Initial Diagnosis Of Leukemia Research Articles

Multiscale adaptive and attention-dilated convolutional neural network for efficient leukemia detection model with multiscale trans-res-Unet3+ -based segmentation network

A precise early-stage leukemia diagnosis is essential for treating patients and saving their lives. The least expensive way for the initial diagnosis of leukemia in patients is the microscopy imaging analysis. However, this work is subjective and time-consuming. Hence, this paper creates an efficient leukemia detection model using deep learning approaches. Initially, the standard leukemia datasets are used to collect the images. The gathered images are given for the region segmentation to the Multiscale Trans-Res-Unet3+ (MTResUnet3+) Network. The segmented regions from the MTResUnet3+ are now considered for the feature extraction phase from which the most relevant attributes are mined. Here, the features like color, shape, and texture are extracted separately for performing efficient detection. Further, the features being extracted are considered for the feature selection phase, where the Election-Based Chameleon Swarm Algorithm (E-CSA) is utilized to optimally select the most appropriate features with the aim of enhancing the performance rate of the developed model. The optimally selected features are given to the next stage for detecting the presence of leukemia. Here, the Multiscale Adaptive and Attention-based Dilated Convolutional Neural Network (MAA-DCNN) is made for detecting leukemia, in which the optimization of the parameter is done with the help of hybrid E-CSA in order to elevate the detection accuracy of leukemia. The simulation analysis is performed to analyze the performance rate of the recommended leukemia detection model by contrasting it with the conventional leukemia detection models and existing algorithms using various performance metrics for validation.

Prognostic factors for clinical outcomes of patients with central nervous system leukemia

Prognostic factors associated with clinical outcomes of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) patients with central nervous system (CNS) involvement are unknown. We retrospectively studied the characteristics and outcomes of 66 (18 pediatric and 48 adult) patients with CNS leukemia with ALL (n = 41) or AML (n = 25). The median age of patients at diagnosis of CNS leukemia was 30 (range, 1–69) years. Nearly two-third patients had CNS involvement at the initial diagnosis of leukemia. Complete remission of CNS leukemia was attained in 58 (88%) patients, and probability of overall survival at 36 months after the diagnosis of CNS leukemia was 43% for the entire cohort. We identified that achieving remission of systemic leukemia and having CNS leukemia diagnosed and treated before allogeneic transplantation were the factors associated with CNS leukemia remission. Prognostic factors associated with better overall survival in patients with CNS leukemia included pediatric age, diagnosis of CNS leukemia before receiving allogenic transplantation, achieving clearance of systemic or CNS leukemia, receiving no cranial radiation in conjunction with intrathecal chemotherapy (IT), and receiving IT consolidation after achieving remission of CNS leukemia. Our findings show that patients with CNS leukemia are at considerable risk of mortality. Awareness of modifiable prognostic factors such as avoidance of cranial radiation whenever possible and use of IT consolidation can result in improved outcomes in subset of patients with CNS leukemia.

Use of artificial intelligence to improve access to initial leukemia diagnosis in low- and middle-income countries.

