The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

A Case of Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia in an Adult Presenting with an Extramedullary Bone Tumor

골수 외 골 종괴를 동반한 필라델피아 염색체 양성 급성 림프모구백혈병

  • Lee, Ho Jin (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Lee, Hye Jung (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Park, In Chul (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Lee, Ji Hyun (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Kim, Sung-Hyun (Department of Internal Medicine, Dong-A University College of Medicine)
  • 이호진 (동아대학교 의과대학 내과학교실) ;
  • 이혜정 (동아대학교 의과대학 내과학교실) ;
  • 박인철 (동아대학교 의과대학 내과학교실) ;
  • 이지현 (동아대학교 의과대학 내과학교실) ;
  • 김성현 (동아대학교 의과대학 내과학교실)
  • Received : 2013.10.01
  • Accepted : 2013.10.29
  • Published : 2014.07.01
⟨ Previous Next ⟩

Abstract

Acute lymphoblastic leukemia (ALL) is a lymphoid malignancy characterized by impaired differentiation and proliferation of leukemic myeloblasts. Normal hematopoietic cells are replaced by excess myeloblasts, causing bone marrow failure. Therefore, patients with ALL typically present with symptoms related to infection, anemia, and thrombocytopenia. Extramedullary involvement of ALL as an initial presenting symptom has rarely been reported in adults, although several such cases of relapse have been described. Isolated extramedullary manifestations may lead to a late diagnosis of ALL. We describe herein a patient with Philadelphia chromosome-positive ALL presenting with an extramedullary bone tumor.

본 증례에서 저자들은 주기적인 혈액 검사에서 정상소견을 유지하였고 백혈병의 골수 외 침범으로 인한 무릎의 통증 이외 특이소견을 보이지 않았던 급성 림프모구백혈병 환자의 사례를 국내에서 경험하였기에 보고하는 바이다.

Keywords

References

  1. Chen CC, Weng HH, Hwang CE, Lu CH, Chen PT, Gau JP. Acute leukemia presenting with extramedullary diseases and completely normal hemogram: an extremely unusual manifestation unique to pre-B ALL. Am J Hematol 2010;85:729-731. https://doi.org/10.1002/ajh.21801
  2. Bayrak IK, Yalin T, Ozmen Z, Aksoz T, Doughanji R. Acute lymphoblastic leukemia presented as multiple breast masses. Korean J Radiol 2009;10:508-510. https://doi.org/10.3348/kjr.2009.10.5.508
  3. Trapani S, Grisolia F, Simonini G, Calabri GB, Falcini F. Incidence of occult cancer in children presenting with musculoskeletal symptoms: a 10-year survey in a pediatric rheumatology unit. Semin Arthritis Rheum 2000;29:348-359. https://doi.org/10.1053/sarh.2000.5752
  4. Jonsson OG, Sartain P, Ducore JM, Buchanan GR. Bone pain as an initial symptom of childhood acute lymphoblastic leukemia: association with nearly normal hematologic indexes. J Pediatr 1990;117(2 Pt 1):233-237. https://doi.org/10.1016/S0022-3476(05)80535-9
  5. Korholz D, Bruder M, Engelbrecht V, Ruther W, Gobel U. Aseptic osteonecrosis in children with acute lymphoblastic leukemia. Pediatr Hematol Oncol 1998;15:307-315. https://doi.org/10.3109/08880019809014014
  6. Maman E, Steinberg DM, Stark B, Izraeli S, Wientroub S. Acute lymphoblastic leukemia in children: correlation of musculoskeletal manifestations and immunophenotypes. J Child Orthop 2007;1:63-68. https://doi.org/10.1007/s11832-007-0013-9
  7. Lin P, Jones D, Dorfman DM, Medeiros LJ. Precursor B-cell lymphoblastic lymphoma: a predominantly extranodal tumor with low propensity for leukemic involvement. Am J Surg Pathol 2000;24:1480-1490. https://doi.org/10.1097/00000478-200011000-00003
  8. Crazzolara R, Bernhard D. CXCR4 chemokine receptors, histone deacetylase inhibitors and acute lymphoblastic leukemia. Leuk Lymphoma 2005;46:1545-1551. https://doi.org/10.1080/10428190500215027
  9. Juarez J, Dela Pena A, Baraz R, et al. CXCR4 antagonists mobilize childhood acute lymphoblastic leukemia cells into the peripheral blood and inhibit engraftment. Leukemia 2007;21:1249-1257. https://doi.org/10.1038/sj.leu.2404684
  10. Lee JH, Choi SJ, Lee JH, et al. Anti-leukemic effect of graft-versus-host disease on bone marrow and extramedullary relapses in acute leukemia. Haematologica 2005;90:1380-1388.