An autopsy study of the metastatic patterns of human leukemias

This paper analyses the distribution of metastases at every site of the human body in acute lymphoblastic, chronic lymphocytic, acute myeblastic and chronic myelocytic leukemias in patients that come to autopsy. It appeared that the 4 types of leukemia had a similar seeding frequency of the skin, breast, trachea, diaphragm and all other muscles. The highest incidence of metastases was found in the lymphatic system (i.e. all lymph-nodes and spleen). Acute lymphoblastic leukemia showed an excess of metastases in the major blood vessels, pleura, large intestines, extrahepatic biliary tract, ureters, prostate, cervix uteri, central nervous system, thymus, ovaries and pituitary. The excess of metastases at specific sites did not cluster either in topographical areas or in anatomical systems, with the exception of metastases in the central nervous and endocrine systems (acute lymphoblastic leukemia). Chronic lymphocytic leukemia showed an excess of metastases in all lymph nodes, kidney, adrenals and heart. A lymphatic route of dissemination, as opposed to a blood-borne spread of malignant cells, was hypothesised to account for the excess of metastases in the above mentioned organs in patients affected with chronic lymphocytic leukemia. Soil specificity with the degree of anaplasia of leukemic cells may account for the higher than expected occurrence of metastases in a given organ, for a specific leukemia. This remark holds true particularly for acute lymphoblastic leukemia.