Leukemic changes of the brain: the involvement of the choroid plexus

Queiroz, Aristides Cheto de; Ribeiro, Dorcas Almeida

doi:10.1590/S0004-282X1978000400007

Abstracts

In the study of 38 cases of leukemia, neoplastic infiltration of the brain was the most frequent lesion, occuring in 70,5%, compared to 48,5% for hemorrhage. The leptomeninges were the most frequent site of leukemic infiltration followed by the choroid plexus (57,8%) and the nervous tissue (50%). In few cases leukemic infiltration of choroid plexus was seen in the absence of meningeal involvement. Very often the leukemic infiltration of the CNS courses without clinical manifestations. The paper points out the importance of the cytologic study of the cerebro-spinal fluid as a routine procedure in cases of leukemia, since it is well known that the therapeutic agents have difficulty in penetrating the blood-brain barrier and that foci of CNS leukemic infiltration may represent points of reactivation of the disease even during the therapeutic remission.

No estudo de 38 encéfalos de indivíduos que faleceram com leucemias. verificou-se que a infiltração neoplásica apareceu como lesão mais frequente (70,5%), seguida de hemorragia intracraneana (48,5%). O local mais frequente da infiltração leucêmica foi o espaço subaracnoideano (79,1%), seguido dos plexos coróides numa frequência de 57,8% que corresponde ao envolvimento de 11 dos 19 casos que foram submetidos a estudo histológico, e, por fim. a infiltração do tecido nervoso (50%). Esta infiltração neoplásica do SNC e principalmente o envolvimento dos plexos coróides, que aparece também independente de infiltração meníngea, frequentemente decorre sem manifestações neurológicas. Isto chama atenção para a necessidade do estudo citológico do líquido cefalo-raquidiano de rotina nos casos de leucemias, para melhor orientação terapêutica, visto que o SNC é local de difícil penetração de quimioterápicos administrados por via sistêmica e pode constituir foco de reativação da doença mesmo na fase de remissão terapêutica.

Alterações encefalicas nas leucemias: aspectos histopatolôgicos do envolvimento dos plexos coroides

Leukemic changes of the brain: the involvement of the choroid plexus

Aristides Cheto de Queiroz^I; Dorcas Almeida Ribeiro^II

^IProfessor Assistente do Departamento de Anatomia Patológica e Medicina Legal da Universidade Federal da Bahia, bolsista do Conselho Nacional de Desenvolvimento Científico e Tecnológico

^IIInterna estagiária do Serviço de Anatomia Patológica do Hospital Prof. Edgard Santos

RESUMO

No estudo de 38 encéfalos de indivíduos que faleceram com leucemias. verificou-se que a infiltração neoplásica apareceu como lesão mais frequente (70,5%), seguida de hemorragia intracraneana (48,5%). O local mais frequente da infiltração leucêmica foi o espaço subaracnoideano (79,1%), seguido dos plexos coróides numa frequência de 57,8% que corresponde ao envolvimento de 11 dos 19 casos que foram submetidos a estudo histológico, e, por fim. a infiltração do tecido nervoso (50%). Esta infiltração neoplásica do SNC e principalmente o envolvimento dos plexos coróides, que aparece também independente de infiltração meníngea, frequentemente decorre sem manifestações neurológicas. Isto chama atenção para a necessidade do estudo citológico do líquido cefalo-raquidiano de rotina nos casos de leucemias, para melhor orientação terapêutica, visto que o SNC é local de difícil penetração de quimioterápicos administrados por via sistêmica e pode constituir foco de reativação da doença mesmo na fase de remissão terapêutica.

SUMMARY

In the study of 38 cases of leukemia, neoplastic infiltration of the brain was the most frequent lesion, occuring in 70,5%, compared to 48,5% for hemorrhage. The leptomeninges were the most frequent site of leukemic infiltration followed by the choroid plexus (57,8%) and the nervous tissue (50%). In few cases leukemic infiltration of choroid plexus was seen in the absence of meningeal involvement. Very often the leukemic infiltration of the CNS courses without clinical manifestations. The paper points out the importance of the cytologic study of the cerebro-spinal fluid as a routine procedure in cases of leukemia, since it is well known that the therapeutic agents have difficulty in penetrating the blood-brain barrier and that foci of CNS leukemic infiltration may represent points of reactivation of the disease even during the therapeutic remission.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Trabalho realizado no Serviço de Anatomia Patológica do Hospital Prof. Edgard Santos, Salvador, BA.

