Abstract
A case of acute lymphocytic leukemia of B cell origin preceded by intra-uterine infiltration is reported. A 38 year-old woman was admitted to our hospital because of gingival bleeding and ecchymosis. She was well until the performance of a total hysterectomy under the diagnosis of uterine myoma 9 months before admission. Since histological examination of the removed myoma revealed neoplastic infiltration of the blood-forming cells, radiotherapy (8,000 rads) was performed to both her inguinal regions. During the therapy, no abnomalities were found in the numbers and shapes of leukocytes in the peripheral blood. Two weeks before admission, she was awared of ecchymosis of both her knees and gingival bleeding. On admission, physical examination showed hepatomegaly, but no splenomegaly nor lymphadenopathy was present. The hematological findings were as follows: RBC 257×104/cmm, WBC 1,800/cmm, and platelet 8,000/cmm. A blood differential showed 5% myelocytes, 2% metamyelocytes, 13% stab cells, 35% segmented granulocytes, 28% lymphocytes, 3% monocytes, and 14% pathological cells. Light microscopically, the leukemic cells had a fine chromatin structure of the nuclei with 1∼2 well defined nucleoli and some cytoplasmic vacuoles. Examination of surface markers disclosed that 62% of the cells had surface-associated mu-heavy chain and 53% kappa-light chain. Incidence of E-rosette and EAC-rosette forming cells were 8% and 35% respectively. Although the administration of large dose of prednisolone decreased dramatically the number of leukemic cells, the subsequent reduction of prednisolone dose, caused a prompt increase in the numer of the cells.
In review of literatures, there are 28 cases reported as ALL of B cell origin. We could find out no common characteristic findings in the reported cases with an exception of a character of poor prognosis. The reported cases showed a difficulty to achieve any clinical remission. In addition, there are no other cases reported with infiltration to female genital organs in ALL of B cell origin.
