Acute lymphocytic leukemia recurring in the spinal epidural space.
A 27-year-old man presented with a very rare spinal epidural mass associated with recurrence of acute lymphocytic leukemia (ALL) manifesting as acute progressive neurological deficits. The patient presented with shoulder pain and ambulatory difficulties 3 years after remission of ALL treated by bone marrow transplantation. Magnetic resonance imaging revealed an epidural mass extending from C-7 to T-3, which compressed the cord and extended to the intervertebral foramen along the roots. After decompression surgery, the symptoms dramatically improved. Histological examination showed clusters of immature lymphocytes consistent with recurrence of leukemia, so chemotherapy and radiation therapy were carried out. At 1 year after the operation, no local mass expansion or systemic progression of leukemia had occurred. Leukemic mass must be considered in the differential diagnosis of spinal epidural mass, even in patients with ALL.
Higashida
Tetsuhiro
T
Department of Neurosurgery, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama, Japan. t056042a@yokohama-cu.ac.jp
Kawasaki
Takashi
T
Sakata
Katsumi
K
Tanabe
Yutaka
Y
Kanno
Hiroshi
H
Yamamoto
Isao
I
D000328:Adult; D014408:Biomarkers, Tumor / Q000032:analysis / Q000378:metabolism; D016026:Bone Marrow Transplantation; D019299:Decompression, Surgical; D004358:Drug Therapy; D015174:Epidural Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D004824:Epidural Space / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D019635:Neurosurgical Procedures; D049268:Positron-Emission Tomography; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000473:pathology* / Q000601:surgery; D011878:Radiotherapy; D012008:Recurrence; D020069:Shoulder Pain / Q000209:etiology; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D013117:Spinal Cord Compression / Q000209:etiology* / Q000503:physiopathology; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery; D016896:Treatment Outcome
D014408:Biomarkers, Tumor