Central hypothyroidism in a pediatric case of primary acute monoblastic leukemia with central nervous system infiltration: A case report.

RATIONALE: Central nervous system (CNS) leukemia is a frequent diagnosis in pediatric acute myeloblastic leukemia (AML) and includes neural symptoms. However, CNS leukemia is rarely associated with central hypsothyroidism. PATIENT CONCERNS AND DIAGNOSES: A 2-year-old female with AML with MLL rearrangement presented with CNS infiltration. Laboratory tests suggested the presence of central hypothyroidism (thyroid-stimulating hormone [TSH]: 0.48 mIU/ml, normal range 0.7-6.4 mIU/ml; serum free thyroxine [FT4]: 0.62 ng/dl, normal range 0.8-2.2 ng/dl; free triiodothyronine: 1.57 pg/ml, normal range 2.7-5.6 pg/ml). Magnetic resonance imaging detected no lesions in the hypothalamus, pituitary, or thyroid. INTERVENTIONS AND OUTCOMES: Levothyroxine (2.5 mg/kg/day) was administered together with chemotherapy and intrathecal injection of methotrexate, cytarabine, and hydrocortisone into the cerebrospinal fluid. The FT4 concentration increased after levothyroxine treatment, but later decreased after relapse of CNS leukemia. The TSH concentrations remained low. After remission of CNS leukemia, the TSH and FT4 concentrations quickly recovered to their normal ranges. LESSONS: We believe that the CNS leukemia directly affected TSH and thyroid hormone secretion in our patient.

Ultrasonic biomicroscopy of viable, dead and apoptotic cells.

Ultrasonic imaging is frequently used in medical diagnosis to differentiate normal and tumour tissues. Here we investigate if distinct types of cell death can be discriminated through the use of ultrasound biomicroscopy. By using a well-controlled system in vitro, we demonstrate that this imaging modality can be used to differentiate living cells, dead cells and cells that have died by programmed cell death or apoptosis. The results indicate a greater than twofold ultrasound backscatter signal from apoptotic cells in comparison to viable cells, whereas heat-killed cells exhibit an intermediate level of ultrasound backscatter. The results have potential implications in the study of disease-related biological processes involving apoptosis.

Unusual pattern of gastric and hepatic infiltration in an infant with acute monocytic leukemia.

A 10-month-old girl with acute monocytic leukemia is presented. Ultrasound of the abdomen on admission showed an unusual distribution of leukemia infiltrates in the stomach and liver. The leukemic infiltrates in the wall of the stomach presented as intraluminal polyps, while the leukemic infiltration of the liver was strictly confined to the portal vessels.

Acute monocytic leukemia presenting in the eyelid. An immunohistochemical and electron microscopic study.

A 28-year-old woman was evaluated for a firm subcutaneous nodule of the left upper eyelid. Results from the examination showed multiple red to brown subcutaneous nodules on her upper extremities and thorax. An excisional biopsy specimen showed the nodules to be cutaneous involvement of acute monocytic leukemia. Acute monocytic leukemia should be considered in the differential diagnosis of a subcutaneous nodule in the eyelid.

Leukemic involvement of the kidney in children: CT features.

Leukemic involvement of the kidney was demonstrated by computed tomography in five children. The findings were bilateral diffuse nephromegaly (2), unilateral diffuse nephromegaly (1), discrete intrarenal mass lesion (1), and a hilar mass lesion (1). In three children undergoing local radiation therapy, the leukemic kidneys responded well to treatment. Computed tomography appeared to be valuable in the diagnosis of leukemic renal involvement, in radiation planning, and in the evaluation of the therapeutic effects.