Ophthalmology · 2006
Pre-B-cell acute lymphoblastic leukemia presenting as an orbital mass in an 8-month-old.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Thakker Manoj M, Rubin Peter A D, Chang Eli
Аннотация
PURPOSE: To present the case of an 8-month-old girl with undiagnosed pre-B-cell acute lymphoblastic leukemia (ALL) presenting as an orbital mass.
DESIGN: Observational case report and literature review.
METHODS: Review of clinical history, radiologic findings, histology of cervical lymph node and orbital biopsies, and follow-up.
RESULTS: An 8-month-old girl presented with a 2-week history of right-sided tearing, lid swelling, proptosis, and rhinorrhea. A computed tomographic scan of the orbits revealed a homogeneous, retrobulbar orbital mass eroding into the ethmoid sinuses and nasal cavity, as well as cervical lymphadenopathy. Biopsy of the lesion and enlarged lymph node disclosed medium-sized, uniform, cytologically atypical lymphocytes in a starry sky pattern. Immunohistochemical analysis showed reactivity to antibodies against CD-10, CD-19, CD-34, and terminal deoxynucleotidyl transferase. Cytogenetic analysis of the tumor also revealed a gene rearrangement on chromosome 11q23. Based on these findings, the diagnosis of pre-B-cell acute lymphoblastic leukemia was made, and systemic as well as intrathecal chemotherapy was instituted, which resulted in rapid remission of the leukemia.
CONCLUSIONS: The initial presentation of ALL as an orbital mass is exceedingly rare. To the best of the authors' knowledge, this is the earliest reported case of pre-B-cell ALL presenting as an orbital lesion.
DESIGN: Observational case report and literature review.
METHODS: Review of clinical history, radiologic findings, histology of cervical lymph node and orbital biopsies, and follow-up.
RESULTS: An 8-month-old girl presented with a 2-week history of right-sided tearing, lid swelling, proptosis, and rhinorrhea. A computed tomographic scan of the orbits revealed a homogeneous, retrobulbar orbital mass eroding into the ethmoid sinuses and nasal cavity, as well as cervical lymphadenopathy. Biopsy of the lesion and enlarged lymph node disclosed medium-sized, uniform, cytologically atypical lymphocytes in a starry sky pattern. Immunohistochemical analysis showed reactivity to antibodies against CD-10, CD-19, CD-34, and terminal deoxynucleotidyl transferase. Cytogenetic analysis of the tumor also revealed a gene rearrangement on chromosome 11q23. Based on these findings, the diagnosis of pre-B-cell acute lymphoblastic leukemia was made, and systemic as well as intrathecal chemotherapy was instituted, which resulted in rapid remission of the leukemia.
CONCLUSIONS: The initial presentation of ALL as an orbital mass is exceedingly rare. To the best of the authors' knowledge, this is the earliest reported case of pre-B-cell ALL presenting as an orbital lesion.
Предметные рубрики MeSH
Antibodies, NeoplasmAntigens, CDAntineoplastic Combined Chemotherapy ProtocolsChromosomes, Human, Pair 11Combined Modality TherapyFemaleGene Rearrangement, B-LymphocyteHumansInfantInjections, SpinalLymph NodesLymphatic MetastasisNeckOrbital NeoplasmsPrecursor B-Cell Lymphoblastic Leukemia-LymphomaTomography, X-Ray Computed