Renal involvement of chronic myelogenous leukemia presenting as a kidney tumor

Renal involvement by leukemic cells is rare in chronic myelogenous leukemia (CML). Herein, this study reports a case of CML associated with renal involvement of leukemic cells, which occurred 1 and 1/2 years after the initial diagnosis. Abdomino-pelvic computed tomography revealed a 4.4 x 4.2 cm-sized, low-density solid mass having a thick wall from the mid to lower pole of the left kidney. A peripheral blood analysis revealed blastic transformation of CML. The biopsied renal parenchyme was diffusely infiltrated by sheets of immature myeloid cells, polymorphonuclear leukocytes, and occasional eosinophils. Most of the infiltrating cells were positive for anti-neutrophil elastase, but negative for lymphoid markers. Therefore, differential diagnosis of a kidney tumor during the course of CML, especially in the time of blastic transformation, should be performed.     

T-cell blast crisis of chronic myelogenous leukemia manifesting as a large mediastinal tumor

We report an unusual case of T-cell blast crisis of chronic myelogenous leukemia (CML) with a clinical presentation more typical of de novo T-cell lymphoblastic lymphoma. The patient was a 32-year-old man who presented with acute superior vena cava syndrome 19 months after an initial diagnosis of CML and 5 months after allogeneic bone marrow transplantation. The tumor was composed of primitive lymphoid cells expressing CD2, CD3, CD4, CD5, CD7, CD8, and CD10. Although the clinical features were more typical of acute lymphoblastic leukemia/lymphoma, fluorescence in situ hybridization analysis showed the bcr-abl fusion gene within blastic tumor cells. This finding confirmed that the mass represented a blastic transformation of CML. We use the unusual features of the current case and the previous reports to suggest that the development of T-cell blast crisis of CML is dependent on the presence of both marrow and extramedullary disease and a mechanism to evade apoptosis.     

Cytogenetic peculiarities in chronic myelogenous leukemia

Cytogenetic investigations were performed in 185 patients with chronic myelogenous leukemia (CML) at all stages of the disease; 166 patients were Ph positive-159 (95.8%) of these showing the standard Ph translocation, and 7 (4.2%) variant translocations-17 patients were Ph negative. In 2 patients the cytogenetic analysis was unsuccessful. Additional aberrations were found in 40 (24.1%) of the Ph-positive patients. Nine (52.9%) of the Ph-negative patients showed chromosome anomalies. Besides the well known nonrandom abnormalities (-7, +8, i(17q), +19, +Ph) we found a high frequency of clones with rare or not yet described structural rearrangements--in 14 cases (34.2%) of the Ph-positive patients and in 2 cases (20%) of the Ph-negative patients with other chromosome abnormalities. The clinical significance of these findings is discussed.     

Bronchial extramedullary hematopoiesis preceding chronic myelogenous leukemia

Extramedullary hematopoiesis of the bronchus is rare. The case of a 72-year-old man in whom the right lower lobe bronchus was obstructed by extramedullary hematopoiesis is presented. Ten months after the initial presentation, Philadelphia chromosome-negative chronic myelogenous leukemia was diagnosed. Such findings have not been reported previously. The various anatomic locations of extramedullary hematopoiesis are reviewed, with an emphasis on intrathoracic and pulmonary presentations. The clinical and pathologic features and the differential diagnosis in the present case are discussed.     

Neoplastic reticulosis associated with chronic myelogenous leukemia

Summary Twelve cases of neoplastic reticulosis associated with chronic myelogenous leukemia were reviewed. These leukemic patients received long-term treatment with cytostatics and irradiation. Blastomatous reticulum cells appeared in the peripheral blood terminally. Neoplastic reticulosis was prevalent in post-mortal findings.This particular type of reticulosis was characterized by: 1. marked proliferation of pleomorphic reticulum cells with formation of giant cells, 2. a terminal dissemination of atypical reticulum cells by the blood stream, and 3. histological patterns specific for the lymph nodes, spleen and bone marrow. The lymph nodes showed a sinus reticulosis, blastomatous in nature. Lesions in the spleen were granulomatous, and the bone marrow had nodular lesions and tumors suggestive of reticulum cell sarcoma.A relationship between leukemia and reticulosis was discussed from various view-points. The treatment of leukemia with cytostatics and/or irradiation was considered to be most important in inducing a neoplastic reticulosis from a reactive one.

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Neoplastische Retikulose nach chronischer myeloischer Leukämie

Zusammenfassung Bericht über 12 Fälle von chronischer myeloischer Leukämie mit neoplastischer Retikulose. Alle 12 Patienten waren langzeitig mit Cytostatica und Bestrahlungen behandelt worden. Erst terminal kam es zur Ausschwemmung blastenartiger Reticulumzellen in die Blutbahn. Die neoplastische Retikulose bestimmte weitgehend den Obduktionsbefund.Die sekundäre maligne Retikulose ist anatomisch gekennzeichnet durch 1. eine Proliferation pleomorpher Reticulumzellen mit Bildung von Riesenzellen, 2. eine terminale Aus schwemmung atypischer Reticulumzellen in die Blutbahn, 3. organcharakteristische Reticulumzellwucherungen in Lymphknoten, Milz und Knochenmark. Die Lymphknoten zeigen das Bild der neoplastischen Sinusretikulose, die Milz das Bild der herdförmigen granulomatösen Reticulumzellwucherung, das Knochenmark sowohl noduläre wie geschwulstige Wucherungen von Reticulumzellen.Die Beziehungen der Leukämie zur Retikulose werden überprüft. Es ist wahrscheinlich, daß diese terminalen neoplastischen Retikulosen durch die Behandlung der Leukämien mit Cytostatica und Bestrahlungen ausgelöst worden sind.

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The author is indebted to Prof.Sasano for his kind advice and to those who gave their precious materials.     

Trisomy 11 in a patient with Ph-negative chronic myelogenous leukemia

A case of Ph-negative chronic myelogenous leukemia associated with functional reduction of platelets is described. Bone marrow cells examined in the blastic phase showed a stem line karyotype of 47,XY,+11.     

Complex cytogenetic changes in Ph-negative chronic myelogenous leukemia

A Ph-negative chronic myelogenous leukemia (CML) with t(3;7)(q21;q32), t(4;9)(q21;q34), and del(8)(q22) is reported. This case is rather unusual for Ph-negative CML in being associated with complex chromosome changes. The patient was diagnosed as in the accelerated phase of CML. It will be important to study this malignant disorder in detail cytogenetically and molecularly in order to ascertain its nature and place among the myeloproliferative disorders.     

14q+ in Ph-positive chronic myelogenous leukemia

Two cases of chronic myelogenous leukemia with a Ph translocation and an additional chromosome change of the long arm of a chromosome #14 (14q+) are reported. The breakpoints on chromosome #14 were identified as 14q24 and 14q32, respectively. One of the patients did not show any evidence of blastic transformation; the other patient developed a myeloid blastic crisis when the abnormal 14q+ was seen in the bone marrow cells.