Presentation
Granulocytic sarcoma can be the presenting feature of acute leukemia and can occur as an abdominal or pelvic mass. [ncbi.nlm.nih.gov]
Immune System
- Splenomegaly
We report a case in a 27-year-old man with leukocytosis (10.6 x 10(3)/microL with 34% blasts), thrombocytopenia and splenomegaly. [ncbi.nlm.nih.gov]
The clinical and morphologic features that prompted us to consider an uncommon evolution from a myeloproliferative neoplasm were massive splenomegaly and peripheral basophilia. [ijpmonline.org]
Initially asymptomatic, CML progression is insidious, with a nonspecific “benign” stage (malaise, anorexia, weight loss) eventually giving way to accelerated or blast phases with more ominous signs, such as splenomegaly, pallor, easy bruising and bleeding [msdmanuals.com]
Patients may show symptoms related to cytopenias and hypercatabolic state with splenomegaly. [medigraphic.com]
Clinical findings: Individuals with CML present with splenomegaly (enlarged spleen); elevated white blood counts exceeding 300,000- 600,000 cells/ μL; and retinas showings papilledema, venous obstruction, and hemorrhages. [secure.ssa.gov]
- Generalized Lymphadenopathy
On physical examination, he had huge splenomegaly and hepatomegaly, sternal tenderness and generalized lymphadenopathy. [ajmhs.org]
Entire Body System
- Fever
A 65-year-old Japanese woman developed low grade fever, headache and exanthema. Hematology testing disclosed leukocytosis of 95,600/mm3 with 65% monocytes and 9% blast cells. Infiltrated erythema and nodules were disseminated over most of her body. [ncbi.nlm.nih.gov]
If infection is suspected or neutropenia and/or fever is present: broad-spectrum antibiotics (see: neutropenic fever ) In case of lymphopenia : PCP prophylaxis with SMP/TMX Herpes simplex prophylaxis with acyclovir may be necessary. [amboss.com]
- Anemia
We experienced one case of refractory anemia with excess blasts which progressed to refractory anemia with excess blasts in transformation and finally to acute myelomonocytic leukemia with eosinophilia showing peculiar chromosomal abnormalities of der [ncbi.nlm.nih.gov]
Differential Diagnosis: Congenital dyserythropoietic anemia, myelodysplastic syndrome, sideroblastic anemia, and megaloblastic anemia. [med-ed.virginia.edu]
[…] w excess blasts in transformation, i Refractory anemia with excess blasts in transformation in remission Clinical Information Acute myeloid leukemia not growing, responding to treatment. [icd10data.com]
This slows the production of red blood cells and platelets, causing tiredness from anemia and a risk of bleeding from a low platelet count. [aamds.org]
- Weight Loss
This case report describes a 53-year-old male who presented with gingival enlargement and bleeding, fatigue, and recent weight loss as initial manifestations of acute myelomonocytic leukemia. [ncbi.nlm.nih.gov]
Symptoms of AML include: Fever Shortness of breath Easy bruising or bleeding Bleeding under the skin Weakness or feeling tired Weight loss or loss of appetite Tests that examine the blood and bone marrow diagnose AML. [icdlist.com]
These patients often have fever, poor appetite, and weight loss. In this phase, the CML acts a lot like an acute leukemia. [cancer.org]
Initially asymptomatic, CML progression is insidious, with a nonspecific “benign” stage (malaise, anorexia, weight loss) eventually giving way to accelerated or blast phases with more ominous signs, such as splenomegaly, pallor, easy bruising and bleeding [msdmanuals.com]
Patients in blast phase often have a fever, an enlarged spleen, weight loss, and generally feel unwell. Resistant CML. Resistant CML is CML that has come back after treatment or does not respond to treatment. [cancer.net]
- Pallor
