Sign Of Acute Myeloid Leukemia Research Articles

Not all hematological malignancies in the gastrointestinal tract are lymphoma

Abstract Introduction/Objective Myeloid sarcoma (MS) is a rare entity that may develop in patients with acute myeloid leukemia (AML). Presentation of MS in the gastrointestinal (GI) tract is uncommon. We describe two cases of MS involving unusual sites: the stomach and appendix. Methods/Case Report A 64-year-old female consulted for fatigue and abdominal pain. A CT scan of abdomen/pelvis revealed appendicitis and CBC showed 76% blasts. An appendectomy was performed. Histologic examination demonstrated the appendiceal wall infiltrated by malignant cells, ultimately demonstrated to be positive for MPO and weak/variable CD117. In the second case, a 50-year-old male presented to the emergency department for nausea, vomiting, and elevated amylase. Esophagogastroduodenoscopy with endoscopic ultrasound demonstrated pancreatic inflammatory changes and a subepithelial nodule in the gastric fundus. Biopsy of the nodule revealed gastric epithelium infiltrated by sheets of malignant cells, ultimately demonstrated to be positive for CD34, myeloperoxidase and CD43. Results (if a Case Study enter NA) NA Conclusion MS is defined as a tumor of myeloid blasts forming outside the bone marrow. Overall, it is an uncommon entity that can occur in patients with known AML, and rarely, as the first sign of AML. Presentation of MS in the GI tract is infrequent (10%), involving primarily the small intestine (63%). The differential diagnosis includes lymphoma, poorly differentiated carcinomas, and melanomas. A review of the clinical history for AML or other myeloproliferative neoplasms should raise suspicion of MS. Expression of lymphoid markers and scant tissue for IHC studies can be diagnostic challenges, rendering B cell lymphoma as the most common misdiagnosis of MS in up to 40-47% of cases. Our two MS cases presented exclusively with GI symptoms without previously known AML and involved unusual GI sites. IHC for myeloid lineage, monocytic or myelomonocytic differentiation should be considered in specific cases. In patients without prior AML diagnosis, especially without hematologic findings, MS is a diagnostic challenge.

Leukemia Cutis as the Presenting Sign of Acute Myeloid Leukemia in an HIV+ patient

Leukemia Cutis (LC) is a rare extramedullary cutaneous manifestation of leukemia that varies in terms of clinical presentation, leukemia type, and timing of presentation in relation to systemic leukemia. LC typically presents following diagnosis of systemic leukemia and during an active flare or relapse. An estimated 3.7% of patients with Acute Myeloid Leukemia (AML) develop LC. A 61-year-old male with poorly controlled HIV presented with a rash that began one month prior on his cheek as a red papule, which he believed was an ingrown hair. On exam, pink and yellow firm papules and nodules covered his entire body surface except the groin and axilla. One nodule held a peau d’orange appearance. The rash was overall asymptomatic, and he reported only increased fatigue. His CD4 count and viral load were 136 and 330,000 respectively. One punch biopsy revealed negative cultures for fungus, bacteria, and acid-fast bacilli. Two biopsies sent for pathologic evaluation revealed AML of the skin. Bone marrow biopsy confirmed AML. Clinically the presentation of LC is nonspecific, and systemic symptoms rarely appear in conjunction with LC. High clinical suspicion and histopathologic examination are necessary for diagnosis of LC.

Relapsed acute myeloid leukemia presenting as conjunctival myeloid sarcoma: a case report

BackgroundConjunctival myeloid sarcoma (MS) as an isolated presentation of acute myeloid leukemia (AML) relapse is rare. Here, we report a case of unilateral conjunctival MS revealed as a sign of AML relapse.Case presentationA 50-year-old man with a history of AML in remission visited our clinic presenting with a left conjunctival injection persisting for 1 month. Diffuse subconjunctival thickening with conjunctival vascular engorgement was observed. Ultrasound biomicroscopy revealed a hyper-reflective, thickened conjunctiva in his left eye. During the incisional biopsy, the lesion was strongly attached to the underlying sclera; histopathologic examination revealed infiltration of leukemic blasts. The relapse of AML was confirmed by a successive bone marrow biopsy. The ocular lesion disappeared after allogeneic peripheral blood stem cell transplantation (PBSCT) and concomitant salvage radiotherapy on the left eye. The patient has remained in remission for 3 years after allogeneic PBSCT.ConclusionsIncidental conjunctival lesions can indicate AML relapse in patients treated earlier for AML. An ophthalmologist may have a role in the early detection of AML when a patient presents with an atypical conjunctival lesion.

