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Naskar S, Paul T, Kulkarni JD, Anand KC, Divya V, Rambhojun HD. TCF3::PBX1 fusion pediatric B acute lymphoblastic leukemia in disguise behind the eyes - an unusual clinicopathologic presentation with hyperdiploid clone. Leuk Lymphoma 2024; 65:852-856. [PMID: 38407197 DOI: 10.1080/10428194.2024.2320827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/14/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Sudipta Naskar
- Department of Pathology, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - Tanusree Paul
- Department of Paediatric Oncology, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - Jayashree D Kulkarni
- Department of Hematopathology, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - K C Anand
- Department of Paediatric Oncology, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - V Divya
- Department of Histopathology, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - Harshitha D Rambhojun
- Department of Pathology, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
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Mejia M, Royero Arias M, Santiago Pacheco V, Pimiento Figueroa J. Extramedullary Imaging Manifestations of Leukemia/Lymphoblastic Lymphoma in Pediatrics: A Case Series. Cureus 2024; 16:e54714. [PMID: 38523951 PMCID: PMC10960658 DOI: 10.7759/cureus.54714] [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: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Leukemia is the most common childhood malignancy and often presents with nonspecific symptoms. Occasionally, it presents with extramedullary manifestations, which have been more frequent in cases of myeloid lineage or T cells. However, precursor B-cell leukemia/lymphoblastic lymphoma can also have extramedullary manifestations in some patients. Describing certain clinical features along with diagnostic imaging can establish a presentation pattern and suggest a diagnosis in the pediatric population. Herein, we present a series of four patients with extramedullary manifestations of B-cell lymphoblastic leukemia, describing their clinical imaging and histopathological characteristics.
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Affiliation(s)
- Marcia Mejia
- Radiology, Universidad de Antioquia, Medellín, COL
| | - Mónica Royero Arias
- Pediatric Radiology, Servicios de Salud San Vicente Fundación, Medellín, COL
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Strawbridge JC, Roelofs KA, Naderi J, Goh TY, Rootman DB. Orbital manifestations of B-cell acute lymphoblastic leukemia/lymphoma. Orbit 2023; 42:654-658. [PMID: 35580237 DOI: 10.1080/01676830.2022.2072901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
Abstract
A 2-year-old boy presented with left periorbital edema, proptosis, hyperglobus and esotropia. Imaging revealed an inferotemporal orbital mass with adjacent bony erosion. Histological evaluation of an orbital biopsy revealed B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/BLL). The patient was subsequently treated with chemotherapy. Although orbital involvement in acute myelogenous leukemia has been well-described, orbital manifestations of B-ALL/BLL are uncommon, with only a limited number of previous reports in the literature.
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Affiliation(s)
- Jason C Strawbridge
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kelsey A Roelofs
- Jules Stein Eye Institute, Division of Orbital and Ophthalmic Plastic Surgery, University of California, Los Angeles, California, USA
| | - Jason Naderi
- Rosalind Franklin University School of Medicine, North Chicago, Illinois, USA
| | - Tracie Y Goh
- Department of Pathology, University of California, Los Angeles, California, USA
| | - Daniel B Rootman
- Jules Stein Eye Institute, Division of Orbital and Ophthalmic Plastic Surgery, University of California, Los Angeles, California, USA
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Anderson D, Pandya A, Patankar C. Acute onset facial oedema: an unusual presentation of acute lymphoblastic leukaemia in a child. BMJ Case Rep 2023; 16:e257705. [PMID: 37996148 PMCID: PMC10668131 DOI: 10.1136/bcr-2023-257705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
A previously fit and well girl of middle-childhood age presented to her local emergency department after waking with upper-facial swelling. She had a 24-hour preceding history of mild vomiting illness and fatigue. Examination revealed palpable splenomegaly and mild cervical lymphadenopathy, with pitting oedema of the forehead, nasal bridge and eyelids. Admission full blood count showed anaemia and neutropenia, and further investigations confirmed a diagnosis of acute lymphoblastic B-cell leukaemia. X-ray of the chest and CT imaging did not reveal any local facial mass, veno-occlusive disease or mediastinal pathology to explain her facial swelling. She was referred to the tertiary paediatric oncology service for commencement of induction chemotherapy.
