Recently., Raz and associates [l] and Haznedar [2] reported in this journal five cases of pancytopenia with hyperplastic marrow, which preceded the development of lung and prostate carcinomas suggesting that pancytopenia resulting from myelodysplasia is a possible paraneoplastic manifestation in solid tumors.
In our experience, five of 18 patients with chronic myelomonocytic leukemia diagnosed according to the FAB criteria [3] presented with an associated epithelial solid tumor. The following abnormalities were found in all cases: an absolute monocytosis in the peripheral blood (> 1 x lO'/liter), high levels of serum lysozyme, splenomegaly, bone marrow infiltration made up of atypical promyelocytes and especially of promonocytes, and a percentage of type I blast cells of less than 10%. In four of the five cases, the in vitro culture of CFU-GM from bone marrow and peripheral blood samples showed a characteristic growth pattern of chronic myelomonocytic leukemia (increased number of colonies and aggregates).
Two patients had a carcinoma of the stomach, one patient a carcinoma of the colon, one patient an epidermoid bronchogenic carcinoma, and the remaining patient an epidermoid tumor of unknown origin. Malignancy was confirmed by histologic study in all cases. In three of the five patients, the diagnosis of the leukemic process and that of the epithelial tumor was established simultaneously, but in two cases (epidermoid mletastatic carcinoma and carcinoma of the colon) the neoplasm developed 5 months, and 2 years, respectively, before chronic myelomonocytic leukemia. This last patient was the only one who died as a consequence of the blastic crisis; in the remaining four patients, the cause of the death was metastatic dissemination of the neoplasm. One of the five patients (epidermoid metastatic carcinoma) was given