A Case of Chronic Myelocytic Leukemia Presenting with a Hematoma in the Left Thigh

Abstract

A 29-year-old male noticed pain and swelling in the left thigh without any notable history of trauma in early February 1979. Hevisited a local hospital and was first found to have extremely high leukocyte count, and referred to our hospital for further examination on March 15 of the same year. On admission, his left thigh was swollen about twice the right one. The liver was palpable two fingerbreadths below the right costal margin and the spleen five fingerbreadths below the umbilicus. No lymphadenopathy was observed. The initial blood study showed sever anemia and marked leukocytosis at all stages of maturation in the myeloid series. The bone marrow aspirate revealed a marked myeloid hyperplasia with 0.8% myeloblasts. The cytogenetic study of bone marrow cells demonstrated metaphases characterized by 46, XY, Ph¹ (+), and the leukocyte alkaline phosphatase activity was definitely reduced. Blood coagulation and platelet function were normal. The femoral arteriography performed on the 35 th hospital day proved a saccular aneurysm in the ramus descendens of the left lateral femoral circumflex artery. Since repeating formation of hematoma was thought to be ascribable to rupture of this aneurysm, aneurysmectomy was carried out on the 44th hospital day. Histological examination of the excised aneurysm showed an entire lack in normal architecture of the arterial wall, and massive infiltration of myeloid cells at all stages of maturation and a few megakaryocytes and eosinophils in the muscle and fat tissue around the aneurysm. The hematoma as aninitial sign in this patient with chronic myelocytic leukemia would have been caused by ruprure of the arterial wall directly invaded by leukemic cells which were nonmyeloblastic in nature.