An Autopsy Case of Acute Myelogenous Leukemia associated with Ascending Transverse Spinal Syndrome and Review of the Literature

Hiroshi SHIBASAKI; Kazuaki TAKEUCHI; Michitoshi SASAKI; Tohru OKAZAKI; Yukishige MITSUYASU

doi:10.2176/nmc.8.49

Hiroshi SHIBASAKI, Kazuaki TAKEUCHI, Michitoshi SASAKI, Tohru OKAZAKI, Yukishige MITSUYASU

著者情報

ジャーナルフリー

1966 年 8 巻 p. 49-72

DOI https://doi.org/10.2176/nmc.8.49

詳細

Published: 1966 Received: - Available on J-STAGE: 2007/01/16 Accepted: - Advance online publication: - Revised: -
訂正情報
訂正日: 2007/01/16 訂正理由: - 訂正箇所: 論文抄録訂正内容: Wrong : The involvement of the nervous system has been noted in 20 to 60 per cent of leukemias^{32, 40, 43, 71, 85, 94, 101, 112)}. However, the spinal involvement is less common (5 per cent)^{70, 102, 106)}. There have been about 95 reports of such complication in the Western countries since the report of Burns (1824)¹¹⁾, and 40 of such in Japan.
The purpose of this paper is to report of our recent case of myelogenous leukemia with spinal complication, and to discuss the pathogenesis of such complication, reviewing the literature.
Right : We reported a case of acute myelogenous leukemia associated with complete spinal transverse syndrome, which suddenly developed 3 weeks prior to death and ascended rapidly to the Th4 level. The serial sections of the spinal cord revealed parenchymatous changes consisting of softening, necrosis and hemorrhage in the Th4 through Th8 cord and the L1 and L2 cord, with no leukemic cell infiltration in the parenchyma. There was an epidural infiltration of leukemic cells, forming tumor-like masses between Th6 and Th10 segment. Hemorrhage was seen in the posterior nerve roots.
The involvement of the spinal cord was reviewed from 40 reported cases in Japan comparing with 95 cases from the Western countries. The spinal cord involvement in leukemia was most frequently seen in young males, and in the course of acute myelogenous leukemia. The commonest clinical manifestation was paraplegia and sphincter disturbance. The commonest pathological change was the parenchymatous changes in the Japanese cases, in comparison with the frequent ocurrence of meningeal infiltration or epidural tumor formation in the Western ones. In the spinal involvement the thoracic cord was involved most frequently.
In our case, the parenchymatous change of the spinal cord was most likely to have been caused by a circulatory disturbance, due to epidural compression by the deposits of leukemic cells.

訂正日: 2007/01/16 訂正理由: - 訂正箇所: 著者情報訂正内容: Wrong : Hiroshi SHIBASAKI¹⁾, Kazuaki TAKEUCHI¹⁾, Michitoshi SASAKI¹⁾, Tohru OKAZAKI¹⁾, Yukishige MITSUYASU²⁾
Right : Hiroshi SHIBASAKI, Kazuaki TAKEUCHI, Michitoshi SASAKI, Tohru OKAZAKI¹⁾, Yukishige MITSUYASU²⁾