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Affiliation(s)
- Darren Anderson
- Paediatrics, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | - Atisha Pandya
- Paediatrics, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | - Chhaya Patankar
- Paediatrics, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
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Orbital Swelling and Ptosis as an Initial Presentation of Childhood Acute Lymphoblastic Leukaemia: A Case Report and Review of the Literature. Case Rep Pediatr 2021; 2021:5587767. [PMID: 34123451 PMCID: PMC8189805 DOI: 10.1155/2021/5587767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
We are reporting the case of a 3-year-old-girl who initially presented with unilateral eyelid swelling and ptosis. A diagnosis of acute lymphoblastic leukaemia (ALL) was eventually made based on an orbital incisional biopsy and a bone marrow examination. Historically, orbital involvement had been linked to myeloid leukaemia; however, in lymphoid leukaemia, they are increasingly being implicated and had been reported as the sole presentation of the disease. These findings stress the importance of conducting ophthalmologic assessments in cases diagnosed with ALL in order to prevent delays in proper assessment and treatment. Management options in orbital disease are fortunately not significantly different than well-established treatment protocols.
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6
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Wang L, Ashraf DC, Kinde B, Ohgami RS, Kumar J, Kersten RC. Hypodiploid B-Lymphoblastic Leukemia Presenting as an Isolated Orbital Mass Prior to Systemic Involvement: A Case Report and Review of the Literature. Diagnostics (Basel) 2020; 11:diagnostics11010025. [PMID: 33375646 PMCID: PMC7824143 DOI: 10.3390/diagnostics11010025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/21/2022] Open
Abstract
We describe a 4-year-old boy who presented with progressive right periorbital edema and proptosis, with no systemic symptoms, who was found to have B-lymphoblastic leukemia (B-ALL). Magnetic resonance imaging (MRI) showed an enhancing mass centered in the right superolateral extraconal orbit. Orbital biopsy was consistent with B-ALL (CD99, TdT, LCA cocktail, CD34, CD79, CD10, PAX5, MIB1 positive; CD3, CD20 negative). A subsequent bone marrow aspirate confirmed a diagnosis of B-ALL with 80% blasts by flow cytometry and haploid cytogenetic findings. The patient improved clinically after chemotherapy. There are seven cases previously reported in the literature with hematogenous orbital masses at initial presentation of childhood ALL, but all with systemic symptoms or an abnormal complete blood count (CBC) at presentation. Our case is the first report in which an orbital mass preceded detectable systemic or laboratory evidence of ALL. This patient highlights the importance of differentiating benign causes of eyelid swelling from malignant ones.
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Affiliation(s)
- Linyan Wang
- Department of Ophthalmology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310002, China;
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA 94143, USA; (D.C.A.); (B.K.)
| | - Davin C. Ashraf
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA 94143, USA; (D.C.A.); (B.K.)
| | - Benyam Kinde
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA 94143, USA; (D.C.A.); (B.K.)
| | - Robert S. Ohgami
- Department of Pathology, University of California, San Francisco, CA 94143, USA;
| | - Jyoti Kumar
- Department of Pathology, Stanford University, Stanford, CA 94305, USA;
| | - Robert C. Kersten
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA 94143, USA; (D.C.A.); (B.K.)
- Correspondence: ; Tel.: +1-(415)-353-2142; Fax: +1-(415)-476-0336
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Unusual Presentation with Orbital Mass in a Child with Precursor B-Cell Acute Lymphoblastic Leukemia. Case Rep Hematol 2019; 2019:8264689. [PMID: 31781427 PMCID: PMC6875307 DOI: 10.1155/2019/8264689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 09/28/2019] [Indexed: 11/18/2022] Open
Abstract
Orbital involvement is one of the extramedullary manifestations in acute leukemia. It is common in acute myeloid leukemia, but rare in acute lymphoblastic leukemia (ALL). We described a 3-year-old girl who presented with progressive proptosis of the right eye and was later diagnosed with precursor B-cell ALL. Initial blood count showed Hb 6.9 g/dL, WBC 42,000/mm3, lymphoblast 50%, and platelet count 185,000/mm3. Bone marrow aspiration revealed 90% lymphoblasts with positivity for CD10, CD19, CD20, CD22, and HLA-DR markers. Computed tomography (CT) scan of the brain and orbit revealed a homogeneous enhancing mass involving the right orbit with intracranial extension. The cytogenetic study showed 46,XX chromosomes. After 4 weeks of induction chemotherapy for very high-risk ALL, although the bone marrow was in remission, the proptosis was partially resolved. CT scan confirmed a decrease in size of the right orbital mass and degree of intracranial extension. Unfortunately, the patient abandoned the treatment after the induction chemotherapy. The actual incidence of orbital involvement in ALL is unknown. Previous case reports describe diverse manifestations of orbital involvement in ALL. The involvement may be unilateral or bilateral, may occur at first diagnosis or at relapse, and may be seen in isolation or with other systemic symptoms. There is no standard treatment protocol. Chemotherapy with or without radiotherapy is generally suggested. The role of upfront hematopoietic stem cell transplantation remains inconclusive. The previously reported prognosis of ALL with orbital involvement is poor.
