Fatal Acute Lymphoblastic Leukemia With Great Enlargement of the Kidneys in an Infant Three Weeks Old

Abstract

first few weeks of life. But no report has been encountered in which such extraordinary enlargement of the kidneys due to lymphocytic invasion has been observed.In a study of 100 cases of leukemia in childhood (91 from the literature, 9 from his own practice), Ramsay 1 noted that all were in children under 8 years of age, that 70 per cent were of the lymphatic type, and that twice as many cases occurred during the first four years of life as during the second. Certain cases seemed to date from birth. In none of these cases was it found that the mother suffered from leukemia. In three of the lymphocytic cases the kidneys were reported as large and easily palpated. All three of these subjects were over 7 months of age. Of 94 cases, 63 per cent occurred in boys. The one constant observation in the blood picture was the high relative increase in lymphocytes, the average percentage being 94.Ramsay found microlymphocytes and mesolvmphocytes predominat¬ ing. In these forms the nucleus stains deeply, and the cytoplasm is scarcely visible. Anomalies of the lymphocytes consist of extreme scanti¬ ness of cytoplasm, with vacuolation-changes in the nucleus indicative of karyokinesis and the familiar "shadow'' or "basket" cells. The latter forms represent the penultimate stage of the lymphocytes that have undergone cytolysis.The red cell count was always markedly diminished. The course was generally acute, death usually occurring in less than two months after the establishment of the diagnosis. Su b mi t t e d for publication, Sept. 20, 1930. Fr om the