Haematological Leukemia

Patients with solid tumours exhibiting positive aPL have been sporadically reported and they include carcinoma of the lung [45, 46] kidney [47, 48], colon

[49], prostate [50], liver [51], ovary [52], trachea [53] as well as thymoma [54].

The 2 patients reported with lung carcinoma [4546] had differing clinical aPL-associated complications. The first had elevated titres of aCL (IgG isotype) and suffered recurrent DVT and pulmonary embolism resistant to anticoagulation with warfarin as well as SC heparin. Venous gangrene supervened and the patient died 7 months following his initial presentation.

The second patient presented with extensive bruising, purpura and splinter haemorrhages. He was also found to have a right hemiplegia. Severe thrombocytopenia (8 x 109/1) was detected with positive LA, elevated IgG and IgM aCL and a false positive VDRL. A CT brain scan was compatible with a left parietal haemorrhagic infarction.

Both the patients reported with renal carcinoma [47] had pulmonary embolism, while the second [48] only demonstrated a false positive VDRL as well as positive serology for SLE with thrombocytopenia. The tumour in this case was a hypernephroma.

Interestingly the patient with a prostate carcinoma

[50] had developed the haemolytic-uraemic syndrome (HUS) accompanying systemic sclerosis. Thrombotic microangiopathy was found on renal histology. It was suggested by the authors that the scleroderma was of paraneoplastic origin.

Ruffatti et al. [52] reported a 41-year-old female who had a history of recurrent superficial thrombophlebitis DVT and pulmonary emboli with positive LA and IgM aCL (IgG aCL was normal).

Three months later, she subsequently developed a right iliac vein occlusion extending to the inferior vena cava and renal veins. CT scan of the abdomen showed a pelvic mass which proved to be an ovarian endometrial adenocarcinoma. With surgical removal, LA activity and IgM aCL disappeared. This patient also demonstrated NBTE affecting the tricuspid valve.

Of interest in this particular case was the demonstration of an increased level of polyclonal IgM suggesting that the IgM aCL activity derived from this abnormal protein.

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