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Kollia E, Biswas S, Shenoy BH. Bilateral Acute Proptosis With Papilledema and Sub-retinal Fluid As Initial Manifestations of Acute Lymphoblastic Leukemia in a Child. Cureus 2024; 16:e64203. [PMID: 39130884 PMCID: PMC11310570 DOI: 10.7759/cureus.64203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/13/2024] Open
Abstract
A five-year-old boy presented with bilateral acute proptosis, papilledema, and sub-retinal fluid. Notably, choroidal thickening exceeded 600 microns. These ocular findings were the initial manifestations of acute lymphoblastic leukemia. This case underscores the importance of recognizing uncommon ocular presentations in pediatric leukemia for timely diagnosis and management.
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Affiliation(s)
- Elpida Kollia
- Paediatric Ophthalmology, Manchester Royal Eye Hospital, Manchester, GBR
| | - Susmito Biswas
- Paediatric Ophthalmology, Manchester Royal Eye Hospital, Manchester, GBR
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Chen TH, Roelofs KA, Goh T, Pullarkat S, Goldberg RA, Rootman DB. Orbital Involvement in Acute Adult Leukemias: Case Series and Review of Literature. Ophthalmic Plast Reconstr Surg 2023; 39:e107-e111. [PMID: 37083726 DOI: 10.1097/iop.0000000000002369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Orbital involvement in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) is well-described in children but is uncommon in adults. This series reports 2 adult patients with orbital leukemic involvement and summarizes the existing literature. A 37-year-old male with recently diagnosed AML underwent induction therapy and subsequently developed a tan-pink colored sub-conjunctival lesion in the left eye. Incisional biopsy confirmed AML. A 35-year-old male with history of ALL presented with left-sided orbital mass. Fine needle aspiration biopsy confirmed ALL. Literature review of adult-onset orbital leukemia yielded 29 cases of AML and 3 cases of ALL. Orbital involvement of acute adult-onset leukemia tends to be unilateral, presents in the extraconal space and can occur at any point during systemic leukemic disease. Chemotherapy is the mainstay of treatment, often in combination with radiation and/or hematopoietic stem cell transplant.
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Affiliation(s)
- Teresa H Chen
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Tracie Goh
- Department of Pathology, University of California, Los Angeles, California, U.S.A
| | - Sheeja Pullarkat
- Department of Pathology, University of California, Los Angeles, California, U.S.A
| | - Robert A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
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Alam MS, Vijay V. To prick or to poke? Indian J Ophthalmol 2019; 67:324. [PMID: 30777945 PMCID: PMC6407394 DOI: 10.4103/ijo.ijo_763_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Md Shahid Alam
- Department of Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Vathsalya Vijay
- Department of Orbit Oculoplasty Reconstructive and Aesthetic Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
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Abstract
The article presents clinical description and instrumental findings (ultrasound examination and multi-slice computed tomography of the orbits) of a rare lacrimal gland tumor, which precedes or concurs with acute myeloblastic leukemia. Due to the low incidence of myeloid (granulocytic) sarcoma, it is not possible to develop a proper algorithm for its diagnosis and treatment. Few descriptions that are available in the literature neither give an idea of the variety of manifestations and the order of organ involvement, nor allow any vital prognosis. Verification of the diagnosis can only be based on immunohistochemical findings of the primary tumor and bone marrow biopsy material. The authors emphasize the importance of combination treatment (radiation therapy of the orbits and chemotherapy) in the prevention of leukemia.
