Central Nervous System Involvement of Acute Lymphoblastic Leukemia

  • Hyun, Seung-Jae (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Kim, Young-Baeg (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Yu, Hyeon (Department of Diagnotic Radiology, College of Medicine, Chung-Ang University) ;
  • Hong, Hyun-Jong (Department of Neurosurgery, College of Medicine, Chung-Ang University)
  • Published : 2006.07.30

Abstract

Central nervous system[CNS] involvement of acute lymphoblastic leukemia may occur. However, CNS involvement as a first manifestation of leukemia is very rare. An 8-year-old girl complained of a backache after playing in the water. Neurological examination detected progressing paraparesis. Magnetic resonance imaging[MRI] of the thoracolumbar spine showed a well-circumscribed homogeneous posterior extradural mass lesion extending from T7 to T9. MRI of the brain showed diffused fatty marrow replacement of the calvarium and the skull base. We report a patient with epidural Burkitt's lymphoma of the thoracic and lumbar vertebra causing compression of the spinal cord after pathologic evaluation. The tumor consisted mainly of lymphoblastic cells, which were identical to those originally seen in the bone marrow aspiration and biopsy. After decompressive laminectomy she began consolidation chemotherapy.

Keywords

References

  1. Almasri NM, Habashneh MA, Khalidi HS : Non-Hodgkin lymphoma in Jordan. Types and patterns of 111 cases classified according to the WHO classification of hematological malignancies. Saudi Med J 25 : 609-614, 2004
  2. Anderson JR, Wilson JF, Jenkin DT, Meadows AT, Kersey J, Chilcote RR, et al : Childhood non-Hodgkin's lymphoma. The results of a randomized therapeutic trial comparing a 4-drug regimen(COMP) with a 10-drug regimen (LSA2-L2). N Engl J Med 308 : 559-565, 1983 https://doi.org/10.1056/NEJM198303103081003
  3. Bennet JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR, et al : Proposals for the classification of the acute leukaemias. Br J Haematol 33 : 451-458, 1976 https://doi.org/10.1111/j.1365-2141.1976.tb03563.x
  4. Catherine P : Treatment of mature B-ALL and high grade B-NHL in children. Best Pract Res Clin Haematol 15 : 695-711, 2003 https://doi.org/10.1053/beha.2002.0231
  5. Hecht JL, Aster JC : Molecular biology of Burkitt's lymphoma. J Clin Oncol 18 : 3707-3721, 2000 https://doi.org/10.1200/JCO.2000.18.21.3707
  6. Jeong HS, Kim MS, Jung YT, Sim JH : Intracranial Chloroma (Granulocytic Sarcoma) by Lymphoblastic Leukemia. J Korean Neurosurg Soc 38 : 65-67, 2005
  7. Myong NH, Cho KJ, Choi SW, Jang JJ : Abdominal Burkitt's lymphoma diagnosed by fine needle aspiration cytology. J Korean Med Sci 5 : 97-99, 1990 https://doi.org/10.3346/jkms.1990.5.2.97
  8. Magrath IT : African Burkitt's lymphoma. History, biology, clinical features, and treatment. Am J Pediatr Hematol Oncol 13 : 222-246, 1991 https://doi.org/10.1097/00043426-199122000-00019
  9. Neiman RS, Barcos M, Berard C, Bonner H, Man R, Rydell RE, et al : Granulocytic sarcoma : a clinicopathologic study of 61 biopsied cases. Cancer 48 : 1426-1437, 1981 https://doi.org/10.1002/1097-0142(19810915)48:6<1426::AID-CNCR2820480626>3.0.CO;2-G
  10. Park WM, Jang JS, Rhee CH, Gwak HS, Lee SH : Epidural granulocytic sarcoma causing cord compression at thoracic region in acute myelogenous leukemia. J Korean Neurosurg Soc 29 : 1533-1537, 2000
  11. Patte C : B-acute lymphoblastic leukemia. The European experiecnce. J Pediatr Hematol Oncol 5 : 81-88, 1998
  12. Patte C : Non-Hodgkin's lymphoma. Eur J Cancer 34 : 359-362, 1998 https://doi.org/10.1016/S0959-8049(97)10142-3
  13. Ripp DJ, Davis JW, Rengachary SS, Lotuaco LG, Watanabe IS : Granulocytic sarcoma presenting as an epidural mass with cord compression. Neurosurgery 24 : 125-128, 1989 https://doi.org/10.1227/00006123-198901000-00024
  14. Salloum E, Tallini G, Levy A, Cooper DL : Burkitt's lymphoma-leukemia in patients treated for Hodgkin's disease. Cancer Invest 14 : 527-533, 1996 https://doi.org/10.3109/07357909609076898
  15. Sandlund JT, Downing JR, Crist WM : Non-Hodgkin's lymphoma in childhood. N Engl J Med 334 : 1238-1248, 1996 https://doi.org/10.1056/NEJM199605093341906
  16. Stefansson TA, Rask BE : Acute paraplegia as the initial symptom of acute leukemia. Case report. J Neurosurg 39 : 648-651, 1973 https://doi.org/10.3171/jns.1973.39.5.0648