Abstract
There have been many discussions of the interrelationship between aplastic anemia and leukemia. In view of this, a brief report seems warranted.
Case: A 57-year-old male with no signs or complaints, was admitted to this hospital for health examination in February, 1968. Hematological examinations showed slight pancytopenia and mild hypoplastic bone marrow. He was treated as hypoplastic anemia for about 7 months since that time in our hematology OPD, working as usual until the second admission in November, 1969, when he was diagnosed as acute leukemia because of fever, skin involvement and the appearance of atypical immature cells in the blood and bone marrow. He suddenly died on the 9th hospital day of bilateral leukemic pneumopathy with marked hemorrhage.
Autopsy revealed leukemic infiltrations in the bone marrow and other organs. Infiltrating cells had some similarity to reticulum cells, having marked cytoplasmic deformity and irregular pseudopods. The majority of the cells showed negative peroxydase and PAS reactions, and positive SDH reaction.
On electron microscopic investigation, free ribosomes were found only sparsely, and the endoplasmic reticulums were rare. The mitochondriae predominantly situated in the nuclear indentation. The Golgi-apparatus were well developed.
Examinations on the first admission had shown various coagulation abnormalities, i.e. prolonged bleeding time and heparin clotting time, decreased plasma prothrombin value, and increased serum prothrombin value. These abnormal coagulabilities might be a good reflection of the preleukemic state. A review of the bone marrow specimen obtained 20 months before his death revealed immature “cell nests” suggestive of developing leukemia in some part of hypoplastic bone marrow.