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8
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Tousifullah M, Gupta AK, Meena JP, Seth R. B cell acute lymphoblastic leukaemia presenting with isolated soft tissue tumours: the non-myeloid sarcoma. BMJ Case Rep 2019; 12:12/10/e230982. [PMID: 31586956 DOI: 10.1136/bcr-2019-230982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Soft tissue leukaemic masses are a well-described clinical feature of myeloid haematological neoplasms. In paediatric acute lymphoblastic leukaemia (ALL), such soft tissue leukaemic sarcomas have not been reported as a presenting feature. Here we report a 3-year-old boy with ALL who presented to us with isolated soft tissue swellings for a duration of 9 months. The significance of these 'non-myeloid' sarcomas in paediatric ALL is uncertain.
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Affiliation(s)
- Mohammad Tousifullah
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Kumar Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jagdish Prasad Meena
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Seth
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Ejstrup R, Mikkelsen LH, Andersen MK, Clasen-Linde E, Gjerdrum LMR, Safavi S, Heegaard S. Orbital precursor B-lymphoblastic lymphoma involving the extraocular muscles in a 56-year-old male and a review of the literature. Oncol Lett 2019; 17:1477-1482. [PMID: 30675202 PMCID: PMC6341779 DOI: 10.3892/ol.2018.9725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 09/26/2018] [Indexed: 12/18/2022] Open
Abstract
The aim of the present study was to describe a rare case of orbital precursor B-lymphoblastic lymphoma (B-LBL) in an adult. A 56-year-old male in complete remission of a gastric precursor B-LBL was referred to our orbital clinic due to rapid development of left-sided painless periorbital swelling, diplopia, and proptosis. Complete ophthalmoplegia was observed. Notably, magnetic resonance imaging showed swelling of the medial and inferior rectus muscles in the left orbit and biopsies were performed. Following histological diagnosis of precursor B-LBL, the patient was treated with radiotherapy (2Gy × 20) and chemotherapy according to the NOPHO ALL 2008 protocol. The disease progressed and the patient succumbed after 5 months. Histomorphologically, a lymphoblastic infiltrate was observed within the skeletal muscle tissue. The tumor cells were small and immature, and stained strongly for cluster of differentiating (CD)10, CD79a, paired box 5 and B cell lymphoma-2. The Ki-67 proliferative index was 90%. Multiplex ligation-dependent probe amplification and array comparative genomic hybridization detected whole chromosomal gain of X and 12, and both hemizygous and homozygous deletion on 9p comprising cyclin dependent kinase inhibitor 2A/B. Furthermore, array comparative genomic hybridization detected copy number imbalances consisting of focal or smaller deletions on chromosomes 1, 9, 10, 11 and 20. The final diagnosis was precursor B-LBL relapse in the extraocular muscles. Orbital precursor B-LBL is extremely rare in adults, and the diagnosis may be challenging to make. It is recommended to obtain material for cytogenetic and molecular analyses.
