Relapsed acute lymphoblastic leukemia with unusual multiple bone invasions: A case report

Area of Science:

• Pediatric Oncology
• Hematology
• Medical Imaging

Background:

• Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
• Relapse can occur despite initial treatment and remission.
• Isolated bone relapse is an uncommon presentation of ALL.

Purpose of the Study:

• To describe a unique pediatric case of acute lymphoblastic leukemia (ALL) with multiple bone invasions during remission.
• To highlight the diagnostic challenges and findings in isolated bone relapse of ALL.
• To discuss the potential implications for understanding ALL relapse patterns.

Main Methods:

• Case report of an eight-year-old male with a history of ALL.
• Utilized magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) for imaging.
• Performed bone marrow (BM) aspiration and iliac bone biopsy for histopathological analysis.

Main Results:

• The patient presented with intermittent, migrating limb pain two years post-remission.
• Imaging revealed multifocal bone and soft tissue involvement.
• Bone marrow aspiration was negative for leukemia, but iliac bone biopsy showed marked leukemic cell infiltration.

Conclusions:

• The findings suggest an isolated bone relapse of ALL.
• This presentation may precede or indicate a systemic bone marrow relapse.
• Understanding such unique relapse patterns is crucial for pediatric ALL management.