Precursor T-cell acute lymphoblastic leukemia presenting with bone marrow necrosis: a case report

Area of Science:

• Hematology
• Pediatric Oncology
• Pathology

Background:

• Bone marrow necrosis (BMN) is a clinicopathological condition often diagnosed postmortem, but also seen with malignancy.
• Morphologically, BMN involves disruption of marrow architecture and necrosis of myeloid tissue and stroma.
• Associated conditions include sickle cell anemia, infections, drugs, DIC, antiphospholipid antibody syndrome, GVHD, leukemia, lymphoma, and metastatic carcinomas.

Purpose of the Study:

• To report a rare case of precursor T-cell acute lymphoblastic leukemia (T-ALL) presenting with extensive bone marrow necrosis.
• To highlight the diagnostic challenges and clinical course of T-ALL with BMN in a pediatric patient.

Main Methods:

• A 10-year-old boy presented with severe bone pain, fever, pancytopenia, and elevated LDH and ESR.
• Imaging revealed mediastinal widening and diffuse bone marrow infiltration.
• Bone marrow biopsy confirmed extensive necrosis and immunophenotyping diagnosed T-ALL (CD3+, TdT+, CD10-, CD20-, CD79a-).

Main Results:

• The patient exhibited aggressive initial symptoms including mediastinal widening and superior vena cava syndrome.
• Extensive bone marrow necrosis complicated initial immunohistochemistry.
• The patient responded well to chemotherapy, with necrosis resolving by day 28.

Conclusions:

• BMN as an initial sign in T-ALL can present aggressively and complicate diagnosis.
• Prognosis of BMN secondary to T-ALL is better in pediatric patients than in adults or those with solid tumors.
• Chemotherapy is effective in treating T-ALL with BMN, leading to resolution of necrosis.