No abstract

The clinical presentation of acute myeloid leukaemia is variable. We report a 40-year-old woman who presented with a 1-month history of galactorrhoea with an elevated prolactin level. The blood counts were normal, but she was found to have acute myeloid leukaemia with monocytic differentiation. The serum prolactin level normalized after chemotherapy. In the absence of evidence of CNS involvement, the hyperprolactinaemia is presumed to be a paraneoplastic phenomenon. We discuss the potential mechanism of prolactin production in this case.

A 75-year-old woman was referred for investigation of severe neutropenia (neutrophil count 0.35 · 10 9 /l). Her only symptoms were of tiredness and arthralgia for some months. Physical examination was unremarkable. Further investigations showed no paraproteinaemia, Bence-Jones protein of 0.12 g/24 h, elevated serum light chains of 1.69 g/l and normal serum calcium and creatinine levels. Skeletal survey showed osteoporosis of T10 and T11 but no lytic lesions. Bone marrow examination showed 11% Gaucher-like cells with cytoplasmic inclusions (top panels). Subsequent staining with anti-CD138 (bottom left) and anti-kappa (bottom right) antibodies were strongly positive, confirming these to be atypical plasma cells loaded with immunoglobulin. A diagnosis of smouldering myeloma was made. Her neutrophil count recovered (to 3.57 · 10 9 /l) after cessation of treatment with enalapril. The patient continues to be observed.

A 52-year-old horse agister presented with 3-month history of fevers, night sweats, 10 kg weight loss, myalgia and backache. He was found initially to have a suspicious bony lesion on plain radiograph of his pelvis, but a bone scan showed no abnormal focal uptake. Computed tomography (CT) scans showedlyticdestructivelesionsatC6andanirregularlucency of the T3 vertebra ( Fig. 1). A CT-guided biopsy showed an immature mononuclear infiltration suspicious of haematological malignancy (Fig. 2). Baseline blood tests showed that 6% lymphoblasts on peripheral blood with white cell count 4.05 Â 10 9 /L, haemoglobin 128 g/L and platelets 49 Â 10 9 / L. Serum-corrected calcium was increased at 2.72 mmol/L (2.10-2.55 mmol/L). Bone marrow examination confirmed the diagnosis of acute lymphoblastic leukaemia (Fig. 3). Magnetic resonance imaging of the spine carried out while the patient was receiving chemotherapy showed compression fractures at C6 and T3 (Fig. 4).Lytic lesions as a presentation of acute lymphoblastic leukaemia (ALL) have been described previously, particularly in the paediatric population, 1 but only rarely in adult ALL. 2 Figure 1 CT scan demonstrating destructive lesion C6 on left and irregular lucency on right at T3 vertebra.