Serviço de Anatomia Patológica - Hospital Prof. Edaard Santos - 40000 Salvador, Bahia - Brasil.

1. AARONSON, A. G.; HAJDU, S. I. & MELAM ED. M. R. - Spinal fluid cytology during chemotherapy of leukemia of the central nervous system in children. Amer. J. Clin. Path. 63:528. 1975.
2. ATKINSON, K.; KAY, H. E.: LAWLER, S. D.; WELLS. D. G. & McELWAIN. T. J. - Meningeal leukemia after blastic transformation of chronic myeloid leukemia. Cancer 35:529. 1975.
3. EPPINGER-HELFT, M.; PAVLOVSKY. S.; SUAREZ, A.; MURIEL. F. S.: HIDALGO, G.; PAVLOVSKY, A. & VILASECA, G. - Sequencial therapy for induction and maintainance of remission in acute myeloblasts leukemia. Cancer 35:347. 1975.
4. EVANS, A. E.; GILBERT, E. S. & ZANDSTRA, R. - The increasing incidence of central nervous system leukemia in children. Cancer 26:404, 1970.
5. FINKELSTEIN, J. Z.; DYMENT. P. G. A HAMMOND, G. D. - Leukemic infiltration of the testis during bone marrow remission. Pediatrics 43:1042. 1969.
6. HAJDU, S. I. & HAJDU, E. O. - Cytopathology of sarcomas and other non-epithelial malignant tumors. W. B. Saunders, Philadelphia, 1976, pág. 29.
7. HENDIN, B.; DeVIVO, D. C.; TO RACK, R.; LELL, M. E.; RAGAB, A. H. & VIETTI, T. S. - Parenchymatous degeneration of the central nervous system in childhood leukemia. Cancer 33:468, 1974.
8. MOORE, E. W.; THOMAS, L. B.; SHAW, R. K. & FREIREICH, E. J. - The central nervous system in acute leukemia. A postmortem study of 117 consecutive cases with particular reference to hemorrhage, leukemic infiltration and syndrome of menigeal leukemia. Arch. Int. Med. 105:141, 1960.
9. POLE, J. G. - Childhood leukemia presenting in the central nervous system. Arch. Dis. Child. 48:867, 1973.
10. PRICE, R. A. & JOHNSON, W. - The central nervous system in childhood leukemia: the arachnoid. Cancer 31:520. 1973.
11. PRICE, R. A. & JAMIESON, P. A. - The central nervous system in childhood leukemia: subacute leukoencephalopathy. Cancer 35:306, 1975.
12. QUEIROZ, A. C. & CARDOSO DE ALMEIDA, M. A. - Alterações testiculares nas leucemias e linfomas. Rev. Brasil. Med. 32:472, 1975.
13. RALL, D. P. - Experimental studies of the blood-brain barrier. Cancer Res. 25:1572, 1965.
14. RUBINSTEIN, L. J.; HERMAN, M. M.; LONG, T. F. & WILBUR, J. R. - Disseminated necrotizing leukoencephalopathy: complication of treated central nervous system leukemia and lymphoma. Cancer 35:291, 1975.
15. SCHOCHET, S. S. & McCORMICK, W. F. - Neuropathology case studies. Medical Examination Publishing Co. New York, 1976, pág. 188.
16. THOMAS, L. B. - Pathology of leukemia in the brain and meninges: postmortem studies of patients with acute leukemia. Cancer Res. 25:1555, 1965.
17. WELLS, C. E. & SILVER, R. T. - The neurologic manifestations of acute leukemias: a clinical study. Ann. Int. Med.. 46:439, 1957.
18. WOLK, R. W.; MASSE, S. R.; CONKLIN, R. & FREIREICH, E. J. - The incidence of central nervous system leukemia in adults with acute leukemia. Cancer 33:863, 1974.

