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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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Lo C, Aziz R, Denstedt JT, Feng ZX, Fournier AV. Orbital Edema Secondary to a Sphenoidal Mass as the Presenting Symptom of High-Risk Precursor B-Cell Acute Lymphoblastic Leukemia. Case Rep Ophthalmol 2024; 15:23-28. [PMID: 38187931 PMCID: PMC10769501 DOI: 10.1159/000534926] [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] [Received: 06/01/2023] [Accepted: 10/25/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy, known to present with ocular manifestations in rare cases. Case Presentation We describe the case of a 9-year-old previously healthy male who developed a 2-day history of periocular swelling and was found on MRI to have a large sphenoidal mass. Further work up showed involvement of the spinal cord, iliac crests, and kidneys. His initial blood work showed no hematological abnormalities. A bone marrow biopsy taken from the iliac crest demonstrated >90% B lymphoblasts and flow cytometry was positive for CD19. Overall, his investigations were consistent with a diagnosis of precursor B-cell ALL (pre B-ALL). His neuro-ophthalmic exam showed right-sided subtle periocular edema, decreased palpebral fissure height, and proptosis. Posterior exam showed mild nasal elevation of the right optic disc without vessel obscuration and mild tortuosity of the peripheral vessels. He otherwise had no overt signs of afferent or efferent dysfunction despite the proximity of the mass to his optic nerve and globe. Conclusion This case demonstrates that high-risk pre B-ALL, a childhood cancer not commonly associated with orbital manifestations, can present with orbital edema and normal leukocyte count in an otherwise healthy child.
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Affiliation(s)
- Cody Lo
- Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, University of Ottawa Eye Institute, Ottawa, ON, Canada
| | - Rem Aziz
- Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, University of Ottawa Eye Institute, Ottawa, ON, Canada
| | - James T. Denstedt
- Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, University of Ottawa Eye Institute, Ottawa, ON, Canada
| | - Zhao X. Feng
- Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, University of Ottawa Eye Institute, Ottawa, ON, Canada
| | - Annick V. Fournier
- Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, University of Ottawa Eye Institute, Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
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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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Goutzanis L, Apostolidis J, Giatra C, Chrysomali E, Deskos D. A case of systemic precursor T-cell lymphoblastic lymphoma presenting with single tooth mobility. SAGE Open Med Case Rep 2020; 8:2050313X20927961. [PMID: 32547763 PMCID: PMC7273617 DOI: 10.1177/2050313x20927961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/29/2020] [Indexed: 01/12/2023] Open
Abstract
Lymphoblastic lymphoma, seen primarily in children or young adults, is a type of
non-Hodgkin lymphoma that originates from B or T lymphocyte precursors and rarely occurs
in the oral cavity. A case of systemic precursor T-cell lymphoblastic lymphoma mimicking
periodontitis of a lower second molar in a 20-year-old adult is currently presented. The
case was initially misdiagnosed as periodontal disease and treated with tooth extraction
by a dentist. Re-evaluation of the patient due to worsening of symptoms lead to cone beam
computed tomography scanning that thoroughly revealed an extended osteolytic lesion of the
right mandible. Afterward, a biopsy was performed, thus reaching the diagnosis of
precursor T-cell lymphoblastic lymphoma. This report discusses differences in epidemiology
of T-cell and B-cell lymphoblastic lymphomas, as well as their various intraoral
manifestations that are mimicking a large family of oral pathology. It also focuses on
conventional imaging findings that imply malignancy, which are often neglected during
routine radiology interpretation.
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Affiliation(s)
- Lampros Goutzanis
- Department of Oral and Maxillofacial Surgery, Dental School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Chara Giatra
- Evangelismos General Hospital of Athens, Athens, Greece
| | - Evanthia Chrysomali
- Department of Oral Pathology, Dental School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Deskos
- Department of Oral and Maxillofacial Surgery, Evangelismos General Hospital of Athens, Athens, Greece
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