Brain Tumor Res Treat.  2014 Oct;2(2):114-118. 10.14791/btrt.2014.2.2.114.

Isolated Central Nervous System Relapse of Acute Lymphoblastic Leukemia

• Sung SH
• Jang IS

• KMID: 2134282
• DOI: http://doi.org/10.14791/btrt.2014.2.2.114

Abstract

Acute lymphoblastic leukemia (ALL) is the most common form of childhood cancer and may exhibit central nervous system (CNS) involvement. Advances in chemotherapy and effective CNS prophylaxis have significantly decreased the incidence of CNS relapse of ALL to 5-10%. Here, we report the case of a patient with isolated CNS relapse of standard risk group pre-B-cell type ALL in an 11-year-old girl, relapsed 3 years after successful completion of chemotherapy. An 11-year-old girl visited our hospital complaining of headache, dizziness, vomiting, and visual field defects. Neurological examination revealed left-side homonymous hemianopsia. Brain magnetic resonance imaging showed a large irregular dural-based sulcal hematoma in the right parietal and occipital lobes. Surgery to remove the hematoma revealed the existence of hematopoietic malignancy after pathologic evaluation. Bone marrow biopsy was subsequently performed but showed no evidence of malignancy.

Keyword

Leukemia; Central nervous system; Recurrence

MeSH Terms

Biopsy
Bone Marrow
Brain
Central Nervous System*
Child
Dizziness
Drug Therapy
Female
Headache
Hematologic Neoplasms
Hematoma
Hemianopsia
Humans
Incidence
Leukemia
Magnetic Resonance Imaging
Neurologic Examination
Occipital Lobe
Precursor Cell Lymphoblastic Leukemia-Lymphoma*
Precursor Cells, B-Lymphoid
Rabeprazole
Recurrence*
Visual Fields
Vomiting

Figure

• 

  Fig. 1 Computed tomography of the brain revealed a large irregular dural-based high-density lesion in right parieto-occipital lobe.

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  Fig. 2 Brain magnetic resonance imaging demonstrated a low-intensity lesion on both T1- (A) and T2- (B) weighted images that appeared to be a sulcal hematoma. Gadolinium-enhanced T1-weighted imaging (C) showed a heterogeneously enhanced dural-based mass-like lesion and sulcal enhancement.

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  Fig. 3 Photomicrographs of the tumor specimen. A: H&E stain (×600). Several lymphoblasts with high nuclear/cytoplasmic ratio and variably condensed nuclear chromatin. B: Immunophenotype stain (CD10). Lymphoblast marker (CD10) was positive. C: Immunophenotype stain (TdT). Lymphoblast marker (TdT) was positive. D: Immunophenotype stain (CD79a). B-cell marker (CD79a) was positive.

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