Schmid K O, Mutz I, Haidvogl M, Rosegger H
Acta Neuropathol. 1977 Jun 15;38(3):233-8. doi: 10.1007/BF00688071.
Among 93 clinical cases of mature and immature leukemia among children in the last 10 years only 3 showed massive cerebral hemorrhage as the first manifestation. The children--aged 5 3/12 yr., m., 2 1/12 yr., f., and 10 3/12 yr., m. died within 40, 48 and 7 h, respectively. Characteristically, an extreme hyperleukocytosis of immature cells with 8999000, 585000, and 360000 cells/mm3, respectively was found. Morphologically the quantitatively varying occurrence of blasts in veins and arteries, basically of hemodynamic origin, is notable, while locally pronounced variations in the venous involvement apparently are strongly dependent upon endovasal growth periods of the blasts. The blasts penetrated extravasal areas not only via passive but also via active migration. The mainly round to oval shape of the perivascular infiltrates of blasts is determined especially by the Virchow-Robins' spaces. The abscence of growth disrupting hemodynamics and texture structures in the unhindered areas of the cerebral ventricle system and retinal detachement favors the formation of leukemic nodules. Neurological symptoms accompanying a high blast count point to a diagnosis of intracerebral hemorrhage.
在过去10年里，93例儿童成熟和不成熟白血病临床病例中，仅有3例以大量脑出血为首发表现。这些儿童分别为5又3/12岁男性、2又1/12岁女性和10又3/12岁男性，分别在40小时、48小时和7小时内死亡。其特征为，分别发现未成熟细胞极度白细胞增多，细胞计数分别为8999000、585000和360000个/mm³。在形态学上，静脉和动脉中原始细胞数量变化明显，基本源于血液动力学，值得注意的是，静脉受累的局部明显变化显然强烈依赖于原始细胞的血管内生长期。原始细胞不仅通过被动迁移，还通过主动迁移穿透血管外区域。血管周围原始细胞浸润主要呈圆形至椭圆形，这尤其取决于魏尔啸-罗宾斯间隙。脑室系统和视网膜脱离未受阻碍区域不存在破坏生长的血液动力学和组织结构，这有利于白血病结节的形成。高原始细胞计数伴随的神经症状提示脑出血的诊断。