119 Central Diabetes Insipidus as an Early Sign of Acute Myeloid Leukemia

119 Central Diabetes Insipidus as an Early Sign of Acute Myeloid Leukemia

Oral manifestations as an early clinical sign of acute myeloid leukemia: A report of two cases

Oral manifestations as an early clinical sign of acute myeloid leukemia: A report of two cases

Acute Myeloid Leukemia Revealed by Abducens Nerve Palsy: About One Case

Abducens palsy in case of acute myeloid leukemia is the result of infiltration of meninges. We report a case of Abducens nerve palsy revealing acute myeloid leukemia. Materials and Methods: A 49 year old female patient was admitted at consultation of ophthalmology in the military hospital Moulay Ismail of Meknes, this patient has an acute diplopia with general asthaenia. Results: The screening has revealed an abducens nerve palsy confirmed by Lancaster test. The MRI showed homogenous infiltration of cerebello pontine angle by an enhanced materiel. A bone marrow specimen was hypercellular without fibrosis. Discussion: Abducens palsy as first sign of an acute myeloid leukemia is rare. In our patient, it seems to be in relation with cerebello pontine angle infiltration as shown by MRI .Curative treatment is based on intensive chemotherapy. Conclusion: Abducens palsy as revealing sign of acute myeloid leukemia is rare.

Combined orbital proptosis and exudative retinal detachment as initial manifestations of acute myeloid leukemia

We report bilateral orbital and choroidal involvement as the presenting sign of acute myeloid leukemia in a 2-year-old white girl. The patient presented with painless proptosis and subconjunctival hemorrhage. Ophthalmic examination and magnetic resonance imaging revealed bilateral leukemic infiltrates of the orbits and choroid, with an exudative retinal detachment in the right eye. Bone marrow biopsy confirmed acute myeloid leukemia. Following radiation treatment, chemotherapy, and hematopoietic stem cell transplantation, the patient was doing well 12 months after presentation. Outcomes can be poor, even with treatment; prompt recognition of ophthalmic manifestations of leukemia, including proptosis, choroidal infiltration, and retinal detachment, is necessary.

Bilateral proptosis as initial sign of acute myeloid leukemia: case report and review of literature

We report bilateral proptosis as the unusual initial presentation of Acute Myeloid Leukemia (AML) in a child. A six years child presented with a history of painless proptosis in the both eyes with fever within 15 days. Radiological investigations were showing infiltration of orbit with the metastatic tumour cell. AML was diagnosed with complete blood count and bone marrow biopsy. The presumptive diagnosis of leukemic infiltration of the orbit and EOM was made, and urgent radiotherapy, allopurinol with high doses of vitamin A, intrathecal methotrexate, and intravenous daunorubicin were instituted. Proptosis was started to decrease. We report this case as AML can rarely present in child as a bilateral proptosis due to leukemic infiltration. Radiation treatment should be considered as an urgent treatment modality for this rare condition.

Acute Unilateral Ophthalmoplegia as the Presenting Sign of Acute Myeloid Leukemia in a 15-Month-Old Girl

Central nervous system manifestations of acute myeloid leukemia are rare at presentation. Acute cranial nerve findings on neurologic examination can be indications for brain imaging. Magnetic resonance imaging can highlight cranial nerves emerging from the brainstem, particularly if they are gadolinium-enhanced or thickened. We describe a 15-month-old girl with acute unilateral ophthalmoplegia as the presenting sign of acute myeloid leukemia. Her presentation emphasizes the importance of appropriate laboratory and radiographic evaluation in a toddler with new-onset strabismus, which may be discounted as a previously unrecognized or benign finding.

Oral Hairy Leukoplakia Which Occurred as a Presenting Sign of Acute Myeloid Leukemia in a Child

Oral hairy leukoplakia (OHL) is caused by the reactivation of a previous Epstein-Barr virus (EBV) infection in the epithelium of the tongue. Most lesions are characterized by corrugated whitish patches on the lateral border of the tongue. It is frequently associated with AIDS, but cases in patients with other immunosuppressed states have also been reported. In leukemia patients, OHL is rarely encountered, and appears only after chemotherapy. We report a case of OHL which occurred as a presenting sign of acute myeloid leukemia (AML) in a previously healthy 15-year-old child. A 15-year-old boy presented with a whitish patch on the left lateral border of the tongue. The biopsy specimen revealed papillomatosis, hyperkeratosis, acanthosis and ballooning degeneration in the stratum spinosum. The patient was EBV seropositive, and PCR analysis of EBV DNA in the lesional tissue was positive. After the diagnosis of OHL in dermatologic department, the patient was referred to pediatrics due to the abnormal peripheral blood smear, and was diagnosed with AML.

Central diabetes insipidus preceding acute myeloid leukemia with t(3;12)(q26;p12)

A 52-year-old woman presented with polyuria and polydipsia. A diagnosis of central diabetes insipidus (DI) was made, which turned out to be the first sign of acute myeloid leukemia (AML). Cytogenetic analysis revealed a balanced translocation between chromosome 3 and 12 t(3;12)(q26;p12). The patient was treated with standard induction chemotherapy and vasopressin. Before consolidation chemotherapy could be administered, deep venous thrombosis was diagnosed and leukemia relapsed. Rescue chemotherapy was started. This is the first report of an association between AML with t(3;12) and DI. Its possible pathogenesis is discussed with a review of the literature.