cases (10.7%) and FCM(-)CC(-) 62 cases (82.7%). According to CNS status classified, there were 3 cases of CNS-2, 2 cases of CNS-3 in FCM(+)CC(+) group there were CNS-1 7 cases, CNS-2 1 case in FCM(+)CC(-) groups, there were CNS-1 60 cases, CNS-2 1 case, CNS-3 1 case in FMC(-)CC(-) group. There was no significant difference in the distribution of the CNS-1, -2, -3 among the FCM(+)CC(+), FCM(+)CC(-), FCM(-)CC(-) groups (P > 0.05). It may be related to the fewer samples. There was higher consistency between results of FCM and CC on CNS-2, -3 diagnoses. FCM increased CC diagnosis positive rate to 20%. Meanwhile, there was no malignant cell in the smear, and no abnormal lymphocytic immunophenotype could be seen in CSF samples from 9 cases of viral encephalitis. It is concluded that cerebrospinal fluid detection with FCM has higher sensitivity, which is an important supplement to CSF routine detections and has significant useful value in diagnosis of children CNSL.
Adolescent ; Central Nervous System Neoplasms ; cerebrospinal fluid ; complications ; diagnosis ; Child ; Child, Preschool ; Female ; Flow Cytometry ; methods ; Humans ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; cerebrospinal fluid ; complications ; diagnosis

Adult ; Bone Marrow Transplantation ; Humans ; Male ; Pancreas ; pathology ; Pancreatic Neoplasms ; diagnosis ; secondary ; surgery ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; complications ; diagnosis ; physiopathology

Protein-losing enteropathy (PLE) is a syndrome characterized by excessive gastrointestinal protein loss, resulting in hypoproteinemia and edema. A variety of benign and malignant conditions can be associated with PLE and acute leukemia is a very rare cause of PLE. We report a case of PLE associated with acute lymphoblastic leukemia. A 27-year-old man was admitted due to watery diarrhea, epigastric pain and bilateral leg edema. Laboratory findings showed hypoproteinemia and polycythemia. The diagnosis of PLE and acute lymphoblastic leukemia were confirmed on the measurement of fecal alpha1-antitrypsin clearance and bone marrow examination. After systemic chemotherapy and autologous stem cell transplantation, his clinical symptoms and abnormal laboratory findings were gradually improved.
Adult ; Bone Marrow Cells/pathology ; Endoscopy, Gastrointestinal ; Humans ; Magnetic Resonance Imaging ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/*diagnosis/genetics ; Protein-Losing Enteropathies/complications/*diagnosis ; Thoracic Vertebrae/radiography ; Tomography, X-Ray Computed ; Translocation, Genetic ; alpha 1-Antitrypsin/analysis

We describe a case of bilateral exudative retinal detachment associated with prodromal symptoms simulating the presentation of acute Vogt-Koyanagi-Harada disease that was eventually diagnosed as acute lymphoblastic leukemia. A 42-year-old man presented with sudden visual loss in both eyes for two weeks. He complained of intermittent headache, neck stiffness and tinnitus for a month. His best-corrected visual acuities were 20/200 in both eyes. Fluorescein angiography, optical coherence topography and indocyanine green angiography featured bilateral serous retinal detachments. A clinical diagnosis of incomplete type Vogt-Koyanagi-Harada disease was considered. However, complete blood cell count showed a marked increase in the number of white blood cells and bone marrow examination revealed precursor B cell lymphoblastic leukemia. The patient started on induction chemotherapy. A week later, his best-corrected visual acuities were 20/25 and the serous retinal detachments were nearly absorbed in both eyes. Bilateral exudative retinal detachment associated with neurologic and auditory abnormalities may be a presenting sign of acute lymphoblastic leukemia. Clinicians should be aware of the possibility of leukemia in such patients.
Adult ; Diagnosis, Differential ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Humans ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/*diagnosis ; Retinal Detachment/diagnosis/*etiology ; Tomography, Optical Coherence ; Uveomeningoencephalitic Syndrome/*diagnosis ; Visual Acuity

