[Occlusion of the femoral arteries in de novo AML].
BACKGROUND
Leukemic emboli in acute (AML) and chronic myelocytic leukemia (CML) are associated with hyperleukocytosis (>100,000/microl leukocytes) and most frequently detected at autopsy. They mainly occur in the small- and middle-sized arteries of lung and brain. Less frequently, leukemic emboli have also been observed in the cardiac chambers. The occlusion of large arteries by a leukemic embolus is a rare event.


METHODS
A 53-year-old woman was admitted with hyperleukocytosis and acute pain in her right leg. An occlusion of the right femoral arteries as the presenting symptom of a de novo AML (FAB M1/WHO: AML without maturation) with hyperleukocytosis was diagnosed.


CONCLUSIONS
Leukemic emboli of large vessels are uncommon in leukemia with hyperleukocytosis. Most frequently, small- and middle-sized vessels of the brain and lung are affected. Leukemic emboli mainly occur in AML and CML in blast crisis and are rare in acute (ALL) and chronic lymphocytic leukemia (CLL). Risk factors are hyperleukocytosis and the expression of adhesion surface molecules which modulate blast-blast and endothelium interaction. Therapeutic options, apart from the immediate start of chemotherapy, are leukapheresis and embolectomy.
Ressel
Anke
A
Abteilung Hämatologie und Onkologie, Medizinische Klinik und Poliklinik, Zentrum Innere Medizin, Universität Göttingen, Germany.
Trümper
Lorenz
L
Bäsecke
Jörg
J
D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000209:etiology* / Q000473:pathology; D001780:Blood Coagulation Tests; D003937:Diagnosis, Differential; D005260:Female; D005263:Femoral Artery / Q000473:pathology; D042381:Granulocyte Precursor Cells / Q000473:pathology; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000473:pathology; D007958:Leukocyte Count; D007964:Leukocytosis / Q000175:diagnosis / Q000473:pathology; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000473:pathology