Primary manifestations include mucosal pallor secondary to anemia, odontalgia, ulceration of the palate, gingival bleeding, gingivitis, petechiae and ecchymoses of the hard and soft palate, tongue and tonsils are also observed. 1-4 Gingival hyperplasia [cda-adc.ca]
Initially asymptomatic, CML progression is insidious, with a nonspecific “benign” stage (malaise, anorexia, weight loss) eventually giving way to accelerated or blast phases with more ominous signs, such as splenomegaly, pallor, easy bruising and bleeding [msdmanuals.com]
Symptoms Symptoms can include : a high fever a large number of infections over a short period breathlessness fatigue and confusion hyperhidrosis (sweating a lot) pain in the joints, and perhaps also the bones pallor skin bruising easily slurred speech [medicalnewstoday.com]
References: [10] Clinical features Symptoms occurring in both AML and ALL Fatigue, pallor, and weakness (caused by anemia ) Bleeding ( petechiae, epistaxis ;, or hematoma, caused by thrombocytopenia ) Hepatomegaly and/or splenomegaly (caused by leukemic [amboss.com]
On general examination, the patient had pallor, huge splenomegaly. Physical examination was otherwise unremarkable. Hemogram revealed hemoglobin - 7.2 g/dl, white blood cell (WBC) - 33500/μl, platelet - 2.43 lakh/μl. [ijpmonline.org]
- Ecchymosis
Six months later, she was brought to the emergency unit with coma, hypovolemic shock, and multiple ecchymosis in her extremities and gingival bleeding. The therapy was maintained in the intensive care unit. [ispub.com]
[…] may also infiltrate spleen, lymph nodes, the central nervous system, skin, gingiva and other tissues throughout the body. [1] Most frequent oral finding in leukemia is erythematous or cyanotic gingival hyperplasia with or without necrosis, petechiae, ecchymosis [jisponline.com]
Physical examination revealed skin ecchymosis and enlarged lymph nodes in his cervical, axillary, and inguinal areas, the largest of which was 3 × 2 cm. Neither hepatosplenomegaly nor splenomegaly was noted. [diagnosticpathology.biomedcentral.com]
Gastrointestinal
- Abdominal Pain
CASE REPORT A 74-year-old Hispanic woman from Ecuador presented to the emergency department with a five-day history of fever, jaundice, and right upper quadrant abdominal pain. [ncbi.nlm.nih.gov]
Some patients may also experience extreme fatigue, shortness of breath, and abdominal pain. Blast crisis closely resembles acute leukemia and has a survival range of three to six months. [nationalcmlsociety.org]
The symptoms of all types of leukemia are generally the same and include: fatigue (tiredness) and weakness swollen lymph nodes recurrent infections (such as bronchitis or tonsillitis ) fever easy bruising bone and joint pain abdominal pain (caused by [kidshealth.org]
Megakaryocytic blast crisis in patients with CML is unusual, constituting [1] A 26-year-old male patient presented to our hospital with complaint of low-grade fever and abdominal pain for the past 6 months. [ijpmonline.org]
[…] images in patients with abdominal pain and distention to rule out perforation; extremity images in patients to rule out metaphyseal bands at the distal femurs (mostly in pediatric ALL), periosteal new bone formation, focal lytic lesions, or pathologic [emedicine.medscape.com]
Skin
- Petechiae
A 48-year-old Japanese man was admitted to our hospital because of general fatigue, nasal bleeding, and petechiae on his extremities. He was diagnosed with acute myelomonocytic leukemia with trilineage myelodysplasia (T-MDS). [ncbi.nlm.nih.gov]
[…] myelomonocytic leukemia Corresponding ICD-10-CM Codes (U.S. only) C92.5 Acute myelomonocytic leukemia (effective October 01, 2015) Signs and Symptoms Anemia Easy bruising or bleeding Fatigue Fever High white blood cell count with numerous blasts and promonocytes Petechiae [seer.cancer.gov]
Primary manifestations include mucosal pallor secondary to anemia, odontalgia, ulceration of the palate, gingival bleeding, gingivitis, petechiae and ecchymoses of the hard and soft palate, tongue and tonsils are also observed. 1-4 Gingival hyperplasia [cda-adc.ca]
