A Case of Acute Lymphoblastic Leukemia with Isolated Orbital Relapse (original) (raw)
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Orbital Swelling: An Unusual Case of Relapsed Acute Lymphoblastic Leukaemia in A Preschool Child
Malaysian Journal of Paediatrics and Child Health, 2021
Acute lymphoblastic leukaemia (ALL) is the most frequent childhood cancer. Children usually present with signs of bone marrow failure like recurrent or prolonged fever, pallor, lethargy, bleeding tendencies, bone pain and others. Occasionally they may present with sign of infiltration of leukaemic cells into other organs such as testicular and central nervous system, rarely to the periorbital or orbital region. Similarly in relapse cases, they typically presented either in bone marrow, central nervous system relapse or testicular but rarely orbital involvement. Here we report the clinical case of a five-year-old boy who developed relapsed B-ALL, presented to us with unilateral right eye swelling without other clinical findings and absence of blast cells in the peripheral blood film as well as bone marrow aspirate specimen.
Unusual Presentation with Orbital Mass in a Child with Precursor B-Cell Acute Lymphoblastic Leukemia
Case Reports in Hematology
Orbital involvement is one of the extramedullary manifestations in acute leukemia. It is common in acute myeloid leukemia, but rare in acute lymphoblastic leukemia (ALL). We described a 3-year-old girl who presented with progressive proptosis of the right eye and was later diagnosed with precursor B-cell ALL. Initial blood count showed Hb 6.9 g/dL, WBC 42,000/mm3, lymphoblast 50%, and platelet count 185,000/mm3. Bone marrow aspiration revealed 90% lymphoblasts with positivity for CD10, CD19, CD20, CD22, and HLA-DR markers. Computed tomography (CT) scan of the brain and orbit revealed a homogeneous enhancing mass involving the right orbit with intracranial extension. The cytogenetic study showed 46,XX chromosomes. After 4 weeks of induction chemotherapy for very high-risk ALL, although the bone marrow was in remission, the proptosis was partially resolved. CT scan confirmed a decrease in size of the right orbital mass and degree of intracranial extension. Unfortunately, the patient a...
Orbital and Ocular Manifestations of Acute and Chronic Leukemia
International Journal of Health Sciences and Research, 2016
Introduction: Ocular disorders have been reported in 30-90% of cases of leukemia. Ophthalmic involvement in leukemia is associated with significant ocular morbidity and vision loss and has critical implications for the natural course and survival prognosis of systemic leukemia. Materials and methods: The present prospective study was conducted at department of Ophthalmology of tertiary Cancer care center from September 2014 to May 2016. All patients ≥ 18 years age diagnosed with leukemia, in spite of chemotherapy status and not underwent bone marrow transplant therapy were included in this study. Each included patient was subjected to ophthalmological evaluation and leukemia related and non-leukemic ophthalmic findings were documented. The data was analyzed by using SPSS version 23 and applying chi square test. Results and Conclusions: Out of 67 patients diagnosed with leukemia ocular lesions were found in 35 (52.23%) leukemic patients with no significant intersex difference. The di...
Acute Leukemia Presenting in the Pediatric Orbit
Cureus, 2022
We present a case series to evaluate the clinical features of acute leukemia presenting with primary orbital manifestations. We undertook a retrospective case review of primary orbital presentations of acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL) over a 10-year period at two hospital sites (Hereford County Hospital and Leicester Royal Infirmary). Our case series included four patients-two with AML and two with ALL. Patients were young (mean age of four years and five months) at presentation, all with unilateral disease, and presented with orbital signs. Although there was some confusion with the diagnosis at the time of referral, a suspicion of malignancy was made rapidly once ophthalmic review was initiated. All four cases were diagnosed with the assistance of peripheral blood film and bone marrow biopsy, without the need for orbital biopsy. All four cases had resolution of the orbital mass and remain disease-free.
[Ophthalmic manifestations of acute leukemia]
Journal français d'ophtalmologie, 2002
Orbital and ocular lesions are the third most frequent extramedullar locations of acute leukemia after the meninges and testicles. These lesions are treated as a central nervous system lesion; therefore diagnosis is essential to therapeutic adjustment. We present a retrospective study on charts of children treated for acute leukemia between 1996 and 1998. Ophthalmic examination was carried out when there were ocular symptoms. One hundred ninety-six children were treated for acute leukemia. Twelve children (6.1%) had an ocular and orbital lesion: 7 boys and 5 girls, with an average age of 6 years. Six had acute lymphoblastic leukemia, 6 had acute myeloid leukemia. Visual acuity was 1/10 in 9 children. Four children had an initial orbital lesion with a rapidly progressing exophthalmos. The hemogram and myelogram showed a granulocytic sarcoma. Two children who had been previously treated for acute leukemia presented a bilateral anterior uveitis with hypopyon; anterior chamber paracente...
Turkish Journal of Hematology, 2012
Ocular findings are rarely the initial symptom of leukemia, although up to 90% of all leukemia patients have fundus changes during the course of the disease. Herein we report a relapsing acute lymphoblastic leukemia patient with the sole presentation of sudden visual loss and exudative retinal detachment. An 8-year-old boy with acute lymphoblastic leukemia developed sudden visual loss during his first remission period. Bullous retinal detachment with total afferent pupillary defect was observed. Orbital magnetic resonance imaging revealed an intraocular mass lesion; simultaneously obtained bone marrow and cerebrospinal fluid samples showed no evidence of leukemic cells. Following local irradiation, and systemic and intrathecal chemotherapy the mass disappeared. Local irradiation, and systemic and intrathecal chemotherapy effectively controlled the isolated ocular relapse of acute lymphoblastic leukemia and eliminated the need for enucleation.