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Affiliation(s)
- V G Likhvantseva
- Lomonosov Moscow State University, 1 Leninskie Gory, Moscow, Russian Federation, 119991
| | - T N Safonova
- Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021
| | - K A Kuzmin
- Lomonosov Moscow State University, 1 Leninskie Gory, Moscow, Russian Federation, 119991
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Pathy S, Venkatesulu BP, Mallick S, Chander S. Radiation Therapy in Paediatric Orbital Granulocytic Sarcomas: Experience from a Tertiary Cancer Center. J Clin Diagn Res 2016; 10:XC01-XC05. [PMID: 27891440 DOI: 10.7860/jcdr/2016/19773.8599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 06/28/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Orbital Granulocytic Sarcoma (OGS) is an uncommon manifestation associated with haematological malignancies. Chemotherapy remains the cornerstone of the treatment. The role of radiation is not well-defined. AIM To evaluate the effect of radiation in OGS and to define an optimal dose for achieving adequate local control. MATERIALS AND METHODS This was a retrospective analysis of 11 patients who received radiation therapy to orbit for Granulocytic Sarcoma (GS) between 2007 and 2014 at a tertiary cancer center in India. Radiotherapy was planned by three dimensional conformal (3DCRT) techniques. Demographic and disease characteristics, including clinical, imaging, histopathology and treatment details in this patient cohort were recorded and their response to therapy was assessed. RESULTS The median age was 7 years (Range: 2-16 years). There were 3 female and 8 male patients. Eight patients were diagnosed as Acute Myelogenous Leukemia (AML), two patients had Primary Orbital Granulocytic Sarcoma (POGS) and one had bi-phenotypic leukemia. Median dose was 24.5Gy (Range-15-45 Gy). Two anterior oblique field design were used most commonly. Out of 11 patients, 5 (45.4%) had complete response, 3 (27.27%) had partial response, 1 patient had stable disease (9%) and 2 developed progressive disease (18%). Median follow-up was 24 months (Range 24-84 months). At last follow-up, 7 (63.6%) patients were alive and 4 patients (37.4%) were dead due to progressive disease. CONCLUSION In patients with residual orbital disease after chemotherapy, low dose radiation can be used to improve local disease control and improve quality of life. Local conformal radiotherapy of 24-30 Gy in conventional fractionation appears optimal with excellent local control and minimal morbidity.
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Affiliation(s)
- Sushmita Pathy
- Additional Professor, Department of Radiation Oncology, All India Institute of Medical Sciences , New Delhi, India
| | - Bhanu Prasad Venkatesulu
- Senior Resident, Department of Radiation Oncology, All India Institute of Medical Sciences , New Delhi, India
| | - Supriya Mallick
- Senior Research Associate, Department of Radiation Oncology, All India Institute of Medical Sciences , New Delhi, India
| | - Subhash Chander
- Professor, Department of Radiation Oncology, All India Institute of Medical Sciences , New Delh, India
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Vera-Aguilera J, Mukarram O, Nutalapati P, Mok M, Bulumulle A, Vera-Aguilera C. Bilateral orbital myeloid sarcoma preceding acute myeloid leukemia in an adult: a case report and review of the literature. J Med Case Rep 2016; 10:31. [PMID: 26846095 PMCID: PMC4743162 DOI: 10.1186/s13256-015-0778-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 11/30/2015] [Indexed: 11/20/2022] Open
Abstract
Background Acute myeloid leukemia is typically a disease of the older population and presents mostly in the fifth decade of life. Myeloid sarcoma is a rare initial presentation of acute myeloid leukemia. Previously it has only been documented in children and younger patients. Case Presentation We present an unusual case of retro-orbital myeloid sarcoma as an initial presentation of acute myeloid leukemia in a 43-year-old Caucasian man, with rearrangement of chromosome 11q23 involving the MLL gene. Conclusions We present an unusual case of retro-orbital myeloid sarcoma as an initial presentation of acute myeloid leukemia in a 43-year-old man, with rearrangement of chromosome 11q23 involving the MLL gene.
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Affiliation(s)
- Jesus Vera-Aguilera
- Internal Medicine Department, Texas Tech University Health Sciences Center at the Permian Basin, 800 W. 4th Street, Odessa, TX, 79763, USA.
| | - Osama Mukarram
- Internal Medicine Department, Texas Tech University Health Sciences Center at the Permian Basin, 800 W. 4th Street, Odessa, TX, 79763, USA.
| | - Prathibha Nutalapati
- Internal Medicine Department, Texas Tech University Health Sciences Center at the Permian Basin, 800 W. 4th Street, Odessa, TX, 79763, USA.
| | - Mary Mok
- Internal Medicine Department, Texas Tech University Health Sciences Center at the Permian Basin, 800 W. 4th Street, Odessa, TX, 79763, USA.
| | - Anushi Bulumulle
- Internal Medicine Department, Texas Tech University Health Sciences Center at the Permian Basin, 800 W. 4th Street, Odessa, TX, 79763, USA.
| | - Carlos Vera-Aguilera
- Departamento de Biología Celular y Tisular, Facultad de Medicina, Universidad Nacional Autónoma de México, México City, México.
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Rath S, Agarwal S, Charan Das P, Tripathy D, Mittal R. Orbital myeloid sarcoma in adults presenting with exposure keratopathy and hearing loss. Can J Ophthalmol 2015; 50:e78-81. [PMID: 26455987 DOI: 10.1016/j.jcjo.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 05/25/2015] [Accepted: 06/03/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Soveeta Rath
- Ophthalmic Plastic Surgery, Orbit and Ocular Oncology Services, LV Prasad Eye Institute
| | | | | | - Devjyoti Tripathy
- Ophthalmic Plastic Surgery, Orbit and Ocular Oncology Services, LV Prasad Eye Institute
| | - Ruchi Mittal
- Dalmia Ophthalmic Pathology Service, LV Prasad Eye Institute, Bhubaneswar, India.