(b) Mandibular occlusal and (c) Maxillary occlusal view of the gingival overgrowth at first visit Click here to view There was no evidence of lymphadenopathy, hepatospleenomegaly, cutaneous bruising, or petechiae. [jisponline.com]
- Night Sweats
Symptoms of chronic myelogenous leukemia include fever, night sweats, and feeling tired. Sometimes chronic myelogenous leukemia does not cause any symptoms. [cdc.gov]
Other symptoms may include excessive sweating (night sweats), weight loss, and an increased sensitivity to warm temperatures. [nationalcmlsociety.org]
The initial symptoms of both lymphocytic and myelogenous leukemia can include fever, fatigue, night sweats, swollen lymph nodes in the neck, under the arms, or in the groin, frequent infections, and weight loss. [blog.dana-farber.org]
When symptoms do appear, they may include a feeling of no energy, fever, lack of appetite, and night sweats. The spleen (in the right upper part of the abdomen) may be swollen and markedly enlarged. [medicinenet.com]
They include: Swollen lymph nodes that usually don't hurt (especially lymph nodes in the neck or armpit) Fevers or night sweats Frequent infections or poor healing of minor cuts Feeling weak or tired Bleeding and bruising easily (bleeding gums, purplish [roswellpark.org]
Neurologic
- Peripheral Neuropathy
Infiltrative peripheral neuropathy of acute monoblastic leukemia during hematologic remission. Rinsho Ketsueki 1994;35:876-80. [ PUBMED ] 15. Fukushima H, Fukushima T, Hiraki A, Suzuki R, Mahmoud SS, Yoshimi A, et al. [ruralneuropractice.com]
Workup
Diagnostic workup should include a complete blood cell count (CBC) with differential, bone marrow analysis with conventional cytogenetics, flow cytometry to determine whether the blast phase is of myeloid or lymphoid origin, and molecular mutational analysis [mdedge.com]
References: [11] [1] [2] [12] Diagnostics Laboratory tests The diagnostic workup usually includes clinical examination, CBC, peripheral blood smear, and a bone marrow aspirate or biopsy. [amboss.com]
Diagnostic workup of a patient with pre–B-cell acute lymphoblastic leukemia. Bone marrow aspiration revealed French-American-British L2 morphology. [emedicine.medscape.com]
The workup for AML includes blood tests, bone marrow aspiration and biopsy (the definitive diagnostic tests), and analysis of genetic abnormalities. (See Workup .) Current standard chemotherapy regimens cure only a minority of patients with AML. [emedicine.com]
Serum
- Hyperuricemia
[…] after initiating cytotoxic treatment of ALL, AML, or NHL Symptoms Nausea, vomiting, and diarrhea Lethargy Hematuria Cardiac dysrhythmias Tetany, muscle cramps Paresthesia Electrolyte changes Hyperphosphatemia and secondary hypocalcemia Hyperkalemia Hyperuricemia [amboss.com]
His previous history further revealed cervical disc extraction in 1981 complicated by recurrent abscess formation and antibiotic treatment until 2010, lumbar disc extraction in 2006, prostatectomy in 2009, knee endoprosthesis in 1/2014, hyperuricemia, [ruralneuropractice.com]
This condition is often characterized by pronounced metabolic abnormalities, including hyperkalemia, hypocalcemia, hyperuricemia, and renal failure. [emedicine.medscape.com]
Laboratory
- Leukocytosis
We report a case in a 27-year-old man with leukocytosis (10.6 x 10(3)/microL with 34% blasts), thrombocytopenia and splenomegaly. [ncbi.nlm.nih.gov]
Hematology testing disclosed leukocytosis of 95,600/mm3 with 65% monocytes and 9% blast cells. Infiltrated erythema and nodules were disseminated over most of her body. Moreover, linear scratched wounds and traumatic scars were indurated. [semanticscholar.org]