We present a case of bilateral serous retinal detachment (SRD) as a presenting sign of Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). A 45-year-old woman presented with decreased vision and was found to have bilateral serous retinal detachment. Peripheral blood smears revealed leukocytosis of 53.9x10(3)/microliter with 64.6% lymphoblasts. A bone marrow aspirate revealed the presence of lymphoblasts. Cytogenetic and molecular genetic analysis detected a reciprocal translocation between chromosome 9 and 22, t(9;22) (q34;q11). A diagnosis of Ph+ ALL was made. Following systemic chemotherapy, the bilateral SRD resolved completely with full recovery of vision. The sudden appearance of SRD should raise suspicion for leukemia. Prompt recognition of this disease is important for early systemic treatment and restoration of visual function.
Antineoplastic Agents/therapeutic use ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Humans ; Middle Aged ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/*complications/diagnosis/drug therapy ; Recovery of Function ; Retinal Detachment/diagnosis/*etiology/physiopathology ; Tomography, Optical Coherence ; Visual Acuity/physiology

This study was aimed to investigate the clinical features and therapy of Ph(+) acute lymphoblastic leukemia (Ph(+)ALL) combined with invasive aspergillosis. A series of examination, including routine blood and bone marrow picture analysis, chest roentgenography, cranial computerized tomography and detection of cell genetics etc were carried out for a Ph(+)ALL patient combined with invasive aspergillosis. This patient received chemotherapy with DVCP, idarubicin and imatinib mesylate and was treated with sporanox and amphotericin B (Amb; including Amb-L) and cerebrotomy for drainage because the invasive aspergillosis occurred during myelosuppression. The results showed that patient gained complete remission and the invasive aspergillosis was controlled successfully. It is concluded that patient with Ph(+)ALL has poor prognosis despite intensive conventional chemotherapy, imatinib mesylate may prove to be an effective treatment for Ph(+)ALL. Because detection rate of the fungus is very low, itraconazole in combination with surgical excision of focus is the best treatment of lung and brain invasive aspergillosis.
Antifungal Agents ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Aspergillosis ; diagnosis ; drug therapy ; Benzamides ; Brain Diseases ; complications ; microbiology ; Humans ; Imatinib Mesylate ; Itraconazole ; therapeutic use ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; complications ; Lung Diseases, Fungal ; drug therapy ; etiology ; Piperazines ; administration & dosage ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; complications ; genetics ; microbiology ; Pyrimidines ; administration & dosage

Indolent T-lymphoblastic proliferation has been rarely reported in the upper aerodigestive tract. The lymphoid cells associated with this condition have the morphological and phenotypical features of immature thymocytes. However, their pathogenesis and biology are unknown. We present an unusual type of tumor infiltrating lymphocytes in a case with hepatocellular carcinoma, presumed to be a T-lymphoblastic proliferation. A 58-yr-old female patient presented with indigestion and a palpable epigastric mass. The abdominal computed tomography revealed a mass in the S6 region of the liver. A hepatic segmentectomy was performed. Microscopic examination showed dense isolated nests of monomorphic lymphoid cells within the tumor. Immunohistochemically, the lymphoid cells were positive for CD3, terminal deoxymucleotide transferase (TdT) and CD1a. In addition, they showed dual expression of CD4 and CD8. The polymerase chain reaction used to examine the T-cell antigen receptor gamma gene rearrangement showed polyclonal T-cell proliferation. This is the second case of hepatocellular carcinoma combined with indolent T-lymphoblastic proliferation identified by an unusual tumor infiltrating lymphocytes.
Antigens, CD3/metabolism ; Antigens, CD4/metabolism ; Antigens, CD8/metabolism ; Carcinoma, Hepatocellular/*diagnosis/pathology/secondary ; DNA Nucleotidylexotransferase/metabolism ; Female ; Humans ; Liver Neoplasms/*diagnosis/immunology/pathology ; Lymphocytes, Tumor-Infiltrating/*pathology ; Mastectomy, Segmental ; Middle Aged ; Precursor Cells, T-Lymphoid/*pathology ; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/complications/metabolism/*pathology ; Tomography, X-Ray Computed