1/23. bone resorption associated with uncoupling of osteoclastic and osteoblastic activities in adult T cell leukemia with hypercalcemia: case report.A 64-year-old woman with adult T cell leukemia (ATL) was admitted to our hospital with severe hypercalcemia. The serum calcium level was elevated to 14.9 mg/dl. Biochemical parameters for bone formation including serum osteocalcin (bone Gla protein, BGP) and alkaline phosphatase (ALP) were normal. The serum levels of tartrate-resistant acid phosphatase (TRAP), a parameter for bone resorption, were increased (4.6 KAU). The serum level of parathyroid hormone-related protein (PTHrP) was elevated (343 pmol/l). The cytokines with stimulatory effects on bone resorption, such as interleukin (IL)-1alpha, IL-1beta, IL-6, and tumor necrosis factor-alpha, were not detected. serum Ca levels, PTHrP levels, and TRAP levels decreased with the decrease in ATL cells after chemotherapy, while serum BGP levels and ALP levels increased. On the 29th hospital day, ATL cells began to increase again. Then serum PTHrP levels, Ca levels, and TRAP levels increased, while serum BGP levels and ALP levels decreased. A marked excessive bone resorption with suppressed bone formation (uncoupling) occurred in this patient. The ATL cells produced not only PTHrP but also IL-1alpha and IL-1beta. These results suggest that PTHrP may act as a humoral factor and IL-1 may act as a local factor in bone metabolism of ATL patients.- - - - - - - - - - ranking = 1keywords = leukemia (Clic here for more details about this article) |
2/23. Megakaryoblastic transformation of polycythemia vera with hypercalcemia.polycythemia vera (PV) is known to occasionally transform into acute leukemia. Administration of alkylating agents seems to be associated with an increased risk of leukemic transformation of PV. hypercalcemia is a serious complication of malignancies, but it is uncommon in acute leukemia. In the majority of malignancies with hypercalcemia, elevated parathyroid hormone-related protein (PTHrP) is thought to be the main cause of hypercalcemia. We report a rare case of megakaryoblastic transformation of PV with hypercalcemia. A 62-year-old man was diagnosed as having PV in 1983, and he had received ranimustine and busulfan. He developed acute megakaryoblastic leukemia 17 years after the initial diagnosis of PV. serum calcium was elevated, the serum level of intact parathyroid hormone (PTH) was suppressed, and the level of intact PTHrP was slightly elevated. He had no lytic bone lesions; however, uncoupling of bone turnover due to an increase in bone resorption and a decrease in bone formation was detected by using biochemical markers. Since the level of PTHrP was slightly elevated from the normal value, we speculated that PTHrP produced in the local field by leukemic cells might have been more abundant than circulating PTHrP. Pamidronate and adrenocortical hormone were effective in reducing the serum calcium level. However, the patient died shortly after the start of induction chemotherapy. The prognosis of cases of PV that has transformed into acute leukemia is generally poor because the majority of such cases are refractory to chemotherapy.- - - - - - - - - - ranking = 0.8keywords = leukemia (Clic here for more details about this article) |
3/23. Severe hypercalcemia in a child with acute nonlymphocytic leukemia: the role of parathyroid hormone-related protein and proinflammatory cytokines.Among the hematological malignancies, hypercalcemia has often been reported in lymphoid malignancies such as multiple myeloma and adult T cell leukemia/lymphoma, but it has only rarely been described in acute nonlymphocytic leukemia. We describe here a 14-month-old girl with acute monocytic leukemia complicated by severe hypercalcemia (4.6 mmol/l) at presentation. A bone survey showed generalized bone resorption, but no localized osteolytic lesions. A search for the etiology of the hypercalcemia revealed that the serum levels of parathyroid hormone-related protein (PTHrP) and also proinflammatory cytokines with stimulatory effects on osteolytic bone resorption - TNF-alpha, IL-6 and M-CSF - were elevated. The patient achieved complete remission with induction chemotherapy, and the levels of PTHrP and the cytokines became normalized. In this case, PTHrP and cytokines might have acted cooperatively to exacerbate bone resorption, resulting in severe hypercalcemia.- - - - - - - - - - ranking = 1.4keywords = leukemia (Clic here for more details about this article) |
4/23. Massive metastatic pulmonary calcification in an infant with aleukemic monocytic leukemia.An 18-month-old infant with aleukemic monocytic leukemia and osteoclastic bone resorption demonstrated in the pelvis, vertebral bodies, and ribs developed severe refractory hypercalcemia. Bilateral interstitial pulmonary radiopacities developed rapidly, accompanied by hypoxemia and hypercapnea. Von Kossa staining of an open lung biopsy revealed extensive, finely granular metastatic septal calcifications not apparent on H&E-stained sections. autopsy revealed the massive nature of the pulmonary calcinosis and the presence of additional calcifications in the atrial subendocardium, liver, kidneys, vessels, and skin. Metastatic pulmonary calcification has been infrequently described in infants, and premortem detection of such deposits has been rarely reported. The Von Kossa stain is useful in detecting minute pulmonary calcifications which may radiographically simulate infiltrates of infectious origin.- - - - - - - - - - ranking = 1keywords = leukemia (Clic here for more details about this article) |