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Orbital myeloid sarcoma in an adult with acute myeloid leukemia, FAB M1, and 12p-deletion. Ophthalmic Plast Reconstr Surg 2013; 29:e73-5. [PMID: 23314098 DOI: 10.1097/iop.0b013e318272d497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 49-year-old woman with acute myeloid leukemia, FAB M1 subtype, and 12p deletion, presented with progressive right proptosis and diplopia for 1 week. Orbital CT revealed a homogenously enhancing, orbital mass engulfing the inferior rectus muscle. Histopathology revealed myeloid sarcoma for which she underwent external beam radiotherapy. Subsequently, there was no sign of local recurrence, but she succumbed to leukemia involving the central nervous system. This is the first case, to the authors' knowledge, of an orbital sarcoma of FAB M1 myeloblasts bearing a 12p deletion.
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Chen WY, Wang CW, Chang CH, Liu HH, Lan KH, Tang JL, Tien HF, Kuo SH, Cheng AL. Clinicopathologic features and responses to radiotherapy of myeloid sarcoma. Radiat Oncol 2013; 8:245. [PMID: 24148102 PMCID: PMC4016483 DOI: 10.1186/1748-717x-8-245] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 10/15/2013] [Indexed: 02/02/2023] Open
Abstract
Background To evaluate clinicopathological features, radiotherapeutic parameters, and their associations with responses to radiotherapy (RT) in patients with myeloid sarcoma (MS). Methods We reviewed 20 patients receiving RT for MS lesions (in 43 RT courses) and analyzed the patients’ clinicopathologic features and radiotherapeutic parameters, and their associations with complete responses (CR) to RT using Fisher’s exact test and univariate logistic regression analysis. Generalized Estimating Equation was used to analyze all 43 irradiated lesions and account for the correlations in RT responses among lesions from the same patient. Results We found that the underlying hematological diseases of the evaluated patients were acute myeloid leukemia (AML) in 14 patients (70%), chronic myeloid leukemia in 4 patients (20%), myelodysplastic syndrome with AML transformation in one patient (5%), and de novo MS in one patient (5%). Most patients (55%) received RT for MS at the time of relapse following bone marrow transplantation (BMT). The most common cytogenetic abnormality was t(8;21)(q22;q22). The median RT dose of 20 Gy (range 6–35 Gy), administered in 1.5-3.5 Gy fractions, provided a 63% CR rate. RT dose, sex, cytogenetics, and bone marrow status at the time of RT had no significant effect on CR. Younger age (<50 y, P = 0.06), BMT prior to RT (P = 0.05), and underlying AML (P = 0.05) were marginally associated with higher CR to RT. Conclusions Our results indicate that a modest RT dose (20-30 Gy) achieves good local control of MS. Age, previous BMT, and underlying hematologic disease can affect RT response.
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Affiliation(s)
| | | | | | | | | | | | | | - Sung-Hsin Kuo
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Isik P, Tavil B, Tunç B, Yarali N, Demir A, Cetin M. Extramedullary orbital granulocytic sarcoma without bone marrow involvement: a report of two cases. Pediatr Hematol Oncol 2011; 28:65-70. [PMID: 20863164 DOI: 10.3109/08880018.2010.511439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The authors present herein 2 extramedullary orbital granulocytic sarcoma (GS) cases without bone marrow involvement in view of their rarity and also to reevaluate the treatment approach in this disease. Seven days of high-dose methyl prednisolone (HDMP) treatment (3 days 30 mg/kg/day and 4 days 20 mg/kg/day) was administered initially, and subsequently Acute Myeloid Leukaemia-Berlin Frankfurt Münster (AML-BFM) 2004 treatment protocol was continued for 2 cases. Eye findings of the cases resolved considerably with HDMP treatment. They have still been under systemic chemotherapy without any complication for 1 year. Thus, early diagnosis and AML-targeted intensive chemotherapy improve the prognosis of GS even if there is no bone marrow involvement.
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Affiliation(s)
- Pamir Isik
- Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey
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Héran F. Imagerie des masses orbitaires. Neurochirurgie 2010; 56:89-120. [DOI: 10.1016/j.neuchi.2010.02.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 01/16/2010] [Indexed: 11/16/2022]
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