訂正日: 2007/01/16 訂正理由: - 訂正箇所: 引用文献情報訂正内容: Wrong : 1) Akanuma, J. und Iwashita, I.: Über 3 Fälle von Chlorom. GANN (Jap.), 33: 175-178, 1939.
2) Anderson, C. D. and Roberts, G. B.: A case of acute leukaemia with complete remission and death from subsequent development of chloromata. Glasgow Med. J., 35: 95-104, 1954.
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Right : 1) Akanuma, J. und Iwashita, I.: Über 3 Fälle von Chlorom. GANN (Jap.), 33: 175-178, 1939.
2) Anderson, C. D. and Roberts, G. B.: A case of acute leukaemia with complete remission and death from subsequent development of chloromata. Glasgow Med. J., 35: 95-104, 1954.
3) Ando, K. and Komori, Y.: Hematomyelia with blood diseases. Advances in Neurol. Sci. (Jap.), 4: 299-302, 1960.
4) Baker, G. P. and Oliver, R. A. M.: Neurological complications of acute leukaemia in remission. Lancet, 1: 837-838, 1962.
5) Bamforth, J. and Edwards, J. L.: Chloroma, an account of four cases. Lancet, 1: 857-861, 1933.
6) Bamforth, J. and Kendall, D.: A case of megakaryocytic myelosis with paraplegia. Acta Med. Scand., 99: 494, 1939.
7) Bassoe, P.: Leukemic infiltration in the spinal canal as a cause of paraplegia. J. Nerv. & Ment. Dis., 47: 180-190, 1918.
8) Baudouin, A. et Parturier, G.: Sur les complications nerveuses des leucémies. Revue Neurol., 19: 673-680, 1910.
9) Blaschy, R.: Polyneuritisähnliches Krankheitsbild bei Leukämie. Münch. Med. Wschr., 76: 2166-2167, 1929.
10) Bloch, E. und Hirschfeld, H.: Zur Kenntnis der Veränderungen an Zentralnervensystem bei Leukämie. Z. Klin. Med., 37: 32-43, 1900.
11) Burns, A.: Observations on the Surgical Anatomy of the Head and Neck. Wardlaw & Cunningham, Glasgow, 2nd ed., 1924, p. 386. Cited from Critchley, M.: Brain, 53: 11, 1930.
12) Burns, E. W.: Chloroma and paraplegia: report of a case. New Zeal. Med. J., 62: 422-425, 1963.
13) Cornil, L., Olmer, D. et Olmer, J. et al.: Paralysie ascendante de Landry avec leucocytomyélie et syndrome de Froin au cours d'une leucémie myéloide. Sang, 6: 114-120, 1932.
14) Critchley, M. and Greenfield, J. G.: Spinal symptoms in chloroma and leukemia. Brain, 53: 11-37, 1930.
15) Cunningham, G. L.: A case of acute leukemia with widespread chloromatous infiltration. Glasgow Med. J., 35: 51-53, 1954.
16) Dereymacker, A.: Complications médullaires au cours d'une leucémie myéloide aigue. J. Gelge. Neurol., 40: 509, 1940.
17) Diamond, I. B.: Leukemic changes in the brain; a report of fourteen cases. Arch. Neur. Psych., 32: 118-142, 1934.
18) Dittrich: Prag. Vierteljschr. Prakt. Heilkunde, 2: 104, 1846. Cited from Critchley, M.: Brain, 53: 11, 1930.
19) Dock, G.: Chloroma and its relation to leukaemia. Am. J. Med. Sc., 106: 152-185, 1893.
20) Dock, G. and Warthin, A. S.: A new case of chloroma with leukemia; with a study of cases reported since 1893. Tr. Ass. Am. Physics., 19: 64-115, 1904.
21) Eichhorst, H.: Über Erkrankungen des Nervensystems im Verlaufe der Leukämie. Dtsch. Arch. f. Klin. Med., 61: 519-544, 1898.
22) Ford, F. F.: Diseases of the Nervous System in Infancy, Childhood and Adolescence. Charles C. Thomas, Springfield, Ill., 4th ed., p. 1073-1079, 1960.
23) Fukuhara, A., Date, Y. and Awai, M.: A case of acute myelogenous leukemia with paraplegia. Saishin-Igaku (Jap.), 13: 1903-1906, 1958.
24) Gadermann, E. und Zeman, W.: Querschnittssyndrom bei Paramyeloblastose. Zschr. ges. inn. Med., 6: 277-280, 1951.
25) Gauld, W. R.: Leukaemia presenting with neurological manifestations. Lancet, 1: 939-941, 1948.
26) Geitlin, F.: Till kännedomen om ryggmärgsförändringar vid nägra konstitutionssjukdomar. Finska läk-sällsk. handl. Helsingfors, 14: 603-614, 1903.
27) Giraud, G., Latour, H. et Lévy, A.: Hémorrhagies du cône médullaire révélatrices d'une leucoblastose. Montpellier Méd., 37: 101-104, 1950.
28) Gordin, R.: Leukämie und Zentralnervensystem. Acta Psychiat. Neurol., 11: 227-250, 1936.
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We reported a case of acute myelogenous leukemia associated with complete spinal transverse syndrome, which suddenly developed 3 weeks prior to death and ascended rapidly to the Th4 level. The serial sections of the spinal cord revealed parenchymatous changes consisting of softening, necrosis and hemorrhage in the Th4 through Th8 cord and the L1 and L2 cord, with no leukemic cell infiltration in the parenchyma. There was an epidural infiltration of leukemic cells, forming tumor-like masses between Th6 and Th10 segment. Hemorrhage was seen in the posterior nerve roots.
The involvement of the spinal cord was reviewed from 40 reported cases in Japan comparing with 95 cases from the Western countries. The spinal cord involvement in leukemia was most frequently seen in young males, and in the course of acute myelogenous leukemia. The commonest clinical manifestation was paraplegia and sphincter disturbance. The commonest pathological change was the parenchymatous changes in the Japanese cases, in comparison with the frequent ocurrence of meningeal infiltration or epidural tumor formation in the Western ones. In the spinal involvement the thoracic cord was involved most frequently.
In our case, the parenchymatous change of the spinal cord was most likely to have been caused by a circulatory disturbance, due to epidural compression by the deposits of leukemic cells.

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