MIXED-LINEAGE ACUTE MYELOID-LEUKEMIA ASSOCIATED WITH A SUPRASELLAR SYSGERMINOMA

An association between primary mediastinal germ cell tumors and hemato logic malignancies has been recognized since 1985. We present a patien t with a suprasellar germ cell tumor and an associated leukemia. A 20- year-old black female presented in December 1987 with a 6-month histor y of headaches and weight loss, confusion, polyuria, and polydipsia. E valuation revealed hypernatremia, normal neurologic examination except poor recall, and an enhancing inhomogeneous suprasellar mass on crani al computed tomography. Biopsy of the mass diagnosed a dysgerminoma, w hich was treated with craniospinal radiation. In February 1988, the pa tient developed pancytopenia, which resolved with discontinuation of c imetidine and phenytoin. She did well until June 1988 when she present ed with skin lesions over the trunk and extremities. Skin biopsy revea led a leukemic infiltration. She was admitted with a WBC 1,500/mul (wi thout blasts), Hb 11.6 g/dl, PLT 210,000 mul. Bone marrow biopsy revea led hypercellularity with 50% blasts, demonstrating mixed-lineage acut e myeloblastic leukemia (myelomonocytic-M4; megakaryoblastic-M7). The patient was induced with a standard Ara-C/daunorubicin regimen. Two we eks postinduction, she became septic and expired. An autopsy demonstra ted leukemic involvement of the spleen, liver, bone marrow, and skin, without residual dysgerminoma. This represents the first reported case of suprasellar dysgerminoma associated with a mixed-lineage leukemia not related to chemotherapy.