5/23. osteolysis in chronic myeloid leukemia.Four patients affected by chronic myeloid leukemia who developed osteolytic lesions in the course of the disease are described. According to the literature, the appearance of these alterations seems to signify an unfavorable prognosis, since they occur slightly before or even at the same time as the blastic transformation of the disease. However, in one case bone biopsy showed a metastasis of a solid tumor, emphasizing the importance of this procedure in order to give a more precise clinical evaluation, both diagnostic and therapeutic.- - - - - - - - - - ranking = 1keywords = leukemia (Clic here for more details about this article) |
6/23. Osteolytic lesion in chronic myelogenous leukemia (CML). Initial manifestation of blastic crisis?Report of a 13-year-old boy who developed osteolytic lesions in the chronic phase of myelogenous leukemia. Five months later a blastic crisis followed.- - - - - - - - - - ranking = 2.1859548376765keywords = myelogenous, leukemia, myelogenous leukemia (Clic here for more details about this article) |
7/23. hypercalcemia, unusual bone lesions, and human T-cell leukemia-lymphoma virus in adult T-cell lymphoma.Extensive generalized and subperiosteal bone resorption was demonstrated in a patient with adult T-cell lymphoma and marked hypercalcemia of unclear pathogenesis. Antibody to the human T-cell leukemia-lymphoma virus (HTLV) was present in the serum of the patient, consistent with the recently reported association of adult T-cell lymphoma, hypercalcemia, and HTLV. The unique feature of this case was the presence of bone radiographic and pathologic findings consistent with hyperparathyroidism, in the absence of elevated parathormone levels. These findings contrast with the few previously reported cases of adult T-cell lymphoma with hypercalcemia, which showed lytic, sclerotic, or osteoporotic bone lesions. The authors suggest that the patient's malignant t-lymphocytes may have produced an osteoclast-activating-factor-like substance or a parathormone-like substance, which caused the striking bone changes. The exact role of HTLV in the pathogenesis of such cases remains to be determined.- - - - - - - - - - ranking = 1keywords = leukemia (Clic here for more details about this article) |
8/23. Acute nonlymphocytic leukemia, monocytic variant. Report of a case.This report documents a case of a patient presenting unusual oral features of one of the rarer variants of acute nonlymphocytic leukemia, a malignancy whose oral manifestations may be the first indication of the presence of an underlying blood dyscrasia. The findings at the initial appointment and the patient's progress for the following 13 months until his death are presented. Initial suspicion of the clinical symptoms and an immediate, subsequent hospital hematology report established the diagnosis. The histologic features of a gingival biopsy taken during the oral examination were strongly suggestive of leukemia. Since the leukemias may imitate other oral conditions, especially various diseases of the periodontium, it is of paramount importance that the dental clinician recognize their clinical manifestations. As future treatment modalities improve, the dental clinician is seeing more leukemic patients in remission as well as more cases that have relapsed.- - - - - - - - - - ranking = 1.4keywords = leukemia (Clic here for more details about this article) |
9/23. B cell malignancies presenting with unusual bone involvement and mimicking multiple myeloma. Study of nine cases.Nine unusual cases of B cell malignancies presenting with lytic bone lesions on radiography and/or hypercalcemia, and mimicking multiple myeloma are reported in this study. These cases included acute lymphoblastic leukemia (one patient), non-Hodgkin's lymphoma (five patients), chronic lymphocytic leukemia (two patients), and Waldenstrom's disease (one patient). Quantitative bone biopsy performed in two patients (one with non-Hodgkin's lymphoma and one with Waldenstrom's disease) demonstrated a dramatic increase in osteoclastic resorption close to tumor cells in both cases, similar to or even more marked than that observed in multiple myeloma. Finally, significant production of bone resorbing activity was found in short-term liquid culture specimens of tumor cells in eight of the nine cases. These observations clearly indicate that in B cell disorders other than multiple myeloma, the malignant B cells can produce significant bone resorbing activity in vitro and result in excessive osteoclastic resorption and lytic bone lesions, frequent hypercalcemia, and an overall disease picture clinically mimicking multiple myeloma.- - - - - - - - - - ranking = 0.4keywords = leukemia (Clic here for more details about this article) |
10/23. hypercalcemia in chronic myelogenous leukemia: evidence for excessive parathyroid hormone secretion.hypercalcemia was associated with osteolytic bone lesions in a 60-year-old woman with chronic myelogenous leukemia in the accelerated phase. Using highly specific antisera to parathyroid hormone, radioimmunoassays disclosed elevated levels of carboxyl-terminal (53-84) and intermediate (44-68) fragments. In addition, concomitant variations of serum calcium level and leukocyte counts, increased urinary c-AMP excretion, morphological integrity of parathyroid glands, and absence of bone resorbing activity in myeloblast culture supernatants are consistent with the hypothesis that the humoral hypercalcemia was due to the excessive production of PTH. This production may have been ectopic, although no PTH secretion was demonstrated in myeloblast culture supernatants.- - - - - - - - - - ranking = 2.1859548376765keywords = myelogenous, leukemia, myelogenous leukemia (Clic here for more details about this article) |
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