e14117 Background: Disparities in access to cancer diagnostic methods affect especially low and middle-income countries (LMIC). Honduras, a country with limited resources of laboratory, and trained personnel to diagnose leukemia have an estimated incidence of leukemia of 5.8 per 100,000 person-years and the mortality is 4.8 per 100,000 person-years. This country has a single immunophenotyping center and similar to many other LMICs, the preliminary diagnosis of leukemia is performed by a morphological study of blood. Machine learning (ML) is a form of artificial intelligence (AI) that has the potential to improve medical attention in several medical fields. The purpose of this study is to evaluate the impact of ML use, as a method to reduce the time interval and the access to a diagnosis of leukemia in Honduras, where the current average time to perform an initial diagnosis of leukemia is from 2 weeks to 3 months. Methods: A quantitative correlational study was designed. With the help of local informatic developers, an automated image processing algorithm was designed, which was fed with a total of 1009, digital images of bone marrow aspirates and peripheral blood of patients with proven leukemia through immunophenotyping. The images were captured using a microscope Carl Zeiss lens with a 100x objective, the process included the segmentation of leukemia cells for its analysis. Bivariate outcomes were assessed using the Pearson chi-squared test. Results: From 2016 to 2018, a total of 341 samples of patients with any symptom of leukemia were included. After anonymization of patient identification, the samples were analyzed using our algorithm by comparing the cells with its database. Posteriorly, an expert hematologist performed an analysis of the sample. A total of 20 samples (5.8%), were diagnosed with a preliminary diagnosis of leukemia. Of the 20 samples, a total of 10(50%) were acute myeloid leukemia, 6 samples (30%) lymphoblastic leukemia and the remaining 4 samples (20%) were compatible with chronic myeloid leukemia. The average time to make an initial diagnosis of leukemia was 75% and 24% in 24 and 48 hours respectively. Local hematologists managed to make treatment decisions earlier with benefit to the patients. In 19 of the samples (95%), there was correspondence between the morphology diagnosis obtained by our algorithm and the immunophenotyping diagnosis. Conclusions: This preliminary study demonstrates that the use of artificial intelligence constitutes an important element to improve access and shortening of the time required to obtain a diagnosis of leukemia in LMCIs, and represents a method to reduce disparities in access to diagnosis of hematological cancers.

Clinical and imaging features of myeloid sarcoma: a German multicenter study

BackgroundMyeloid sarcoma (MS), also known as chloroma, is an extramedullary manifestation of malignant primitive myeloid cells. Previously, only small studies investigated clinical and imaging features of MS. The purpose of this study was to elucidate clinical and imaging features of MS based upon a multicenter patient sample.MethodsPatient records of radiological databases of 4 German university hospitals were retrospectively screened for MS in the time period 01/2001 and 06/2019. Overall, 151 cases/76 females (50.3%) with a mean age of 55.5 ± 15.1 years and 183 histopathological confirmation or clinically suspicious lesions of MS were included into this study. The underlying hematological disease, localizations, and clinical symptoms as well as imaging features on CT and MRI were investigated.ResultsIn 15 patients (9.9% of all 151 cases) the manifestation of MS preceded the systemic hematological disease. In 43 cases (28.4%), first presentation of MS occurred simultaneously with the initial diagnosis of leukemia, and 92 (60.9%) patients presented MS after the initial diagnosis. In 37 patients (24.5%), the diagnosis was made incidentally by imaging. Clinically, cutaneous lesions were detected in 35 of 151 cases (23.2%). Other leading symptoms were pain (n = 28/151, 18.5%), neurological deficit (n = 27/151, 17.9%), swelling (n = 14/151, 9.3%) and dysfunction of the affected organ (n = 10/151, 6.0%). Most commonly, skin was affected (n = 30/151, 16.6%), followed by bone (n = 29/151, 16.0%) and lymphatic tissue (n = 21/151, 11.4%). Other localizations were rare. On CT, most lesions were homogenous. On T2-weighted imaging, most of the lesions were hyperintense. On T1-weighted images, MS was hypointense in n = 22/54 (40.7%) and isointense in n = 30/54 (55.6%). A diffusion restriction was identified in most cases with a mean ADC value of 0.76 ± 0.19 × 10− 3 mm2/s.ConclusionsThe present study shows clinical and imaging features of MS based upon a large patient sample in a multicenter design. MS occurs in most cases meta-chronous to the hematological disease and most commonly affects the cutis. One fourth of cases were identified incidentally on imaging, which needs awareness of the radiologists for possible diagnosis of MS.

Radiological and clinical patterns of myeloid sarcoma.

