title: Parenchymal brain leukemia. Case report: problems related to the diagnosis and treatment.
abstract: A case of intracerebral nodular leukemic mass that developed in a girl eight years after a diagnosis of acute lymphoblastic leukemia (ALL) and 18 months after second discontinuation of therapy for a central nervous system (CNS) relapse is reported. The morphologic picture and the long time that elapsed from the diagnosis raised the suspicion of a cerebral neoplasm; the immediate and dramatic effect of steroid treatment, on the contrary, indicated the presence of a leukemic infiltration and in the meantime, a bone marrow relapse occurred. The patient soon after received high-dose Cytosine Arabinoside (HD ARA C) + Vincristine (VCR) + Levo-Asparaginase (L-ASE) + Prednisone (PDN) without any intrathecal antiblastic drug. We observed a neurological recovery and a complete disappearance of the mass. After consolidation of the remission the patient began an ablative regimen for bone marrow transplantation. The efficacy of HD ARA C in the treatment of the intracerebral nodular leukemic mass is emphasized.
authors.affiliation: Clinica Pediatrica, Università di Milano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Corbetta
authors.forename: M
authors.initials: M
authors.lastname: Jankovic
authors.forename: V
authors.initials: V
authors.lastname: Conter
authors.forename: T
authors.initials: T
authors.lastname: Fuga
authors.forename: M
authors.initials: M
authors.lastname: Crivellaro
authors.forename: G
authors.initials: G
authors.lastname: Masera
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001037:Aphasia / Q000209:etiology; D001215:Asparaginase / Q000008:administration & dosage; D001812:Blood-Brain Barrier; D016026:Bone Marrow Transplantation; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003561:Cytarabine / Q000008:administration & dosage / Q000493:pharmacokinetics; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D008727:Methotrexate / Q000008:administration & dosage; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000473:pathology* / Q000628:therapy; D011241:Prednisone / Q000008:administration & dosage; D012074:Remission Induction; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D003561:Cytarabine; D014750:Vincristine; D003907:Dexamethasone; D001215:Asparaginase; D011241:Prednisone; D008727:Methotrexate