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Pleural effusion as the initial extramedullary manifestation of Acute Myeloid Leukemia.

Nieves-Nieves J, Hernandez-Vazquez L, Boodoosingh D, Fernández-Gonzalez R, Fernández-Medero R, Adorno-Fontánez J, Adorno-Fontánez E, Lozada-Costas J - F1000Res (2012)

Bottom Line: The diagnosis was confirmed by bone marrow biopsy with expression of the antigens CD 34+ and CD13+, with unfavorable cytogenetic prognosis and a trisomy 21 chromosomal defect.Complications and disease progression precludes in the patient's death.Although rare, due to the unusual presentation of the disease, this case clearly demonstrates the importance of biochemical analysis and cytopathology specimens obtained in pleural fluid.

View Article: PubMed Central - PubMed

Affiliation: Pulmonary Medicine, San Juan City Hospital, San Juan, Puerto Rico.

ABSTRACT
Leukemias rarely debut by pleural involvement as the first manifestation of the hematologic malignancy. This complication is most commonly seen in solid tumors such as carcinomas of the breast, lung, gastrointestinal tract and lymphomas. We present a case of a 66 year old male who presented with a pleural leukemic infiltration of his undiagnosed Acute Myeloid Leukemia that was not a complication of the disease extension, but the acute presentation of the illness. Progressive shortness of breath for two weeks, cough, clear sputum and weight loss were the initial complaints. Serum dyscrasia suggested a hematologic abnormality. A chest x-ray performed demonstrated a buildup of fluid with layering in the left pleural cavity. Diagnostic thoracentesis suggested an exudative etiology with cytology remarkable for 62% leukemic myeloblast. The diagnosis was confirmed by bone marrow biopsy with expression of the antigens CD 34+ and CD13+, with unfavorable cytogenetic prognosis and a trisomy 21 chromosomal defect. Chemotherapy was initiated, though no remission achieved with induction chemotherapy. Complications and disease progression precludes in the patient's death. Although rare, due to the unusual presentation of the disease, this case clearly demonstrates the importance of biochemical analysis and cytopathology specimens obtained in pleural fluid.

No MeSH data available.


Related in: MedlinePlus

Trisomy 21 as the sole acquired karyotypic abnormality in our patient with acute myeloid leukemia (arrow).
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f3: Trisomy 21 as the sole acquired karyotypic abnormality in our patient with acute myeloid leukemia (arrow).

Mentions: A karyotypic abnormality of Trisomy 21 was revealed through cytogenetic studies (Figure 3), which is the second most common chromosomal defect in AML. The patient was treated with Idarubicin combined with Cytarabine for the recently discovered AML and there was no re-accumulation of the pleural fluid. However, bone marrow aspiration was repeated to assess response to chemotherapy and he still presented with 62% of blasts cells. A new cycle of chemotherapy was started with Mitoxantrone, Etoposide and Cytarabine but only a partial response was obtained. Despite the therapeutic regimen, due to the severity of the disease and the poor cytogenetic prognosis, the patient’s condition deteriorated. In view of no significant response to therapy and dismal prognosis, supportive measures and palliative care was provided and eventually the patient died due to complications associated to AML.


Pleural effusion as the initial extramedullary manifestation of Acute Myeloid Leukemia.

Nieves-Nieves J, Hernandez-Vazquez L, Boodoosingh D, Fernández-Gonzalez R, Fernández-Medero R, Adorno-Fontánez J, Adorno-Fontánez E, Lozada-Costas J - F1000Res (2012)

Trisomy 21 as the sole acquired karyotypic abnormality in our patient with acute myeloid leukemia (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3814911&req=5

f3: Trisomy 21 as the sole acquired karyotypic abnormality in our patient with acute myeloid leukemia (arrow).
Mentions: A karyotypic abnormality of Trisomy 21 was revealed through cytogenetic studies (Figure 3), which is the second most common chromosomal defect in AML. The patient was treated with Idarubicin combined with Cytarabine for the recently discovered AML and there was no re-accumulation of the pleural fluid. However, bone marrow aspiration was repeated to assess response to chemotherapy and he still presented with 62% of blasts cells. A new cycle of chemotherapy was started with Mitoxantrone, Etoposide and Cytarabine but only a partial response was obtained. Despite the therapeutic regimen, due to the severity of the disease and the poor cytogenetic prognosis, the patient’s condition deteriorated. In view of no significant response to therapy and dismal prognosis, supportive measures and palliative care was provided and eventually the patient died due to complications associated to AML.

Bottom Line: The diagnosis was confirmed by bone marrow biopsy with expression of the antigens CD 34+ and CD13+, with unfavorable cytogenetic prognosis and a trisomy 21 chromosomal defect.Complications and disease progression precludes in the patient's death.Although rare, due to the unusual presentation of the disease, this case clearly demonstrates the importance of biochemical analysis and cytopathology specimens obtained in pleural fluid.

View Article: PubMed Central - PubMed

Affiliation: Pulmonary Medicine, San Juan City Hospital, San Juan, Puerto Rico.

ABSTRACT
Leukemias rarely debut by pleural involvement as the first manifestation of the hematologic malignancy. This complication is most commonly seen in solid tumors such as carcinomas of the breast, lung, gastrointestinal tract and lymphomas. We present a case of a 66 year old male who presented with a pleural leukemic infiltration of his undiagnosed Acute Myeloid Leukemia that was not a complication of the disease extension, but the acute presentation of the illness. Progressive shortness of breath for two weeks, cough, clear sputum and weight loss were the initial complaints. Serum dyscrasia suggested a hematologic abnormality. A chest x-ray performed demonstrated a buildup of fluid with layering in the left pleural cavity. Diagnostic thoracentesis suggested an exudative etiology with cytology remarkable for 62% leukemic myeloblast. The diagnosis was confirmed by bone marrow biopsy with expression of the antigens CD 34+ and CD13+, with unfavorable cytogenetic prognosis and a trisomy 21 chromosomal defect. Chemotherapy was initiated, though no remission achieved with induction chemotherapy. Complications and disease progression precludes in the patient's death. Although rare, due to the unusual presentation of the disease, this case clearly demonstrates the importance of biochemical analysis and cytopathology specimens obtained in pleural fluid.

No MeSH data available.


Related in: MedlinePlus