BackgroundMyeloid sarcoma (MS), also known as granulocytic sarcoma or chloroma, is a solid tumor of extramedullary localization composed of malignant primitive myeloid cells. The purpose of the study was to identify clinical and imaging features in a large patient sample.Patients and methodsOverall, 71 cases (34 females (47.9%) and 37 males (52.1%) with a median age of 56 (± 16 years) of histopathologically confirmed myeloid sarcoma were included into this study. The underlying hematological disease, occurrence, localizations and clinical symptoms as well as imaging features on computed tomography and magnetic resonance imaging were investigated.ResultsIn 4 cases (5.63%) the manifestation of MS preceded the systemic hematological disease by a mean value of 3.8 ± 2.1 months. In 13 cases, first presentation of MS occurred simultaneously with the initial diagnosis of leukemia, and 51 patients presented MS after the initial diagnosis of the underlying malignancy with a mean latency of 39.8 ± 44.9 SD months. The visceral soft tissue was affected in 26 cases, followed by the cutis/subcutis was affected in 21 cases. Further localizations were bones (n = 13), central nervous system (n = 9), lymph nodes (n = 4) and visceral organs (n = 9).ConclusionsMS is a rare complication of several hematological malignancies, predominantly of acute myeloid leukemia, which can affect any part of the body. In most cases it occurs after the diagnosis of the underlying malignancy, and affects frequently the cutis and subcutis.

Gingival enlargement as oral manifestation in acute myeloid leukemia patient

Background: Acute myeloid leukemia (AML) is a bone marrow cancer, a malignant disease that triggering the cells develops into different types of blood cells. It is widely recognized that the main manifestation of AML could be gingival hyperplasia and bleeding. Occasionally, an initial diagnosis of leukemia is made after a dental examination. In relation to systemic diseases, gingival enlargement could constitute the intensification of an existing inflammation initiated by dental plaque, or a manifestation of the systemic disease independent of the inflammatory condition of the gingiva. Gingival enlargement negatively affects the quality of life, especially nutritional intake. Purpose: This study aimed to report on gingival enlargement in AML patients, dental management of this condition and considerations when treating patients. Case: A 46 year-old woman diagnosed with AML who chiefly complained of gingival enlargement in all parts of the mouth which restricted her nutritional intake. Case management: The subject attended the clinic twice where nonsurgical treatment for the gingival enlargement, supragingival scaling and dental health education to maintain her oral hygiene was carried out. Unfortunately, she did not return for follow-up appointments due to having already passed away. Information about AML and its relation to gingival enlargement contained in the literature is also reviewed. Conclusion: In conclusion, gingival enlargement represents one oral manifestation of AML. This condition is related to and affects the nutritional intake of the patient.

B12 Vitamini Eksikliğine İkincil Hemoliz Bulguları Olan Yaşamı Tehdit Eden Anemi, Trombositopeni ve Beyin Atrofisi

Megaloblastic anemia due to vitamin B12 deficiency is rare in infancy. It usually occurs in exclusively breast-fed infants born to vitamin B12-deficient mothers. We report a one-year-old female infant with initial diagnosis of leukemia who was found severely vitamin B12-deficient secondary to maternal deficiency. She had marked neurodevelopmental retardation, and presented with life-threatening anemia, findings of hemolysis, thrombocytopenia and cerebral atrophy on magnetic resonance imaging.

MANIFESTAÇÃO ORAL DA LEUCEMIA MIELÓIDE AGUDA COMO PRIMEIRO SINAL PARA O DIAGNÓSTICO: RELATO DE CASO

Acute myeloid leukemia (AML) is a malignant disease of the bone marrow that can present systemic and oral manifestation. In this case report we describe a patient, 16 years of age, who presented the oral manifestation ulcerated lesions on the dorsum of the tongue and cervical lymph node in the right region. After clinical examination and complementary tests, it was taken as a hypothesis the diagnosis of acute leukemia, and the patient was referred to a specialized medical service. Showing the importance of the dentist in the initial diagnosis of leukemia.

