Acute lymphocytic leukemia recurring in the spinal epidural space

Area of Science:

• Oncology
• Neurology
• Hematology

Background:

• Acute lymphocytic leukemia (ALL) is a hematologic malignancy. Spinal epidural masses are rare but serious complications.
• Bone marrow transplantation is a curative treatment for ALL, but relapse can occur.

Observation:

• A 27-year-old man, 3 years post-remission of ALL and bone marrow transplant, developed progressive neurological deficits. Symptoms included shoulder pain and ambulatory difficulties.
• MRI revealed a C-7 to T-3 spinal epidural mass compressing the spinal cord and extending into intervertebral foramina.

Findings:

• Surgical decompression led to dramatic symptom improvement. Histopathology confirmed recurrent leukemia (clusters of immature lymphocytes).
• Post-operative chemotherapy and radiation therapy were administered. No local mass recurrence or systemic leukemia progression was observed at 1-year follow-up.

Implications:

• Leukemic recurrence should be considered in the differential diagnosis of spinal epidural masses, even in patients previously treated for ALL.
• Prompt diagnosis and multidisciplinary management (surgery, chemotherapy, radiation) are essential for patients with spinal epidural leukemia recurrence.