An Infant of Acute Megakaryoblastic Leukemia with Hypercalcemia and Infiltration to the Lung, Heart and Brain

We report herein a 4-month-old girl with acute megakaryoblastic leukemia, who presented with hypercalcemia at diagnosis and showed infiltration to the lung, heart and brain. Her serum calcium level was elevated at 16.8 mg/di on admission. Bone X-ray revealed marked osteolytic change of the whole ske...

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Published inThe Japanese Journal of Pediatric Hematology Vol. 8; no. 3; pp. 245 - 249
Main Authors KIGASAWA, Hisato, HONDA, Kohjiro, NISHIHIRA, Hirokazu, NAGAO, Takeshi, OGAWA, Shoko, TOYODA, Yasunori, ODA, Takanori
Format Journal Article
LanguageJapanese
Published THE JAPANESE SOCIETY OF PEDIATRIC HEMATOLOGY/ONCOLOGY 1994
特定非営利活動法人 日本小児血液・がん学会
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ISSN0913-8706
1884-4723
DOI10.11412/jjph1987.8.245

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Abstract We report herein a 4-month-old girl with acute megakaryoblastic leukemia, who presented with hypercalcemia at diagnosis and showed infiltration to the lung, heart and brain. Her serum calcium level was elevated at 16.8 mg/di on admission. Bone X-ray revealed marked osteolytic change of the whole skeleton. Chest roentgenogram and computed tomography revealed diffuse infiltration in the bilateral lung fields, and a mass lesion in the left atrium was shown by echocardiogram. After chemotherapy, serum calcium level normalized quickly. Although brain involvement appeared during the course of treatment, the lesions of organ involvements were improved by more intensive chemotherapy. She is alive 36 months after the onset, and has remained disease-free 16 months after cessation of chemotherapy. Only two cases who were acute megakaryoblastic leukemia with hypercalcemia were reported, while no case with hypercalcemia at the onset was reported. This is the first report of a pediatric case of affected megakaryoblastic leukemia with hypercalcemia. Since her organ involvements were observed with roentgenogram, computed tomography and echocardiogram, without pathological examinations, this case may provide useful information.
AbstractList We report herein a 4-month-old girl with acute megakaryoblastic leukemia, who presented with hypercalcemia at diagnosis and showed infiltration to the lung, heart and brain. Her serum calcium level was elevated at 16.8 mg/di on admission. Bone X-ray revealed marked osteolytic change of the whole skeleton. Chest roentgenogram and computed tomography revealed diffuse infiltration in the bilateral lung fields, and a mass lesion in the left atrium was shown by echocardiogram. After chemotherapy, serum calcium level normalized quickly. Although brain involvement appeared during the course of treatment, the lesions of organ involvements were improved by more intensive chemotherapy. She is alive 36 months after the onset, and has remained disease-free 16 months after cessation of chemotherapy. Only two cases who were acute megakaryoblastic leukemia with hypercalcemia were reported, while no case with hypercalcemia at the onset was reported. This is the first report of a pediatric case of affected megakaryoblastic leukemia with hypercalcemia. Since her organ involvements were observed with roentgenogram, computed tomography and echocardiogram, without pathological examinations, this case may provide useful information.
We report herein a 4-month-old girl with acute megakaryoblastic leukemia, who presented with hypercalcemia at diagnosis and showed infiltration to the lung, heart and brain. Her serum calcium level was elevated at 16.8 mg/di on admission. Bone X-ray revealed marked osteolytic change of the whole skeleton. Chest roentgenogram and computed tomography revealed diffuse infiltration in the bilateral lung fields, and a mass lesion in the left atrium was shown by echocardiogram. After chemotherapy, serum calcium level normalized quickly. Although brain involvement appeared during the course of treatment, the lesions of organ involvements were improved by more intensive chemotherapy. She is alive 36 months after the onset, and has remained disease-free 16 months after cessation of chemotherapy. Only two cases who were acute megakaryoblastic leukemia with hypercalcemia were reported, while no case with hypercalcemia at the onset was reported. This is the first report of a pediatric case of affected megakaryoblastic leukemia with hypercalcemia. Since her organ involvements were observed with roentgenogram, computed tomography and echocardiogram, without pathological examinations, this case may provide useful information. 高カルシウム血症で発症し, 肺, 心筋および脳実質に浸潤を呈した急性巨核芽球性白血病の1乳児例を報告する.症例は生後4カ月の女児で, 入院時血清Caは16.8mg/dlであった.全身骨X線写真は, 著しい骨融解像を示した.また, 胸部X線およびCTにて両肺にび慢性浸潤陰影を, 心エコーにて左房内に腫瘤を認めた.化学療法により, 血清Caは急速に低下し正常化した.経過中, 脳実質浸潤を示したが, より強力な化学療法にて, 臓器浸潤病変も軽快した.現在, 発症後3年, 治療終了後1年4カ月, 無病生存中である.高カルシウム血症を合併した急性巨核芽球性白血病の報告は過去に2例のみであり, 初発時にみられたもの, および小児例の報告はない.また, 本症例は, 臓器浸潤が認められ, 剖検によってではなく, その治療経過を画像によって追跡できた, 貴重な症例である.
Author NAGAO, Takeshi
OGAWA, Shoko
ODA, Takanori
TOYODA, Yasunori
NISHIHIRA, Hirokazu
KIGASAWA, Hisato
HONDA, Kohjiro
Author_FL 小川 晶子
小田 孝憲
長尾 大
本多 康次郎
西平 浩一
気賀沢 寿人
豊田 恭徳
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DocumentTitleAlternate 高Ca血症および,肺,心筋,脳実質に浸潤がみられた急性巨核芽球性白血病の1例
DocumentTitle_FL 高Ca血症および,肺,心筋,脳実質に浸潤がみられた急性巨核芽球性白血病の1例
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特定非営利活動法人 日本小児血液・がん学会
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References 5) Suva LJ, Winslow GA, Wettenhall REH, et al : A parathyroid hormone-related protein implicated in malignant hypercalcemia : Cloning and expression. Science 237 : 893-896, 1987
10) Soares FA, Landell GAM, Cardoso MCM : Pulmonary leukostasis without hyperleukocytosis, a clinicopathologic study of 16 cases. Am J Hematol 40 : 28-32, 1992
12) Hunkeler N, Canter CE : Antemortem diagnosis of gross cardiac metastasis in childhood leukemia, echocardiographic demonstration. Pediatr Cardiol 11 : 225-226, 1990
11) Klatt EC, Heitz DR : Cardiac metastases. Cancer 65 : 1456-1459, 1990
6) Breton-Gorius J, Bizet M, Reyes F, et al : Myelofibrosis and acute megakaryoblastic leukemia in a child. Leuk Res 6 : 97-110, 1982
8) 南部静洋, 岩田猛邦, 種田和清, 他 : 剖検症例における悪性腫瘍に合併した転移性肺胞石灰化症の検討.日胸疾患会誌 29 : 963-970, 1991
1) McKay C, Furman WL : Hypercalcemia complicating childhood malignancies. Cancer 72 : 257-260, 1993
2) 花野政晴, 小池正, 青木定夫, 他 : 高カルシウム血症を伴った急性巨核芽性白血病の1例.臨床血液29 : 1237-1243, 1988
3) 三谷絹子, 斎藤恒博, 藤岡成徳, 他 : 高カルシウム血症を呈した急性巨核芽性白血病の1例.臨床血液29 : 2287-2291, 1988
7) Tashjian AH, Hohmann EL, Antoniades HN, et al : Platelet-derived growth factor stimulates bone resorption via a prostaglandin-mediated mechanism. Endocrinology 111 : 118-124, 1982
4) 松本俊夫, 尾形悦郎 : 悪性腫瘍と高Ca血症.代謝23 : 261-270, 1986
9) Kovalski R, Flaschen JH, Lodato RF, et al : Localized leukemic pulmonary infiltrates. Chest 97 : 674-678, 1990
References_xml – reference: 1) McKay C, Furman WL : Hypercalcemia complicating childhood malignancies. Cancer 72 : 257-260, 1993
– reference: 2) 花野政晴, 小池正, 青木定夫, 他 : 高カルシウム血症を伴った急性巨核芽性白血病の1例.臨床血液29 : 1237-1243, 1988
– reference: 5) Suva LJ, Winslow GA, Wettenhall REH, et al : A parathyroid hormone-related protein implicated in malignant hypercalcemia : Cloning and expression. Science 237 : 893-896, 1987
– reference: 10) Soares FA, Landell GAM, Cardoso MCM : Pulmonary leukostasis without hyperleukocytosis, a clinicopathologic study of 16 cases. Am J Hematol 40 : 28-32, 1992
– reference: 9) Kovalski R, Flaschen JH, Lodato RF, et al : Localized leukemic pulmonary infiltrates. Chest 97 : 674-678, 1990
– reference: 8) 南部静洋, 岩田猛邦, 種田和清, 他 : 剖検症例における悪性腫瘍に合併した転移性肺胞石灰化症の検討.日胸疾患会誌 29 : 963-970, 1991
– reference: 11) Klatt EC, Heitz DR : Cardiac metastases. Cancer 65 : 1456-1459, 1990
– reference: 4) 松本俊夫, 尾形悦郎 : 悪性腫瘍と高Ca血症.代謝23 : 261-270, 1986
– reference: 6) Breton-Gorius J, Bizet M, Reyes F, et al : Myelofibrosis and acute megakaryoblastic leukemia in a child. Leuk Res 6 : 97-110, 1982
– reference: 3) 三谷絹子, 斎藤恒博, 藤岡成徳, 他 : 高カルシウム血症を呈した急性巨核芽性白血病の1例.臨床血液29 : 2287-2291, 1988
– reference: 7) Tashjian AH, Hohmann EL, Antoniades HN, et al : Platelet-derived growth factor stimulates bone resorption via a prostaglandin-mediated mechanism. Endocrinology 111 : 118-124, 1982
– reference: 12) Hunkeler N, Canter CE : Antemortem diagnosis of gross cardiac metastasis in childhood leukemia, echocardiographic demonstration. Pediatr Cardiol 11 : 225-226, 1990
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Snippet We report herein a 4-month-old girl with acute megakaryoblastic leukemia, who presented with hypercalcemia at diagnosis and showed infiltration to the lung,...
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SubjectTerms acute megakaryoblastic leukemia
hypercalcemia
organ involvement
Title An Infant of Acute Megakaryoblastic Leukemia with Hypercalcemia and Infiltration to the Lung, Heart and Brain
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