Cytologic findings of acute leukemia in bronchoalveolar lavage fluid

Bronchoalveolar lavage (BAL) is often performed in patients with acute leukemia developed with respiratory failure or pulmonary infiltrates. Patients usually undergo BAL to rule out infection. Occasionally, however, leukemic infiltrate may be detected. We present a series of 11 cases in which the diagnosis of leukemia was made on the BAL material. We retrospectively reviewed all BAL samples from January 1, 2006 to December 31, 2008. There were a total of 1,130 cases, of which 139 showed malignant cytology, including 10 with leukemia. Sixteen samples were unsatisfactory and 904 were benign, of which 32 had identifiable microorganisms. In additional to the 10 leukemia cases identified, two more were reviewed after the search criteria. The 12 patients (seven men, five women) ranged from 22 to 75 years old. All patients had previously biopsy-proven leukemia [two acute myelomonocytic leukemia, two acute promyelocytic leukemia, two acute myeloid leukemia (AML) with inv16, two therapy-related AML, one acute monocytic leukemia, one chronic myeloid leukemia in blast face, one AML with maturation, one myelodysplastic syndrome with excess blasts, and one large granular leukemia]. Four had a prior diagnosis of myelodysplastic syndrome. The time from initial diagnosis of leukemia to BAL ranged from 1 to 233 days, with 8 of 10 occurring within 8 days of diagnosis. Symptoms that prompted BAL included shortness of breath/hypoxia (8), fever (3), chest pain (2), and cough (2). Chest X-rays in all cases revealed opacities or consolidations mimicking an inflammatory process. Seven patients subsequently died, while three were alive, and, in remission, and two were lost to follow-up. The presence of a leukemic infiltrate can mimic infection. BAL is a relatively safe and useful diagnostic tool in this setting for differentiating a leukemic infiltrate from an infection/inflammatory infiltrate. The prognosis of patients with lung involvement of acute leukemia is poor.

Clinical and laboratory features of leukemias at the time of diagnosis: An analysis of 1,004 consecutive patients

To determine the major presenting features of the most frequent leukemias and to describe the period from the first symptoms to the final diagnosis, we analyzed the records of 1,004 consecutive patients with acute (AL) and chronic (CL) leukemias diagnosed between 2004 and 2009. In 24% of AL and 63% of CL, the diagnosis was made incidentally. In contrast to the frequency of the symptoms, their spectrum did not differ from historical studies, and fatigue and weakness were the most frequent symptoms observed [with the exception of acute promyelocytic leukemia (APL) where bleeding predominated]. More profound cytopenia was found in AL compared to CL. The median time from the first symptoms to final diagnosis was 3 weeks in AL and 4 weeks in CL. APL had the shortest time to a definitive diagnosis (2 weeks); however, a very short duration of symptoms was also observed in CML (3 weeks). This study is the largest series reported to date on symptoms in leukemia patients at the time of diagnosis, and the first such report that reflects on clinical practice in the new millennium.

Gene Expression and Ex Vivo Drug Sensitivity Profiles in Children with Acute Leukemia: An Insight for High-Dose Therapy and Role of Etoposide and Fludarabine.

