Burkitt lymphoma–leukemia
Journal Title: Αρχεία Ελληνικής Ιατρικής - Year 2013, Vol 30, Issue 6
Abstract
A 62-year-old male patient presented to our unit for further evaluation and treatment of a diffuse large B-cell lymphoma (DLBCL). Approximately one month ago, he experienced an abdominal pain and underwent a laparoscopic cholecystectomy, since physical examination revealed Murphy's sign and upper abdominal ultrasonography revealed slugje and gallblodder wall thickening. Preoperative computed tomography (CT) imaging was negative for lymphadenopathy or tumor lesions. Intraoperatively, the surgeon noticed multiple, “tiny”, subcentimeter, white lesions on the surface of the liver. Biopsy of a lesion revealed DLBCL and the patient was referred to our department. Medical history was only remarkable for arterial hypertension and diverticulitis. While the result of the histologic examination was pending, the patient developed low-grade fever, night sweats and rapid weight loss. His clinical condition deteriorated promptly. At presentation, ECOG (Eastern Cooperative Oncology Group) performance status was 3. He had no abnormal physical findings except of appearing ill. Laboratory evaluation revealed the following: Hematocrit 31.8%, hemoglobin 10.2 g/dL, RBC 3.6×1012/L, WBC 16×109/L with leukoerythroblastosis (poly 62%, lymphs 12%, monos 5%, metamyelocytes 6%, myelocytes 14%, blasts 1%, erythroblasts 7 per 100 WBC; figures 1−3), PLTs 80×109/L, ESR 132 mm/h, CRP 392 mg/L, normal serum glucose, sodium, potassium and bilirubin levels, mild renal insufficiency (urea 71 mg/dL, creatinine 1.6 mg/dL), ypercalcemia 12.9 mg/dL, hyperphosphatemia 4.7 mg/dL, hyperuricemia 12.9 mg/dL, abnormal liver function tests [AST 52 U/L (upper normal limit, UNL 31 U/L), ALT 52 U/L (UNL 34 U/L), serum alkaline phosphatase 570 U/L (UNL 141 U/L), γGT 537 U/L (UNL 36 U/L)], hypoproteinemia 5.7 g/dL with slightly reduced albumin levels (3.4 g/dL), and highly elevated serum lactate dehydrogenase levels (1,973 U/L versus UNL 220 U/L or approximately 9×). Liver biopsy histologic report described a DLBCL-not otherwise specified (DLBCL NOS) with the following immunophenotype: CD20+, CD10+, bcl6+, bcl2-. The proliferation index Ki67 was highly elevated reaching 98%. Bone marrow aspiration was not possible (dry tap), but bone marrow touch preparations revealed extensive monomorphic infiltration (figures 4−6). An urgent pathologic review was performed within few hours and further diagnostic tests were ordered.
Authors and Affiliations
T. VASSIULAKOPOULOS, K. PETEVI, L. PAPAGEORGIOU, E. KOUTSI, G. LEVIDOU, I. GOGOLOU, P. FLEVARI, A. KANELLOPOULOS, V. TELONIS, M. ANGELOPOULOU, J. MELETIS
Keywords
Related Articles
- EP ID EP151908
- DOI -
- Views 64
- Downloads 0
Recognition and immune response models in infection
The immune system reacts to protect the host from infection. During the past 50 years immunologists have elucidated the basic mechanisms which control the immune response against pathogens. They have suggested theoretica...
Estimation of cardiovascular risk profile in patients with essential hypertension according to the ESH/ESC-2007 guidelines
No abstract available
Pathophysiology in people with intellectual disability: The importance of regular exercise in their health
Many studies have confirmed the negative impact of inactivity on physical fitness, lifestyle related risk factors for poor health functional capacity and quality of life in the general population. There is evidence, also...
Message 1: “Be a safe driver”<br /> Message 2: “Βe a safe road user” <br /> <br />
Road traffic accidents constitute the first cause of unintentional injury death in the European Union (EU). In EU-25, an estimated 43,000 people die every year due to motor vehicle crashes. Nevertheless, road traffic inj...
Systemic mast cell diseasewith an associated non mast-cell hematological disorder
No abstract available