Revista Brasileira de Oftalmologia, 2021
The Acute Lymphocytic Leukemia (ALL) is a disease characterized by a high survival rate, but the absolute number of children who die from it represents a large proportion of cases of infant deaths from cancer. The morbidity resulting from its treatment can leave sequelae in people with high life expectancy, making it extremely necessary to understand the pathogenesis of this disease, enabling the development of new treatments and reduction of sequelae caused by the disease. This early diagnosis is important to avoid ocular complications that may lead to low long-term visual acuity and to evaluate treatment relapses and determine the conducts.
Ophthalmological Manifestations in Acute Lymphoblastic Leukemia
InTech eBooks, 2011
The aim of the present chapter is to review the different ophthalmological signs and symptoms that can be observed in acute lymphoblastic leukemia and the importance of the examination of these patients by an ophthalmologist whenever an ocular affectation is suspected. Acute lymphoblastic leukemia is a malignant neoplasm caused by the proliferation of poorly differenciated precursors of the lymphoid cells, which are known as blast cells. Blast cells replace the normal elements of the bone marrow, decreasing the production of normal blood cells and, therefore, causing anemia, thrombocytopenia and neutropenia. They can also infiltrate other organs, such as liver, spleen, lymph nodes or, less frequently, central nervous system. (Florensa et al, 2006; Ribera & Ortega, 2003; Sharma et al, 2004) Acute lymphoblastic leukemia is the most common type of leukemia in children, although it is also seen in adult patients. If blood test results are abnormal or the doctor suspects leukemia despite normal cell counts, a bone marrow aspiration and biopsy are the next steps. Treatment is based on chemotherapy, radiotherapy and bone marrow transplantation.
Orbital mass secondary to infantile acute lymphoblastic leukaemia
BMJ Case Reports, 2016
Full clinical cases submission template TITLE OF CASE Do not include "a case report" Orbital mass secondary to infantile acute lymphoblastic leukaemia SUMMARY Up to 150 words summarising the case presentation and outcome (this will be freely available online) An 8-month-old Asian female infant was referred with a one-week history of left periorbital swelling on a background of a narrowed left palpebral aperture over the preceding 8 weeks. There was no history of chronic illness, fever or other systemic features. Examination revealed a tender and fluctuant medial canthal swelling with associated periorbital haematoma. There were no other ophthalmic findings and neurological examination was normal. A MRI scan of the brain and orbit demonstrated abnormal soft tissue with features of an aggressive tumour in the left orbital region with no globe invasion. Peripheral blood smear revealed blast cells, confirmed by bone marrow aspirate. A diagnosis of infant acute lymphoblastic leukaemia was made. The patient was started on risk-stratified chemotherapy according to the Interfant-06 Protocol. The periorbital swelling resolved by day eight following a course of prednisolone, the patient continues on chemotherapy and is currently in molecular remission. BACKGROUND Why you think this case is important-why did you write it up? Orbital masses secondary to acute lymphoblastic leukaemia (ALL) are a rare entity, with only seven cases reported in the literature, five of which were known to already have a systemic diagnosis.(1) Only 10% of orbital tumours in childhood are due to leukaemias and lymphomas, with granulocytic sarcomas secondary to acute myelogenous leukaemia (AML) being the most prevalent.(2) This patient was misdiagnosed with unilateral conjunctivitis, revised to dacryocystitis, and finally referred to our tertiary referral centre with an extensive dacryocele. ALL was found to be infiltrating the orbit as the sole presenting feature. Due to the misdiagnosis and delay in referral, it is important to highlight more sinister cases of orbital swelling as a potential differential diagnosis. CASE PRESENTATION Presenting features, medical/social/family history An 8-month-old Asian female infant was referred to the Ophthalmology department at Great Ormond Street Hospital (UK) with a one-week history of left periorbital swelling, preceded by an eight-week history of a narrowed left palpebral aperture. This was initially treated as conjunctivitis and then dacryocystitis. There was no fever, weight loss or other systemic features reported. There was no significant medical or family history and the baby was previously healthy with normal development. On examination, the patient was afebrile and appeared comfortable, alert and interactive. External examination revealed extensive swelling around the left medial canthus extending into the periorbital region with evidence of haematoma (Fig 1A). The palpebral aperture in the left eye was smaller than the right. The patient was able to fix and follow, and using forced choice preferential looking Teller acuity cards, the visual acuity was 6 cpd in both eyes (6/45), and there was no strabismus. Pupils were equally reactive to light with no relative afferent pupillary defect. Slit lamp examination revealed no anterior segment abnormalities, and fundus examination was normal with healthy optic disc, macula and peripheral retina. Regional examination of the lymph nodes revealed a 1 cm enlarged, firm, mobile occipital node on the left. On auscultation of the chest, there was diffuse bilateral wheeze. Tonsils were also enlarged. Abdomen was distended but soft and non-tender. Liver and spleen were 4 cm and 3 cm below the costal margin, respectively. Neurological and cardiovascular examinations were normal.