Anzeige
Erschienen in:
01.08.2014 | Scientific Letter
Acute Myeloid Leukemia Presenting as Mediastinal Mass
Erschienen in: Indian Journal of Pediatrics | Ausgabe 8/2014
Einloggen, um Zugang zu erhaltenExcerpt
To the Editor: Mediastinal mass as a presenting feature of AML (Acute Myeloid Leukemia) is rare. We report three pediatric patients with mediastinal mass at initial presentation, in whom AML was diagnosed by bone marrow examination. Two patients had features of superior mediastinal syndrome, out of which one patient had generalized lymphadenopathy and hepatosplenomegaly. The third patient had mediastinal mass with pleural and pericardial effusion. Clinical features, diagnostic investigations and treatment outcome are described in Table 1.
Table 1
Clinical features, investigations, treatment and outcome of three patients presenting as mediastinal mass
|
Patient details
|
Patient #1
|
Patient #2
|
Patient #3
|
|---|---|---|---|
|
Age & sex
|
14 y, male
|
2 y, male
|
1½ y, male
|
|
Presenting complaints
|
Irregular fever, bone pains, abdominal pain of 15 d duration, brassy cough of 1 wk duration
|
Fever, swelling of both sides of neck of 10 d duration and swelling in front of the ear of 1 wk duration.
|
Facial puffiness, fever and irritability of 6 d duration
|
|
Physical examination
|
Hepatomegaly of 2 cm, splenomegaly of 5 cm
|
Cervical, axillary, preauricular and inguinal lymphadenopathy
|
Obese, with puffiness around both eyelids
|
|
Hematology profile
|
WBC count 6000/mm3 with 40 % abnormal cells, PLC 335000/mm3, Hgb 12 g%
|
WBC count 2,10,000/mm3 with 55 % abnormal cells, PLC 53,000/mm3, Hgb 10.4 g%
|
WBC count 1,56,000/mm3 with 86 % abnormal cells, PLC 74000/mm3, Hgb 10.1 g%
|
|
Biochemistry
|
LDH 915 U/L
|
LDH 9800 U/L
|
LDH 615 U/L
|
|
Chest X-ray
|
Mediastinal mass with pericardial effusion
|
Mediastinal widening
|
Mediastinal widening
|
|
CT chest
|
Large superior and anterior mediastinal mass lesion with pleural and pericardial effusion
|
Not done
|
Not done
|
|
Bone Marrow AML morphologic subtype
|
AML M2
|
AML M4
|
AML M5
|
|
Flow cytometry
|
Not done
|
Positive for CD13, 33, 117,HLA DR. Negative for CD 10,19,3,7,56,34
|
Not done
|
|
Cytogenetics*
|
Negative for t(8;21),t(9;22)
|
Negative for inv(16), t(9;22)
|
Not done
|
|
CSF study
|
Normal
|
Normal
|
Not done
|
|
Treatment
|
AML protocol (Ara-C/DAU)
|
Induction with DAU/Ara-C, consolidation with high dose Ara-C; 2nd line with Mitoxantrone and later FLAG-IDA regimen
|
Not treated
|
|
Outcome
|
Died of refractory disease
|
Achieved CR but developed CNS and bone marrow relapse while on treatment, died after 2nd line therapy
|
No therapy taken
|