Publication Dates

Publication in this collection
27 Aug 2012
Date of issue
Dec 1978

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. AARONSON, A. G.; HAJDU, S. I. & MELAM ED. M. R. - Spinal fluid cytology during chemotherapy of leukemia of the central nervous system in children. Amer. J. Clin. Path. 63:528. 1975.

[2] 2. ATKINSON, K.; KAY, H. E.: LAWLER, S. D.; WELLS. D. G. & McELWAIN. T. J. - Meningeal leukemia after blastic transformation of chronic myeloid leukemia. Cancer 35:529. 1975.

[3] 3. EPPINGER-HELFT, M.; PAVLOVSKY. S.; SUAREZ, A.; MURIEL. F. S.: HIDALGO, G.; PAVLOVSKY, A. & VILASECA, G. - Sequencial therapy for induction and maintainance of remission in acute myeloblasts leukemia. Cancer 35:347. 1975.

[4] 4. EVANS, A. E.; GILBERT, E. S. & ZANDSTRA, R. - The increasing incidence of central nervous system leukemia in children. Cancer 26:404, 1970.

[5] 5. FINKELSTEIN, J. Z.; DYMENT. P. G. A HAMMOND, G. D. - Leukemic infiltration of the testis during bone marrow remission. Pediatrics 43:1042. 1969.

[6] 6. HAJDU, S. I. & HAJDU, E. O. - Cytopathology of sarcomas and other non-epithelial malignant tumors. W. B. Saunders, Philadelphia, 1976, pág. 29.

[7] 7. HENDIN, B.; DeVIVO, D. C.; TO RACK, R.; LELL, M. E.; RAGAB, A. H. & VIETTI, T. S. - Parenchymatous degeneration of the central nervous system in childhood leukemia. Cancer 33:468, 1974.

[8] 8. MOORE, E. W.; THOMAS, L. B.; SHAW, R. K. & FREIREICH, E. J. - The central nervous system in acute leukemia. A postmortem study of 117 consecutive cases with particular reference to hemorrhage, leukemic infiltration and syndrome of menigeal leukemia. Arch. Int. Med. 105:141, 1960.

[9] 9. POLE, J. G. - Childhood leukemia presenting in the central nervous system. Arch. Dis. Child. 48:867, 1973.

[10] 10. PRICE, R. A. & JOHNSON, W. - The central nervous system in childhood leukemia: the arachnoid. Cancer 31:520. 1973.

[11] 11. PRICE, R. A. & JAMIESON, P. A. - The central nervous system in childhood leukemia: subacute leukoencephalopathy. Cancer 35:306, 1975.

[12] 12. QUEIROZ, A. C. & CARDOSO DE ALMEIDA, M. A. - Alterações testiculares nas leucemias e linfomas. Rev. Brasil. Med. 32:472, 1975.

[13] 13. RALL, D. P. - Experimental studies of the blood-brain barrier. Cancer Res. 25:1572, 1965.

[14] 14. RUBINSTEIN, L. J.; HERMAN, M. M.; LONG, T. F. & WILBUR, J. R. - Disseminated necrotizing leukoencephalopathy: complication of treated central nervous system leukemia and lymphoma. Cancer 35:291, 1975.

[15] 15. SCHOCHET, S. S. & McCORMICK, W. F. - Neuropathology case studies. Medical Examination Publishing Co. New York, 1976, pág. 188.

[16] 16. THOMAS, L. B. - Pathology of leukemia in the brain and meninges: postmortem studies of patients with acute leukemia. Cancer Res. 25:1555, 1965.

[17] 17. WELLS, C. E. & SILVER, R. T. - The neurologic manifestations of acute leukemias: a clinical study. Ann. Int. Med.. 46:439, 1957.

[18] 18. WOLK, R. W.; MASSE, S. R.; CONKLIN, R. & FREIREICH, E. J. - The incidence of central nervous system leukemia in adults with acute leukemia. Cancer 33:863, 1974.