A patient with acute myeloblastic leukemia who presented with conus medullaris syndrome and review of the literature

Bone Infarct as an Indicator of Acute Spinal Ischaemia

Acute spinal cord infarct in childhood is extremely rare, generally secondary to spinal/cardiovascular surgery or severe vertebral injuries. However, spontaneous spinal cord infarct cases have been described. We present a clinical case of a teenager who developed an acute weakness and paraesthesia in lower limbs after playing piggyback. Laboratory tests and MRI (magnetic resonance imaging) were normal. During her hospital admission, her motor strength improved. After 10 days, MRI was repeated, and a bone infarct was observed. She was medicated with acetylsalicylic acid, and she completed a rehabilitation program.

Development of acute promyelocytic leukemia in a patient with tetraplegia while in inpatient rehabilitation: A case report

STUDY DESIGN

a single case report.

OBJECTIVES

To report a case of a patient with tetraplegia who developed acute promyelocytic leukemia (APL) while in inpatient rehabilitation after 10.5 months.

SETTING

A VA Medical Center Spinal Cord Injury Service and Disorders Unit Case Report: A 47 year-old male with a stage IV sacral pressure ulcer and C4 AIS A complete tetraplegia secondary to a motor vehicle collision, developed fever, thrombocytopenia, and anemia 20 months after his injury while in inpatient rehabilitation and was found to have APL, confirmed following bone marrow biopsy.

CONCLUSION

There is a wide differential for fever after a spinal cord injury. In this case report, the source of fever was APL. It is important as healthcare providers to not overlook fevers when otherwise common causes do not fit the clinical picture. Additionally, there has been no association found between traumatic spinal cord injury and the development of acute leukemia, however this is the first case report. Therefore, it is important to continue investigating to determine if an association exists.

Defining the optimal dose of radiation in leukemic patients with extramedullary lesions

BACKGROUND

Analysis of the clinical response of extramedullary lesions in leukemic patients treated with radiation therapy (RT) and defining the optimal dose of radiation.

METHODS

Forty-two extramedullary lesions found in 24 leukemic patients treated with RT were reviewed. The radiation was delivered usually 2 Gy/day, up to a median of 20 Gy (range: 18.0-40.8). The clinical response and symptom palliation effect were analyzed. The factors affecting the response were also included in the analysis.

RESULTS

After a median time of 7.9 weeks, the overall response rate was 76.2%. A complete response (CR) was achieved in 35.7%, a partial response in 40.5%. The symptom was relieved in 85.7% sites. The overall response rate was better in patients whose initial tumor size was smaller than 10 cm2 (p = 0.010) or who were treated with more than 25 Gy (p = 0.031). The overall CR rate was also higher in those who had smaller tumors (smaller than 6 cm or 30 cm2) (p = 0.015), or when the tumor was located in soft tissue (p = 0.029).

CONCLUSIONS

Extramedullary lesions in leukemic patients can be successfully treated with RT. The tumor response rate was excellent and symptom relief was achieved in almost all patients. There was a better response to treatment when the tumor was small or it was located in soft tissue. Although, there was no definite correlation between volume reduction and total dose, it seems that higher total dose more of than 25 Gy is needed for better response.

Granulocytic sarcoma of the knee and the spine as aleukemic relapse of acute myeloid leukemia in a child

Granulocytic sarcoma is a very rare disease in childhood, which may precede the clinical manifestations of acute myeloid leukemia or may occur as a relapse of a nonleukemic acute myeloid leukemia. It is a malignant, solid tumor consisting of myeloblasts or immature myeloid cells occurring in extramedullary sites. We report interesting magnetic resonance images of a nonleukemic relapse of acute myeloid leukemia in a child presenting as a granulocytic sarcoma unusually localized to the knee and spine.