Below are some differential diagnoses based on the CBC and WBC differential Leukocytosis and ≥20% blasts Acute leukemia Leukopenia and ≥20% blasts Acute leukemia Leukocytosis and 1-19% blasts Acute leukemia Myeloproliferative neoplasm (e.g. chronic myeloid [corpath.net]
Treatment
During the course of the treatment, the patient achieved and maintained good general condition for more than nine months after the initiation of the treatment. [ncbi.nlm.nih.gov]
Prognosis
Two cases of granulocytic sarcomas presenting as ovarian masses in patients with acute myelomonocytic leukemia with a characteristic inversion of chromosome 16 are described and the current literature regarding treatment and prognosis is reviewed. [ncbi.nlm.nih.gov]
Etiology
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]
While renal insufficiency may result from a variety of mechanisms in the setting of leukemia, severe leukostasis with microvascular insufficiency and renal parenchymal infiltration by blast cells are rare and infrequently described etiologies. [ncbi.nlm.nih.gov]
[…] remote likelihood of chance association of acute leukemia and multiple myeloma, the known effect of alkylating agents on deoxyribonucleic acid, the fact that the leukemia was myelomonocytic, and the long period of treatment with melphalan, a possible etiologic [nejm.org]
Epidemiology
[…] bleeding Fatigue Fever High white blood cell count with numerous blasts and promonocytes Petechiae Thrombocytopenia Shortness of breath Weakness Diagnostic Exams Immunophenotyping Lumbar puncture Peripheral blood smear Progression and Transformation None Epidemiology [seer.cancer.gov]
Case Name (click on case name to open) Comments Size M4-1 M5b or M4 8.5 Mb Case 2 AMoML case submitted by UTMC 2.6 Mb Epidemiology Acute myelomonocytic leukemia comprises approximately 15-25% of all cases of AML. [wiki.clinicalflow.com]
Gertz Springer, 15 mar. 2018 - 1338 pagini The new edition of this textbook integrates the history, epidemiology, pathology, pathophysiology, therapeutics, and supportive care of modern neoplastic hematopathology. [books.google.ro]
[…] adulthood are myelogenous References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
Pathophysiology
Gertz Springer, 15 mar. 2018 - 1338 pagini The new edition of this textbook integrates the history, epidemiology, pathology, pathophysiology, therapeutics, and supportive care of modern neoplastic hematopathology. [books.google.ro]
The underlying pathophysiology in AML consists of a maturational arrest of bone marrow cells in the earliest stages of development. (See Pathophysiology .) [emedicine.com]
This includes their origin (B or T cell ) and maturity: B-cell ALL (around 80–85% of cases) T-cell ALL (around 15–20% of cases) References: [2] [9] Pathophysiology Two-hit hypothesis The two-hit hypothesis assumes that leukemia is the result of two separate [amboss.com]
Prevention
B and T cells play active roles in preventing the body from infections and germs and destroying cells that have already become infected. B cells particularly help prevent germs from infecting the body while T cells destroy the infected cells. [cancercenter.com]
Screening & Prevention for Gastric Cancer Information about the prevention of cancer and the science of screening appropriate individuals at high risk of developing cancer is gaining interest. [news.cancerconnect.com]
Preventive CNS treatment Supportive therapy Supportive therapy is very important as patients are severely immunocompromised. [amboss.com]
Genomic instability and prevention of blastic transformation Currently, BP-CML remains a major therapeutic challenge. [bloodadvances.org]
These cells crowd the bone marrow, preventing it from making normal blood cells. They can also spill out into the bloodstream and circulate around the body. Due to their immaturity they are unable to function properly to prevent or fight infection. [leukaemia.org.au]