Ogata M, Uno N, Ohtsuka E, Kikuchi H, Nasu M
Second Department of Internal Medicine, Oita Medical University, Japan.
Rinsho Ketsueki. 1996 Jan;37(1):29-34.
A 76-year-old man was admitted to our hospital in February, 1994 because of fever and general fatigue. The patient had received radical gastrectomy for gastric cancer in August, 1987 and was subsequently treated with adjuvant chemotherapy using UFT for 25 months. On admission, the leukocyte count was 57,700/microliters with 74% blasts. Bone marrow aspiration revealed proliferation of blasts with marked giant cells and polynucleolar cells. The diagnosis of T-lineage of acute lymphoblastic leukemia (ALL) was then made by analysis of surface markers and T-cell receptor rearrangement. Although combination chemotherapy was initially effective, blasts rapidly reappeared in the peripheral blood, and the patient died of pneumonia in August, 1994. In the presented case, blasts showed marked morphologic abnormalities. It is well known that most cases of therapy-related leukemia deviate from the myeloid lineage, and rarely from the lymphoid lineage. In addition, morphologic abnormalities are rare in de novo ALL. Since such abnormalities were demonstrated in our patient, and UFT was administered for a long period, it is possible that this leukemia occurred as a second malignancy related to UFT treatment.
一名76岁男性于1994年2月因发热和全身乏力入院。该患者于1987年8月因胃癌接受了根治性胃切除术，随后使用优福定进行辅助化疗25个月。入院时，白细胞计数为57,700/微升，原始细胞占74%。骨髓穿刺显示原始细胞增生，伴有明显的巨细胞和多核仁细胞。通过表面标志物分析和T细胞受体重排，诊断为T系急性淋巴细胞白血病（ALL）。尽管联合化疗最初有效，但原始细胞很快再次出现在外周血中，患者于1994年8月死于肺炎。在本病例中，原始细胞表现出明显的形态学异常。众所周知，大多数治疗相关白血病偏离髓系，很少偏离淋巴系。此外，形态学异常在原发性ALL中很少见。由于我们的患者出现了此类异常，且长期使用优福定，因此这种白血病有可能是与优福定治疗相关的第二种恶性肿瘤。
