Gastrointestinal Lesions in Leukemic Patients Ikuko Iwashita 1 , Naokuni Uike 2 , Ken-ichi Taguchi 3 1Department of Radiology, National Kyushu Cancer Center 2Department of Hematology, National Kyushu Cancer Center 3Department of Pathology, National Kyushu Cancer Center Keyword: 白血病 , ATL/L , 消化管浸潤 , 日和見感染 , granulocytic sarcoma , neutropenic enterocolitis , 消化性潰瘍 pp.585-599
Published Date 2003/4/24
DOI https://doi.org/10.11477/mf.1403100919
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 Pathogenesis of gastrointestinal lesions of leukemia could be broadly classified as follows ; Firstly, direct or indirect toxicity of chemotherapy such as necrotizing enterocolitis and, secondly, decreased immunity due to leukemia itself or to medication used for leukemia resulting in opportunistic infection, and peptic ulcer. In this paper analysis was made on four subjects as follows.

 1. Concerning lesions due to gastrointestinal infiltration of ATL/L (adult T-cell leukemia/lymphoma). A total of 34 lesions in 22 cases with ATL/L at our institute were studied and comparision with primary gastrointestinal malignant lymphoma unrelated to HTLV-1 was carried out with reference to the Japanese literature. Tumor cell infiltration was seen in only one case in the esophagus, in 15 cases in the stomach, in 10 cases in the small bowel and in 8 cases in the large bowel. As a result, we concluded that gastrointestinal lesions associated with lymphoma are not rare. As for the site of involvement, an esophageal lesion has been seen in only two cases including our own case, but when compared this data with the data of autopsy cases, the low frequency of reported esophageal involvement was thought to be due to the difficulty of clinical detection. Gastrointestinal lesions of ATL/L were more likely to be multiple and diffuse than those of HTLV-1 unrelated malignant lymphoma. Above all, 70 % of small intestinal lesions revealed multiple small elevations which were thought to be typical features of infiltration in the small bowel. As for gastrointestinal lesions of leukemia other than ATL/L, characteristics of macroscopic features of reported cases in the Japanese literature were analyzed. In addition, clinical manifestations and macroscopic features of granulocytic sarcoma (chloroma), which is a specific pathologic feature of gastrointestinal infiltration of leukemia, were analysed with reference to the medical literature of Europe and America.

 2. Necrotizing enterocolitis seen during the clinical course of Leukemia includes neutropenic enterocolitis, pseudomembranous colitis and ischemic colitis. In this paper, clinical manifestations and macroscopic features of reported cases in European and American literature concerning neutropenic enterocolitis, which is a characteristic complication of leukemia, were described.

 3. As details of opportunistic infection are described elsewhere by other authors, we analyzed only our own cases.

 4. The part of our paper on the reports that peptic ulcer is frequently complicated with CML (chronic myelogeneous leukemia), consists mainly of a description and analysis of the medical leterature on the subject.

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