Abstract 2747Poster Board II-723 Background:A distinct phenotype of combined ex vivo drug resistance and gene expression associated with this phenotype discriminates treatment outcome and identifies a subset of patients with a markedly inferior outcome in childhood acute lymphoblastic leukemia (ALL). No similar relationship was found so far in acute myeloblastic leukemia (AML). We hypothesized that drug sensitivity profile combined with gene expression profile can provide a new insight into selection of drugs used in high-dose therapy before hematopoietic stem cell transplantation and determine the role of specific drugs. Objective:The aim of the study was to analyze the gene expression profile in correlation to the ex vivo obtained chemosensitivity profile of drugs used in high-dose therapy before hematopoietic stem cell transplantation in children with ALL and AML. Methods:We tested leukemic cells from 56 children (43 ALL de novo, 8 relapsed ALL, 5 AML de novo) for ex vivo sensitivity to etoposide, fludarabine, 4-HOO-cyclophosphamide, busulfan, treosulfan and melphalan. The cells were then subjected to an assessment of global profile of gene expression to identify differentially expressed genes in drug-sensitive and drug-resistant ALL. Cells were isolated from bone marrow at the initial diagnosis of leukemia or its relapse. In vitro cytotoxicity was analyzed by means of the MTT assay. The drug resistance was expressed as the IC50, the inhibitory concentration to 50% of the cells. RNA was extracted with the use of Trizol, purified and assessed for integrity. Samples were hybridized to the Human Genome U133A Chip oligonucleotide microarrays (Affymetrix) according to manufacturer's protocol. Dataset was pre-processed by RMA method and small variability genes were filtered out. The final analysis was carried out in 13 835 probe sets. Non-parametric Spearman's correlations of IC50 and gene expression values were analyzed. Results:From all analyzed drugs, the largest number of genes significantly associated with the chemosensitivity profile across samples was observed for etoposide. We found 386 probests significantly correlated with the IC50 values (Spearman's correlation coefficient ranging from R==0.7 to R=0.61, p<0.001). NUDT21 gene (Nudix, nucleoside diphosphate linked moiety X-type, motif 21) was found to be highly significantly (False Discovery Rate, FDR<0.0001%) associated with chemosensitivity (larger expression associated with decreased IC50). Global test of association confirmed (p<0.001) that overall gene expression profile is associated with etoposide resistance, among selected genes there was over-representation of transcripts from chromosomes 1, 16 and 19. Two other drugs were found to exhibit noticeable association: fludarabine chemosensitivity was correlated with the expression of 197 probesets, global test of significance p=0.002; for cyclophosphamide 111 probesets and p=0.006 in global test was obtained. Much less significant association was observed for melphalan (72 genes, global test p=0.02) and almost no association was found for treosulfan (28 probesets, global test p=0.12) and busulfan (22 probesets, global test p=0.18). Fludarabine resistance was associated with an increased expression of FRY gene (Drosophila Furry homolog), Spearman's correlation coefficient R=0.61 (FDR=0.27%). Melphalan sensitivity was associated with biologically interesting differences in gene expression of PIP4K2A (Phosphatidyloinositol-5-phosphate 4-kinase, type II, alpha; over-expressed in patients with high IC50 for this drug) and POLR2C (RNA Polymerase II, DNA directed, polypeptide C, 33 kDa; down-regulated in this subset of cases). Conclusions:Expression of a single genes is strongly associated with drug resistance in childhood acute leukemia, and it may aid to determine drug sensitivity to high-dose chemotherapy. Etoposide and fludarabine sensitivity seem to be related to the significant number of biologically important genes. Acknowledgments:This study was supported by grants MNiSW N407 078 32/2964 and UMK BW 10/09. JSz and MJ contributed equally to the study. Disclosures:No relevant conflicts of interest to declare.

The Influence of Pretreatment Characteristics and Radiotherapy Parameters on Time Interval to Development of Radiation-Associated Meningioma

To identify pretreatment characteristics and radiotherapy parameters which may influence time interval to development of radiation-associated meningioma (RAM). A Medline/PUBMED search of articles dealing with RAM yielded 66 studies between 1981 and 2006. Factors analyzed included patient age and gender, type of initial tumor treated, radiotherapy (RT) dose and volume, and time interval from RT to development of RAM. A total of 143 patients with a median age at RT of 12 years form the basis of this report. The most common initial tumors or conditions treated with RT were medulloblastoma (n = 27), pituitary adenoma (n = 20), acute lymphoblastic leukemia (n = 20), low-grade astrocytoma (n = 19), and tinea capitis (n = 14). In the 116 patients whose RT fields were known, 55 (47.4%) had a portion of the brain treated, whereas 32 (27.6%) and 29 (25.0%) had craniospinal and whole-brain fields. The median time from RT to develop a RAM or latent time (LT) was 19 years (range, 1-63 years). Male gender (p = 0.001), initial diagnosis of leukemia (p = 0.001), and use of whole brain or craniospinal field (p <or= 0.0001) were associated with a shorter LT, whereas patients who received lower doses of RT had a longer LT (p < 0.0001). The latent time to develop a RAM was related to gender, initial tumor type, radiotherapy volume, and radiotherapy dose.

