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Acute Myelomonocytic Leukemia

Blastic Granulocytic Leukemia


Presentation

  • Granulocytic sarcoma can be the presenting feature of acute leukemia and can occur as an abdominal or pelvic mass.[ncbi.nlm.nih.gov]
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]
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]
  • Three patients were being treated for typical multiple myeloma (anemia, elevated sedimentation rate, monoclonal serum peak, Bence-Jones protein in the urine, lytic bone lesions and increased numbers of myeloma cells in the marrow), and one for a plasma-cell[nejm.org]
  • Procedures Corresponding ICD-9 Codes 205.0 Acute myeloid leukemia Corresponding ICD-10 Codes C92.5 Acute myelomonocytic leukemia Corresponding ICD-10-CM Codes (U.S. only) C92.5 Acute myelomonocytic leukemia (effective October 01, 2015) Signs and Symptoms Anemia[seer.cancer.gov]
  • Differential Diagnosis: Congenital dyserythropoietic anemia, myelodysplastic syndrome, sideroblastic anemia, and megaloblastic anemia.[med-ed.virginia.edu]
  • A routine blood count revealed leukocytosis white blood cell (WBC) count, 58,000/cmm and anemia (HBG 6 g/dl) suggesting an acute leukemia and the patient were referred to Department of Medicine, Goa Medical College and Hospital.[jisponline.com]
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]
  • Thus, there is a diminished production of normal erythrocytes, causing anemia, weakness, fatigue, and pallor; granulocytes causing granulocytopenia, fever, and infection; and platelets causing thrombocytopenia, bleeding, petechiae, and bruising.[jisponline.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]
  • 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]
Gangrene
  • Histopathology of the gallbladder showed infiltrating myeloblasts within the mucosa, submucosa, and muscularis consistent with a granulocytic sarcoma associated with gangrenous cholecystitis due to cholelithiasis.[ncbi.nlm.nih.gov]
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]
  • Patients may show symptoms related to cytopenias and hypercatabolic state with splenomegaly.[medigraphic.com]
  • 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]
  • 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]
Pelvic Mass
  • Granulocytic sarcoma can be the presenting feature of acute leukemia and can occur as an abdominal or pelvic mass.[ncbi.nlm.nih.gov]
Murphy's Sign
  • The right upper quadrant ultrasound showed a thickened gallbladder wall with cholelithiasis, a positive sonographic Murphy sign, and marked dilatation of the common bile duct, which was up to 17 mm in diameter.[ncbi.nlm.nih.gov]
Jaundice
  • 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]
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]
Loss of Initiative
  • 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]
Renal Insufficiency
  • 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]
  • In a retrospective analysis of 256 patients who received high-dose bolus cytarabine at a single institution, the most powerful predictor of cytarabine neurotoxicity was renal insufficiency.[northshore.org]
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

  • 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]
  • 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]
Ovarian Mass
  • 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]
Elevated Sedimentation Rate
  • Three patients were being treated for typical multiple myeloma (anemia, elevated sedimentation rate, monoclonal serum peak, Bence-Jones protein in the urine, lytic bone lesions and increased numbers of myeloma cells in the marrow), and one for a plasma-cell[nejm.org]

Treatment

  • Bone pain and promyelocytes regressed spontaneously while maintenance treatment continues. We advise that a pseudorelapse must be borne in mind after HDMP and probably GM-CSF treatments in acute leukaemias.[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]
  • Epidemiology of myelodysplastic syndromes and chronic myeloproliferative disorders in the United States, 2001-2004, using data from the NAACCR and SEER programs. Blood. 2008 Jul;112(1):45-52. DOI: 10.1182/blood-2008-01-134858. 9.[content.sciendo.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]
Sex distribution
Age distribution

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]
  • Preventive CNS treatment Supportive therapy Supportive therapy is very important as patients are severely immunocompromised .[amboss.com]
  • 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]
  • 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]
  • […] and “What can I do to prevent AML from coming back?” Find organizations that provide support Organizations such as the American Cancer Society (ACS) offer a number of supportive services.[healthline.com]

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