Pathological anatomy of leukemia

General characteristic pathological changes. Leukemia characterized by proliferation of the cells of hematopoietic tissue, which differ from the normal loss of ability to maturity. Leukemia process starts with the defeat of blood-forming organs (bone marrow, lymphatic tissue). Are involved in it also, those bodies was blood in the prenatal period (liver, spleen). Gradually, the process becomes generalized character and leukemic infiltration found almost everywhere. They arise autohtona of undifferentiated reticular cells located in the walls of blood vessels, interstitium glands and parenchymatous organs, in the membranes of nerve tissue and serous sheets. Leukemia infiltrates or diffuse infiltrate the body or have the appearance of small or larger sites. In adults in 8-10% of cases of acute leukaemia (N. A. Kraevsky and M. Hohlova), the children much more often, the leukemia infiltrates may have a mass character, they germinate, spaivayut and squeeze neighboring organs and tissues.

genocidalists
Fig. 5. Tumorous growths in the thymus and lymph nodes in the mediastinum when genocidalists.

In children occurs granulomas form of acute HP localization and beginning of the process in the thymus gland [cook (J. Cook); printing. table, Fig. 5].
In chronic forms of leukemia can also be observed-like form, and tumor growth are localized in organs in this form L. most of all involved in the process (N. A. Kraevsky and M. P. Khokhlov). For example, in chronic limfoleikoze tumor growth is observed in the retroperitoneal lymph nodes or lymph nodes in the mediastinum.
Secondary changes in L. depend on the failure of the authorities of the blood system in General and from local disorders of blood circulation and tissue trophism, emerging in connection with the growth of leukemia infiltrates. Due to anaemia (leukaemia) is expressed paleness of skin, mucous membranes and internal organs.
The skin may occur focal leukemia infiltrates in the form of bluish-red speakers knots or diffuse leukemic infiltration, for example facies leonina (see below Skin manifestations of leukemia). In the field of leukemia infiltrates and outside on the skin often develop hemorrhage, necrosis, gangrene, secondary suppuration. Necrosis are located at the corners of the mouth, the nostrils, on the back, buttocks (bedsores).


Fig. 4. Granulomas nodular leukemia infiltrates in the mucous membrane of the stomach in genocidalists.

Leukemic infiltration of the mucous membranes is more likely to occur in the digestive tract. Tonsils are sharply increased, especially in acute forms of leukemia, with symptoms gangrenous decay. May be diffuse leukemic infiltration of the gums (leukemia gingivitis). Diffuse leukemic infiltration of the mucous membrane of the stomach leading to a sharp thickening with emphatic folding (gyroscopically leukemic infiltration of the stomach). In the stomach, there is also a knot balashovrussia leukemic infiltration (printing. table, Fig. 4). Peyer's patches and solitary follicles intestines, increasing in volume, can morphologically to simulate picture mozgovenko swelling of typhoid fever; similarity is further complicated by the presence of necrosis and ulceration. Ulcero-necrotic changes may occur in the lining of the larynx, the epiglottis; mucous membranes urinary and genital tracts are less common.
Diffuse leukemic infiltration of serous sheets leads to their opacity and thickening that can simulate a picture of chronic inflammation, such as the cerebral membranes. Nodular or balashovrussia flat leukemia infiltrates are found in the pleura, pericardium, the meninges.
Leukemic infiltration of the bone marrow, the discovery of which is essential for the diagnosis of leukemia, usually has a diffuse character. A fat bone marrow is replaced by cellular and sawing on the long bones such as the diaphysis of the thigh may be removed in the form of "sausages"; color bone marrow depends on the form of leukemia and may be reddish, reddish-grey, greenish or blackish from the foci of hemorrhage.
Bone - in most cases with symptoms of osteoporosis, already perceptible in macroscopic examination. In sharp degree of osteoporosis, bone can be cut with a knife. Rare is the osteosclerosis.
Lymph nodes in the vast majority of cases of diffuse infiltrated, the cut-whitish, granulomas, with reddish and blackish foci.
In parenchymatous organs (liver, kidneys) and glands diffuse leukemic infiltration leads to a significant increase their volume and weight. The parenchyma of the body is exposed to atrophy; circulatory disorder lead to hemorrhage, necrosis, heart attacks, sometimes with a broken capsule body. Leukemia infiltrates in parenchymatous organs have the form of multiple, equal in volume, units or nodules whitish color, homogeneous type, soft consistency and this remind metastases of malignant tumors (printing. table, Fig. 1).


Fig. 1. Granulomas leukemia infiltrates, which developed in the course of the vessels of the liver, with genocidalists.

In light leukemic infiltration, spreading along peribronchial tissue and the alveolar walls, detected in the majority of cases histological examination. Circulatory disorders cause effusion in the cavity of the alveoli. The accession of autoinfection accompanied by the development of pneumonia, abscesses and gangrene.


Fig. 2. Leukemic infiltration of the kidney with massive bleeding in the pelvis in acute genocidalists.

Leukemia process, usually accompanied hemorrhagic diathesis, which is often the direct cause of death of patients. Typical bleeding in the brain with a massive red lesions softening or hemorrhagic purpura. Characterized by bleeding in the epicardium, the pleura, peritoneum, in the pelvis of the kidney (printing. table, Fig. 2), in the light, in the cavity of the gastrointestinal tract.
Autoinfection in the tissues affected leukemia process, which may cause the development coccal mycotic or sepsis.
Modern methods of treatment with hormones and antimetabolites significantly change the picture of leukemia. Therapeutically due pathomorphosis (see) HP changes the quality of their leukemia cells, to the degeneration and necrosis of leukemia infiltrates. Qualitative change in the nature of leukemia infiltrates expressed in the appearance of atypical reticular cells and plazmaticescoy. Especially significant are degeneration and necrosis of leukemia cells in the bone marrow, which in some cases leads to antielitism. In rare cases, a massive collapse of the leukemia cells and their nuclei leads to the formation in kidneys and uric acid heart attacks until the development of anuria. In bone tissue, especially when hormonal therapy in children increases osteoporosis with the development of Rivisondoli (subsidence of the vertebrae in cranio-caudal direction), violation of statics and the emergence in the bodies of lime metastases. Rarely is strengthening osteosclerosis up to burnetii. Modern complex therapy of leukemia may also be accompanied by the emergence of the syndrome Itsenko - Kushinga, atrophy of the adrenal hyperplasia anterior pituitary, Plasmodium and arteriolopathy, focal necrosis parenchymatous organs, the rising of septic processes, despite the use of antibiotics.