MRI diagnosis of bone marrow relapse in children with ALL

Diffuse marrow replacement in acute leukemia is well known, but there are few reports describing the MRI features of pediatric leukemic relapse. Our purpose was to describe the MRI appearance of pediatric leukemic relapse. A total of 53 consecutive children with a history of ALL were referred for musculoskeletal MRI from 1 January 1998 to 28 February 2007 at one center, and from 1 January 2000 to 2 May 2007 at a second center. From this group, 14 children seen at initial diagnosis of leukemia and 2 children who underwent MRI after therapy for relapse were excluded. The remaining 37 children, 8 with relapse and 29 in remission, were studied. Images of patients with relapse and in remission were reviewed for type and configuration of marrow infiltration; coexisting marrow alterations including osteonecrosis or stress reaction were also reviewed. All eight children with relapse demonstrated nodular lesions with well-defined margins. Coexisting osteonecrosis was present in three children (38%) and pathologic fracture in one. Among the 29 children in remission, 9 showed stress reaction/fracture, 14 showed osteonecrosis and 9 showed ill-defined nodules, and in 5 the marrow was completely normal. Well-defined nodules in all patients with leukemic relapse suggest that this appearance is characteristic and distinct from the published findings of diffuse marrow replacement in acute leukemia.

Immunophenotypic Analysis of the TCR-Vβ Repertoire in 98 Persistent Expansions of CD3 +/TCR-αβ + Large Granular Lymphocytes : Utility in Assessing Clonality and Insights into the Pathogenesis of the Disease

At present, a major challenge in the initial diagnosis of leukemia of large granular lymphocytes (LGLs) is to establish the clonal nature of the expanded population. In the present study we have analyzed by flow cytometry immunophenotyping the TCR-Vbeta repertoire of 98 consecutive cases of persistent expansions of CD4(+) or CD8(+bright) CD3(+)/TCR-alphabeta(+) LGLs and compared the results with those obtained in molecular studies of TCR-beta gene rearrangements. Fifty-eight cases were considered to be monoclonal in molecular studies whereas in the remaining 40 cases there was no evidence for monoclonality (11 cases were considered oligoclonal and 29 polyclonal). The TCR-Vbeta repertoire was biased to the preferential use of one or more TCR-Vbeta families in 96% of cases, a total of 124 TCR-Vbeta expansions being diagnosed: one TCR-Vbeta expansion in 71 cases and two or more TCR-Vbeta expansions in 23 cases. The highest TCR-Vbeta expansion observed in each case was higher among monoclonal (74 +/- 19%) as compared to nonmonoclonal cases (24 +/- 14%) (P = 0.001), as did the fraction of LGLs that exhibited a TCR-Vbeta-restricted pattern (86 +/- 16% and 42 +/- 23%, respectively; P = 0.0001); by contrast, the proportion of cases displaying more than one TCR-Vbeta expansion was higher in the latter group: 7% versus 48%, respectively (P = 0.001). Results obtained in oligoclonal cases were intermediate between those obtained in polyclonal and monoclonal cases and similar results were observed for CD4(+) as for CD8(+bright) T-cell expansions. TCR-Vbeta families expressed in CD8(+bright) T-cell-LGL proliferations showed a pattern of distribution that mimics the frequency at which the individual TCR-Vbeta families are represented in normal peripheral blood T cells. Assuming that a given proliferation of LGLs is monoclonal whenever there is an expansion of a given TCR-Vbeta family of at least 40% of the total CD4(+) or CD8(+bright) T-cell compartment, we were able to predict clonality with a sensitivity of 93% and a specificity of 80%. By increasing the cut-off value to 60%, sensitivity and specificity were of 81% and 100%. In summary, our results suggest that flow cytometry immunophenotypic analysis of the TCR-Vbeta repertoire is a powerful screening tool for the assessment of T-cell clonality in persistent expansions of TCR-alphabeta(+) LGLs.

Late mortality experience in five-year survivors of childhood and adolescent cancer: the Childhood Cancer Survivor Study.

