Leukemic nodules in the eye in immature-cellular infantile leukoses

Two boys, aged 5 1/4 and 10 1/4, respectively, with acute immature-cell leukosis, died of massive cerebral haemorrhage. Their eyes showed extensive leukaemic involvement of the retina with development of numerous miliary leukaemic nodules; the vitreous of case 2 was also involved. The lesions were considered to have developed because of high circulating white cell counts, a tendency of blast cells to produce nodules, an oxygen poor avascular matrix in which to grow, and a physical environment which permitted growth without haemorrhage or distortion due to tissue pressures etc. Using histological methods, an attempt is made to trace the pattern of formation of the nodule, from an initial growing focus through "colonial" form resembling a bacterial colony to lysis. Necrotic blast cells are apparently a metabolic source for viable tumour cells. Their localization in the eye makes access by cytotoxic drugs difficult; thus they should be considered as blast cell pools.