An Autopsy Case of Acute Myelogenous Leukemia Associated with Ascending Transverse Spinal Syndrome and Review of the Literature

We reported a case of acute myelogenous leukemia associated with complete spinal transverse syndrome, which suddenly developed 3 weeks prior to death and ascended rapidly to the Th4 level. The serial sections of the spinal cord revealed parenchymatous changes consisting of softening, necrosis and hemorrhage in the Th4 through Th8 cord and the L1 and L2 cord, with no leukemic cell infiltration in the parenchyma. There was an epidural infiltration of leukemic cells, forming tumor-like masses between Th6 and Th10 segment. Hemorrhage was seen in the posterior nerve roots.The involvement of the spinal cord was reviewed from 40 reported cases in Japan comparing with 95 cases from the Western countries. The spinal cord involvement in leukemia was most frequently seen in young males, and in the course of acute myelogenous leukemia. The commonest clinical manifestation was paraplegia and sphincter disturbance. The commonest pathological change was the parenchymatous changes in the Japanese cases, in comparison with the frequent ocurrence of meningeal infiltration or epidural tumor formation in the Western ones. In the spinal involvement the thoracic cord was involved most frequently.In our case, the parenchymatous change of the spinal cord was most likely to have been caused by a circulatory disturbance, due to epidural compression by the deposits of leukemic cells.