Survivors of childhood and adolescent cancer are at risk for long-term effects of disease and treatment. The Childhood Cancer Survivor Study assessed overall and cause-specific mortality in a retrospective cohort of 20,227 5-year survivors. Eligible subjects were individuals diagnosed with cancer (from 1970 to 1986) before the age of 21 who had survived 5 years from diagnosis. Underlying cause of death was obtained from death certificates and other sources and coded and categorized as recurrent disease, sequelae of cancer treatment, or non-cancer-related. Age and sex standardized mortality ratios (SMRs) were calculated using United States population mortality data. The cohort, including 208,947 person-years of follow-up, demonstrated a 10.8-fold excess in overall mortality (95% confidence interval, 10.3 to 11.3). Risk of death was statistically significantly higher in females (SMR = 18.2), individuals diagnosed with cancer before the age of 5 years (SMR = 14.0), and those with an initial diagnosis of leukemia (SMR = 15.5) or CNS tumor (SMR = 15.7). Recurrence of the original cancer was the leading cause of death among 5-year survivors, accounting for 67% of deaths. Statistically significant excess mortality rates were seen due to subsequent malignancies (SMR = 19.4), along with cardiac (SMR = 8.2), pulmonary (SMR = 9.2), and other causes (SMR = 3.3). Treatment-related associations were present for subsequent cancer mortality (radiation, alkylating agents, epipodophyllotoxins), cardiac mortality (chest irradiation, bleomycin), and other deaths (radiation, anthracyclines). No excess mortality was observed for external causes (SMR = 0.8). While recurrent disease remains a major contributor to late mortality in 5-year survivors of childhood cancer, significant excesses in mortality risk associated with treatment-related complications exist up to 25 years after the initial cancer diagnosis.

Embryonal Carcinoma of the Testis after Acute Myelomonocytic Leukemia: A Case Report

A case of embryonal carcinoma of the testis after acute myelomonocytic leukemia is reported. The interval between the initial diagnosis of leukemia and the appearance of embryonal carcinoma was almost three years. Although the patient had received neither irradiation nor alkylating agents, the case is regarded as one of secondary malignancy. Possible contributing factors are discussed.

Primary Gingival Enlargement as a Diagnostic Indicator in Acute Myelomonocytic Leukemia

A 25-YEAR-OLD CHINESE FEMALE, five months pregnant, came to our dental clinic with a chief complaint of slight gingival inflammation. A diagnosis of pregnancy gingivitis was made. One week later, there was a sudden onset of extremely generalized gingival enlargement and very high WBC count (144,000/cmm) was noted. Physical, laboratory, and microscopic examination led to the diagnosis of acute myelomonocytic leukemia. The observations of good oral hygiene and clinical course suggested that leukemic cell infiltration was the major cause of sudden onset of gingival enlargement. This article emphasizes the importance of primary gingival enlargement in the initial diagnosis of leukemia.

Scottish validation study of cancer registration data childhood leukaemia 1968–1981. Bone marrow review—II

Following a review of central leukaemia registration data for Scottish children 1968–1981 a retrospective assessment of leukaemia type was made by inspection of bone marrow slides. Only 57% of slides were still available and in 72% of these the review panel confirmed the initial diagnosis of leukaemia and its type. In eight cases the panel disagreed with the diagnosis or the type of leukaemia designated. Central slide review at diagnosis in childhood leukaemia is essential if subsequent epidemiological studies are to be meaningful.

Radiation treatment of testicular relapse in acute lymphoblastic leukemia.

Ten patients with testicular relapse among 128 cases of acute lymphoblastic leukemia are reported. At the time of the initial diagnosis of leukemia all patients with later testicular relapse showed one or more risk factors as predictive for leukemic infiltration of the testicles. All patients except one, who underwent orchiectomy and died 11 weeks after surgical intervention, received radiation therapy with doses ranging from 12 to 20 Gy and chemotherapy. The local control was excellent. Average survival time from testicular relapse to death was 68 weeks in 8 of 9 patients treated by irradiation and chemotherapy. One patient is still alive without signs of disease after 6 years.

Prostatic infiltration in leukaemia and lymphoma.

12 cases are reported in which the prostate was the site of a leukaemic or lymphomatous infiltration. Hodgkin's disease, not previously reported as involving the prostate, was seen in one instance. In all cases the diagnosis was made histologically. Although 5 patients were known to have leukaemia or lymphoma prior to surgery, the preoperative clinical diagnosis in 3 cases was benign prostatic hypertrophy and in 3 instances prostatic carcinoma. In 6 patients, the initial diagnosis of leukaemia or lymphoma was made on the prostatic specimen and in one instance infiltration was discovered at postmortem. The management of leukaemic and lymphomatous infiltration is discussed.