Association of chronic myelomonocytic leukemia and carcinoma: A possible paraneoplastic myelodysplasia

Abstract

Recently., Raz and associates [l] and Haznedar [2] reported in this journal five cases of pancytopenia with hyperplastic marrow, which preceded the development of lung and prostate carcinomas suggesting that pancytopenia resulting from myelodysplasia is a possible paraneoplastic manifestation in solid tumors.In our experience, five of 18 patients with chronic myelomonocytic leukemia diagnosed according to the FAB criteria [3] presented with an associated epithelial solid tumor. The following abnormalities were found in all cases: an absolute monocytosis in the peripheral blood (> 1 x lO'/liter), high levels of serum lysozyme, splenomegaly, bone marrow infiltration made up of atypical promyelocytes and especially of promonocytes, and a percentage of type I blast cells of less than 10%. In four of the five cases, the in vitro culture of CFU-GM from bone marrow and peripheral blood samples showed a characteristic growth pattern of chronic myelomonocytic leukemia (increased number of colonies and aggregates).Two patients had a carcinoma of the stomach, one patient a carcinoma of the colon, one patient an epidermoid bronchogenic carcinoma, and the remaining patient an epidermoid tumor of unknown origin. Malignancy was confirmed by histologic study in all cases. In three of the five patients, the diagnosis of the leukemic process and that of the epithelial tumor was established simultaneously, but in two cases (epidermoid mletastatic carcinoma and carcinoma of the colon) the neoplasm developed 5 months, and 2 years, respectively, before chronic myelomonocytic leukemia. This last patient was the only one who died as a consequence of the blastic crisis; in the remaining four patients, the cause of the death was metastatic dissemination of the neoplasm. One of the five patients (epidermoid metastatic carcinoma) was given

Myelokathexis and Monocytosis in a Patient with Gastric Cancer

“…Dysplasia of the bone marrow accompanying malignant processes has been documented [9][10][11]. The persistent monocytosis in our pa tient, observed also in other cases of malignant diseases [11,12], supports the etiological role of the malignant tu mor in the development of the myelokathexis.…”

Myelodysplastic syndromes and malignant solid tumors: Analysis of 21 cases

“…This association has been also recognized by others [S-lo], but whether the incidence is actually increased remains to be confirmed. Although it has been stated that the coexistence of CMML and malignant tumors is not purely fortuitous [9,12], the fact that this question has generally been omitted in important studies on MDS is striking [16-19].…”

Prognostic factors and survival in chronic myelomonocytic leukaemia (CMML)

“…The immediate cause of death Miescher & Farquet, 1974;Sexauer et al, 1974;Geary et al, (where applicable) was taken from the death certificate or 1975), it was only with the adoption of a fixed set of post-mortem report and survivals calculated from initial diagnostic criteria (Bennett et al, 1982) that comparisons diagnosis. could be made between studies by different centres.…”

“…CMML may however be viewed as a spectrum of diseases with wide variations in peripheral blood leucocyte Morphology was examined on May-Grunwald-Giemsa counts and clinical course and someinvestigatorstained peripheral blood and bone marrow smears and the CMML shoud clin l considered as a distinct entity, with diagnosis of CMML made according to FAB criteria CMML should be (Bennett et al, 1982). Minimal diagnostic criteria for features of both myeloproliferative and myelodysplastic CMML were the presence of a total peripheral blood disorders (Solal-Celigny et al, 1984;Milner et al, 1977 Haznedar, 1985;Sans-Sabrafen et al, 1986; (Altman et al, 1974;Thomas et al, 1981 (cx-naphthyl acetate and chloroacetate) esterase staining, previously associated with MDS (Scott et al, 1983, were cytochemically assessed by conventional techniques Matenials and methods (Yam et al, 1971).…”