title: Simultaneous conjunctival, uveal, and orbital involvement as the initial sign of acute lymphoblastic leukemia.
abstract: BACKGROUND
  A case of acute lymphoblastic leukemia with an initial presentation of unilateral simultaneous conjunctival, uveal, and orbital infiltration is reported.
  
  
  METHODS
  A 9-year-old girl presented with mild proptosis and chemosis and total exudative retinal detachment in the right eye.
  
  
  METHODS
  B-mode ultrasonography showed diffuse uveal thickening and a retrobulbar mass. Magnetic resonance imaging scans demonstrated a well-circumscribed peribulbar orbital mass. Incisional biopsy from the conjunctiva and bone marrow sampling established the diagnosis of acute lymphoblastic leukemia L1 type.
  
  
  CONCLUSIONS
  Blast-cell infiltration of three distinct ocular structures simultaneously in the absence of any peripheral signs is an extremely rare initial manifestation of acute lymphoblastic leukemia.
authors.affiliation: Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey. hkiratli@hacettepe.edu.tr
authors.forename: Hayyam
authors.initials: H
authors.lastname: Kiratli
authors.forename: Sevgül
authors.initials: S
authors.lastname: Bilgiç
authors.forename: Serkan
authors.initials: S
authors.lastname: Emeç
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D003230:Conjunctival Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009918:Orbital Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D014463:Ultrasonography; D014604:Uveal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy