21833              ACUTE LYMPHATIC LEUKAEMIA

The patient was a man aged 25 whose illness began with epistaxis, skin bruising and weakness.  Acute lymphatic leukaemia was found which was treated initially with Vincristine and prednisolone, with good effect.  Two months later he was readmitted with vomiting, haematuria and meningism.  Lumbar puncture showed numerous lymphoblasts in the CSF.  He went rapidly downhill with recurrent haemorrhages.  The liver, spleen and lymph nodes were enlarged.

The specimen consists of a slice of kidney and of spleen.  The kidney is grossly enlarged and massively infiltrated by pale leukaemic tissue against which numerous large areas of blotchy haemorrhage stand out prominently.  The spleen is only moderately enlarged and shows small relatively inconspicuous suet pudding nodules on the cut surface.  Histology showed leukaemic meningitis and mild demyelination in the white matter of the spinal cord.