Abstract
There are only 3 papers reporting chronic granulocytic leukemia associated with chronic hemodialysis, although a high incidence of malignancy in uremic or hemodialysis patients has been reported.The authors present a patient under chronic hemodialysis who represented tumor-forming acute exacerbation of chronic granulocytic leukemia (CGL).
A 45-year-old man was admitted to our hospital on August 30, 1983, with the complaints of severe right frontalgia and total ophthalmoplegia.He had been on chronic hemodialysis/since March 1976. In July 1980, he was diagnosed as having chronic granulocytic leukemia because of leukocytosis, hypercellular bone marrow without hiatus leukemicus, a low neutrophil alkaline phosphatase level, and positive Ph' chromosome in bone marrow cells.No symptoms had been observed, and the white blood cell count had been controlled between 30, 000 and 50, 000/mm3 with busulfan until August 1983.Computed tomography (CT) of the brain showed a mass near the sella in July 1983, when he had complained of headache and ophthalmoplegia.
On admission, bone marrow examination and peripheral blood smears were consistent with the chronic phase of CGL.However, a second enhanced CT revealed a bulky mass in the cavernous sinus invading toward the sella and sphenoidal sinus, indicating tumor-forming acute exacerbation of CGL These symptoms improved immediately after cranial irradiation. However, generalized tumor formation had appeared gradually, followed by acute leukemic axacerbation in the bone marrow. He died of hyperkalemia due to gastrointestinal bleeding on January 24, 1984.
The autopsy showed multiple tumors in the subcutis, mediasteinum, thyroid gland, liver, kidney, gastrointestinal tract, bone marrow, and other areas.The microscopic findings were similar to those of the large cell type of non -Hodgkin's lymphoma.
