Congenital Leukaemia

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Abstract
Day pathologists are keenly aware of the extraord!inary lability of the infant 's hematopoietic system. As a consequence, but somewhat paradoxically, fewer cases of this disorder are now- recognized than in the past. Many of the older reports are now more accurately classified as erythroblastosis fetalis, congenital syphilis, or sepsis. Table 1 lists the 14 cases in the literature that presented! acceptable documentation as to the presence of a leukemic state at bi!'th. To these we have added 4 cases from the files of the Armed Forces Institute of Pathology (table 2). In addition to autopsy examination and microscopic studly of the tissues, adedluat.e hematologic studies had 1)een conducted dui'ing life in each of these cases. To fulfill the criteria of congenital leukemia, there must 1)e manifest at birth or shortly thereafter, symptoms or signs which can be correlated with the characteristic hematologic disturbance. The i'ecognit ion of the nature of the latter, however, may be delayed as in Case 4 (AFIP 234131). Significant phys- ical manifestations are: spontaneous hemorrhages of skin and! mucous membrane, nodular skin infiltrations, enlargement of spleen and livei', ad!enopathy, fever and pallor. The blood should reflect an alteration of the marrow by showing an undue proportion of poorly differentiated oi' undiffei'entiated cells usually of the granulocytic series; ideally there should be confirmatory bone mai'I'Ow studies. In most. cases considerable elevation of the white blood cell count and reduced numbers of red cells and platelets arc also observed. Nucleated red cells may be present. in varying number. Since changes easily confusedl pat holog- ically with leukemia occur in congenital syphilis and ervthroblastosis fetalis, i'eports of serologic studies on the mother should he available and information regaro!ing the possibility of blood group or type incompatibility between mothei'
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