23 years old man with abdominal pain

 

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Doctor's Information

Name :  Noshin
Family :Shirvandehi
Email :   This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident :  Morteza Babaii

 

Patient's Information

Gender :  Male
Age :  23

 

Case Section

Muskuloskeletal System

 

Clinical Summary

23 years old man with abdominal pain.

 

 

Imaging Procedures and Findings

Permeative involvement of left iliac bone is noted. Wall thickening of stomach and some bowel loops is evident. Pancreatic tail shows homogenous thickening. the spleen is enlarged.

 

Discussion

Acute leukemia is a malignancy of the hematopoietic progenitor cell. These cells proliferate in an uncontrolled fashion and replace normal bone marrow elements. Most cases arise with no clear cause. However, radiation and some toxins (benzene) are leukemogenic. In addition, a number of chemotherapeutic agents (especially cyclophosphamide, melphalan, other alkylating agents, and etoposide) may cause leukemia. Acute lymphoblastic leukemia (ALL) comprises 80% of the acute leukemias of childhood. The peak incidence is between 3 and 7 years of age. It is also seen in adults, causing approximately 20% of adult acute leukemias.The signs and symptoms of acute leukemia are usually rapid in onset, developing over a few weeks to at most a few months, and result from decreased normal marrow function and invasion of normal organs by leukemic blasts. Anemia is present at diagnosis in most patients and causes fatigue, pallor, headache, and, in predisposed patients, angina or heart failure. Thrombocytopenia is usually present, and approximately one third of patients have clinically evident bleeding at diagnosis, usually in the form of petechiae, ecchymoses, bleeding gums, epistaxis, or hemorrhage. Most patients with acute leukemia are significantly granulocytopenic at diagnosis. As a result, approximately one third of patients with AML and slightly fewer patients with ALL have significant or life-threatening infections when initially seen, most of which are bacterial in origin.In addition to suppressing normal marrow function, leukemic cells can infiltrate normal organs. In general, ALL tends to infiltrate normal organs more often than AML does. Enlargement of lymph nodes, liver, and spleen is common at diagnosis. Bone pain, thought to result from leukemic infiltration of the periosteum or expansion of the medullary cavity, is a common complaint, particularly in children with ALL. Leukemic cells sometimes infiltrate the skin and result in a raised, nonpruritic rash, a condition termed leukemia cutis. Leukemic cells may infiltrate the leptomeninges and cause leukemic meningitis, typically manifested by headache and nausea. As the disease progresses, central nervous system (CNS) palsies and seizures may develop. Although fewer than 5% of patients have CNS involvement at diagnosis, the CNS is a frequent site of relapse, particularly with ALL; because of the so-called blood-brain barrier, the CNS requires special therapy. Testicular involvement is also seen in ALL, and the testicles are a frequent site of relapse.

 

Final Diagnosis

Acute lymphoblastic leukemia

 

References

1.Current Medical Diagnosis & Treatment 2008 Stephen J. McPhee, Maxine A. Papadakis, and Lawrence M. Tierney, Jr., Eds. Ralph Gonzales, Roni Zeiger, Online Eds. 2.Lee Goldman,Dennis Ausiello: Cecil Medicine, 23rd ed.

 

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