Leukemic ophthalmopathy: a report of 21 pediatric cases

Concurrent hypopituitarism and leukemic retinopathy in a child with B-precursor acute lymphoblastic leukemia and isolated central nervous system relapse

Hypopituitarism in leukemia is very rare. In addition, central nervous system (cns) relapse and leukemic retinopathy in childhood acute lymphoblastic leukemia (all) have declined with the use of modern systemic chemotherapy that includes cns prophylaxis. Here, we report the case of a 4-year-old girl who received chemotherapy and intrathecal therapy without cns radiation after a diagnosis of B-precursor all without cns involvement. Three months after chemotherapy completion, she presented with lower-extremity weakness and was diagnosed with an isolated cns relapse. Concurrent hypopituitarism and leukemic retinopathy were also found. After receiving craniospinal radiotherapy and systemic chemotherapy, her retinopathy and vision improved. She is now in complete remission, and she is still on chemotherapy according to the guideline from the Pediatric Oncology Group. Although rare, hypopituitarism and leukemic retinopathy should be taken into consideration in patients with cns involvement by leukemia.

Leukemic infiltration of the orbit: report of three cases and literature review

Orbital infiltration by acute lymphoblastic leukemia is rare. The authors present 3 patients, 2 with optic nerve involvement and 1 with anterior chamber infiltration, treated by chemotherapy and radiotherapy. Two are in continuous remission at 64 and 59 months and 1 relapsed in the central nervous system 35 months after ocular relapse. Visual deterioration was prevented in two. Early diagnosis and treatment are important for preservation of vision.

Fluorescence in situ hybridization (FISH) detects clonal instability in an optic nerve relapse of acute lymphoblastic leukemia

PURPOSE

We report a case of an isolated optic nerve relapse 3.5 years after diagnosis of hyperdiploid acute lymphoblastic leukemia (ALL) in a 6-year-old boy who had been off treatment for 3 months. The use of interphase fluorescence in situ hybridization (FISH) for clonal identification of chromosome abnormalities is described.

PATIENT AND METHODS

An asymptomatic lesion over the right optic nerve head was identified on routine funduscopic exam. Fine needle aspiration of the optic nerve infiltrate provided tissue for morphologic, immunohistochemical, and FISH analyses.

RESULTS

FISH showed similar but not identical chromosome makeup of the leukemic blasts at the time of relapse as compared to tissue samples obtained at the time of diagnosis.

CONCLUSION

Despite antimetabolite therapy, hyperdiploid ALL can rarely recur isolated to an optic nerve. FISH is a useful adjunct for confirming relapse when low numbers of white blood cells are obtained with fine needle aspiration.

Optic nerve head infiltration in acute leukemia in children: an indication for emergency optic nerve radiation therapy

Two pediatric patients with acute leukemia who developed optic nerve head leukemic infiltration are presented. In one patient both eyes were involved at diagnosis as well as her central nervous system. Despite systemic and intrathecal chemotherapy she lost her vision within a few weeks. Cranial irradiation at that point could not reverse this outcome. In the second patient optic nerve head infiltration was found a few months after diagnosis, treated promptly with cranial irradiation and her vision was saved. Her central nervous system (CNS) was not involved at any time. It is stressed that ocular complaints including eye pain or blurred vision in the pediatric patient with leukemia should be investigated without delay by an ophthalmologist. In the young child these complaints may be absent and change in the visual behavior should then alert the pediatric oncologist for possible ocular problems. If optic nerve head leukemic infiltration is diagnosed and promptly treated with emergency radiation, vision can be salvaged.