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Acute Lymphoblastic Leukemia

 

 

 

Patterns of Spread

Organ involved Consequence

Intramedullary

Bone marrow

  • BM failure (see presentation)

Extramedullary

Lymph nodes

  • Mediastinal adenopathy can lead to superior vena cava syndrome and respiratory distress.

Spleen and liver

  • Splenomegaly and further trapping of red blood cells and platelets. 

 

  • Hepatitis can be seen at diagnosis.

CNS

  • In less than 10% of ALL patients at diagnosis.

 

  • Hyperleukocytosis in the peripheral blood and CSF may lead to leukostasis in CNS vasculature causing:
  • Altered level of consciousness
  • Predispose to cerebrovascular accident, sinovenous thrombosis, and intracranial hemorrhage.

Testicles

  • Painless enlargement of testes

 

  • In 10 - 20% of boys during the course of their disease

 

Kidney

  • Rare
  • Hypertension, renal failure and hematuria
  • More common in T-cell

Gastrointestinal

  • GI bleeding commonest sign
Bone and Joint

Bone pain common due to:

  • Leukemic infiltration of periosteum
  • Bone infarction
  • Expansion of marrow cavity
Skin
  • Most common in neonates and AML
Cardiac
  • Symptomatic disease in less than 5% of patients
  • At autopsy series cardiac involvement 30% or so.
Lung
  • Leukemic infiltrates or hemorrhage

 

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