A Case of Acute Lymphoblastic Leukemia with Pleural and Pericardial Effusions as Initial and Later Manifestations

Abstract

A case of acute lymphoblastic leukemia (ALL) accompanied by massive leukemic pleural and pericardial effusions, is reported. A 27 year-old housewife, whose initial symptoms were edema of the face and dyspnea, had a hydrothorax of the right pleural cavity. Leukemic lymphoblasts were found in the pleural effusion as well as in the peripheral blood and bone marrow, and were revealed to be void of membrane markers for T and B cells. A partial remission was induced by courses of daunorubicin, ara-C, vincristine and prednisolone, and a continuous aspiration of the pleural effusion was followed by an intrapleural injection of adriamycin. After a few months, however, a frank relapse occurred, when a pericardial effusion was noted. The effusion, which contained numerous lymphoblastic cells, was successfully treated with pericardiocentesis and intrapericardial injection of methotrexate. Chromosome examinations of cells from the bone marrow and the pleural effusion at diagnosis revealed a leukemic clone with a karyotype of 45, X, -X, -1, -14, -17, t (11; 12) (p15; p11), +der (1), t (1; ?) (p34; ?), +i (17q), +mar 1. An evolved clone with 46 chromosomes was demonstrated in later examinations, which has replaced the original clone completely. The pericardial effusion contained only cells with the evolved karyotype. The karyotypic evolution seems to have affected the clinical picture of this patient.