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Affiliation(s)
- Rasmus Ejstrup
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Lauge Hjorth Mikkelsen
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark.,Department of Pathology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Mette Klarskov Andersen
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Erik Clasen-Linde
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | | | - Setareh Safavi
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark.,Department of Pathology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
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A Palpable Back Mass as First Presenting Sign of Acute Lymphoblastic Leukemia in a Pediatric Patient. J Pediatr Hematol Oncol 2019; 41:77-78. [PMID: 29750743 DOI: 10.1097/mph.0000000000001214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Orbital lymphomas constitute 50-60% of ocular adnexal lymphomas. A total of 2211 cases of orbital lymphoma with a known subtype have been reported in the last 24 years (1994-2017). The vast majority of orbital lymphomas are of B-cell origin (97%), of which extranodal marginal zone B-cell lymphoma (EMZL) (59%) is the most common subtype, followed by diffuse large B-cell lymphoma (23%), follicular lymphoma (9%), and mantle cell lymphoma (5%). Orbital lymphoma is primarily a disease of the elderly. Gender distribution varies according to lymphoma subtype. However, extranodal marginal zone B-cell lymphoma (53%) and follicular lymphoma (75%) show a female predominance, whereas diffuse large B-cell lymphoma shows an even gender distribution. Mantle cell lymphoma has a striking male predominance of 80%. The histopathological subtype and the clinical stage of the disease are the best indicators of prognosis and patient outcome. Low-grade lymphomas such as extranodal marginal zone B-cell lymphoma and FL have a good prognosis, whereas high-grade lymphomas (diffuse large B-cell lymphoma and mantle cell lymphoma) are associated with a poor prognosis. When managing solitary low-grade lymphomas, radiotherapy is the treatment of choice. Chemotherapy, with or without radiotherapy, should be chosen for disseminated and high-grade lymphomas.
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Affiliation(s)
- Tine Gadegaard Olsen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark.
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Hanapi MS, Ghani SI, Sonny Teo KS, Wan-Embong WZ, Ariffin N, Wan Hitam WH. Extensive Forehead Swelling Including the Periorbital Area in a Child: A Rare Manifestation of Acute Lymphoblastic Leukemia. Cureus 2018; 10:e3539. [PMID: 30648072 PMCID: PMC6318090 DOI: 10.7759/cureus.3539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) manifestations in a child are varied. We report a unique and rare presentation of acute lymphoblastic leukemia in a child who presented with frontal swelling involving bilateral upper lids. A previously healthy one-year-old girl presented with progressively increasing frontal swelling of seven months duration. An examination revealed erythematous, firm, nontender forehead swelling that extended up to the medial part of bilateral upper eye lids. The extraocular muscle movement was normal. The anterior segment and fundus examination were also normal in both eyes. Other systemic examination revealed multiple leukemic cutis on the scalp. The cervical lymph nodes were also palpable with hepatosplenomegaly. A full blood picture (FBP) showed the presence of leucoerythroblastic blood film with 62% blast cells. Flow cytometry and bone marrow aspiration confirmed the diagnosis. Computed tomographic (CT) scan images revealed multiple well-defined hyperdense lesions at the subcutaneous skull with the largest lesion at the anterior glabella. Upon diagnosis, the patient was started on chemotherapy and the swelling resolved after one month post treatment. Extensive forehead swelling is a rare manifestation of acute lymphoblastic leukemia. A high index of suspicion aided with diagnostic investigations could help the doctors arrive at a correct diagnosis and treatment.
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Affiliation(s)
- Maya Sapira Hanapi
- Ophthalmology, School of Medical Sciences/Universiti Sains Malaysia, Kota Bharu, MYS
| | - Siti-Ilyana Ghani
- Ophthalmology, School of Medical Sciences/Universiti Sains Malaysia, Kota Bharu, MYS
| | | | | | - Nasir Ariffin
- Paediatrics, School of Medical Sciences/Universiti Sains Malaysia, Kota Bharu, MYS
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Stein AP, Norris RE, Shah JR. Pediatric acute lymphoblastic leukemia presenting with periorbital edema. OTOLARYNGOLOGY CASE REPORTS 2018. [DOI: 10.1016/j.xocr.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Acute Lymphoblastic Leukemia with Infective Endocarditis Presented with Unusual Intracardiac Mass. Case Rep Cardiol 2017. [PMID: 28634553 PMCID: PMC5467278 DOI: 10.1155/2017/1528416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) is a systemic disease that is presented with different symptoms and signs. Cardiac manifestation is rare in ALL, but it is very important and needs appropriate management. It usually presents as leukemic myocardial infiltration and in the presence of cardiac mass comprehensive evaluation for other etiologies is mandatory. We reported on a 6-year-old boy in remission phase of ALL and large cardiac mass in the right atrium with obscure early symptoms and signs, in whom infective endocarditis (IE) was diagnosed and appropriate medical treatment was performed. Because the mass was sustained, surgical resection was considered for the patient.
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