Ovarian tumours: late extramedullary recurrence of acute leukaemia.
OBJECTIVE
Isolated extramedullary relapse, especially ovarian recurrence, of acute leukaemia is rare. Local therapy such as irradiation or extensive surgical resection of the mass is ineffective and unnecessary.


METHODS
Over a 20-year period we observed two girls with ovarian relapse of acute lymphoblastic leukaemia (ALL) in over 300 treated children for ALL. Pre-B ALL was diagnosed in a girl at the age of three. Treatment was initiated according to the CoALL 82-protocol. At the age of 11, the girl presented with a huge abdominal mass. Chemotherapy and low-dose radiotherapy succeeded in shrinking the tumour mass, making it operable. A salpingo-oophorectomy was performed. In the second case, a 14-year-old girl in whom pre-B ALL was diagnosed was treated according to the protocol CoALL 06-97. After having achieved complete haematological remission in the bone marrow, she stayed in remission for 18 months. Subsequently, she developed a painless abdominal tumour. Laparoscopic lymph node staging was performed and biopsies were taken. Chemotherapy was initiated according to the BFM protocol for ALL recurrence. Extensive surgical resection of the leukaemic mass, as well as additional radiation was avoided.


CONCLUSIONS
Because we experienced favourable results with laparoscopic biopsy in our patients, we are of the opinion that laparoscopy-assisted biopsies are well suited for the management of intra-abdominal tumours in systemic malignant disease.
Turial
S
S
Department of Paediatric Surgery, University Medical Centre, Mainz, Germany. turial@ukmainz.de
Karabul
N
N
Gutjahr
P
P
Engel
V
V
Bierschock
S
S
Schier
F
F
D000293:Adolescent; D019046:Bone Marrow Neoplasms / Q000473:pathology* / Q000601:surgery; D002675:Child, Preschool; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local; D010051:Ovarian Neoplasms / Q000556:secondary* / Q000601:surgery; D010052:Ovariectomy; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome