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Chronic lymphocytic leukemia presenting with symptomatic central nervous system involvement
O Akintola-Ogunremi1, C Whitney, S C Mathur
1Department of Pathology, State University of New York Upstate Medical University, Syracuse 13210, USA.
Annals of Hematology
|August 20, 2002
Summary
Central nervous system (CNS) involvement is rare in chronic lymphocytic leukemia (CLL). This case highlights CNS involvement as an initial presentation of de novo B-CLL, emphasizing diagnostic utility.
Area of Science:
- Neurology
- Hematology
- Oncology
Background:
- Chronic lymphocytic leukemia (CLL) rarely involves the central nervous system (CNS).
- Symptomatic CNS involvement as the initial presentation of undiagnosed CLL is exceptionally rare.
- Altered mental status in elderly patients can mask underlying hematologic malignancies.
Observation:
- An 89-year-old female with prior Alzheimer's disease diagnosis presented with rapidly worsening mental changes.
- Cerebrospinal fluid (CSF) analysis revealed lymphoid cells with kappa light chain restriction.
- Peripheral blood flow cytometry confirmed de novo B-cell CLL diagnosis.
Findings:
- Immunocytological examination of CSF identified a clonal B-cell lymphoproliferative disorder.
- The findings were consistent with de novo B-cell chronic lymphocytic leukemia.
- Flow cytometry confirmed the peripheral blood diagnosis of B-CLL.
Implications:
- CSF immunocytology can detect monoclonal lymphoid populations in patients with altered mental status and lymphocytic pleocytosis.
- This diagnostic approach aids in identifying rare CNS manifestations of B-CLL.
- Early detection of CNS involvement in CLL can guide appropriate therapeutic strategies.