Pericardial Relapse of Acute Lymphoblastic Leukemia (ALL)
Diana V Maslov1, Ambuga Badari2
1Ochsner Clinic Foundation, Department of Internal Medicine, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
Case Reports in Oncological Medicine
|December 6, 2021
Summary
This case study highlights a rare presentation of relapsed acute lymphoblastic leukemia (ALL) where measurable residual disease (MRD) was found in the pericardium, not the bone marrow. This underscores the importance of considering extramedullary sites for ALL relapse diagnosis.
Area of Science:
- Hematology
- Oncology
- Cardiology
Background:
- Acute lymphoblastic leukemia (ALL) is a hematologic malignancy affecting B or T cells.
- Diagnosis typically involves bone marrow biopsy and peripheral blood smear analysis.
- Relapsed disease or measurable residual disease (MRD) can manifest with symptoms of bone marrow infiltration.
Observation:
- A 59-year-old male with a history of relapsed ALL and allogeneic stem cell transplant presented with recurrent shortness of breath.
- Echocardiography identified a recurrent pericardial effusion.
- The patient's pericardial effusion was found to contain MRD.
Findings:
- Cytology and culture from a pericardial window procedure confirmed B cell lymphoblastic leukemia/lymphoma in the pericardium.
- This finding represents an extramedullary relapse of ALL with MRD in the pericardial space.
- The patient's symptoms of shortness of breath were attributed to the pericardial effusion caused by leukemia.
Implications:
- This case demonstrates that measurable residual disease in relapsed ALL can occur in extramedullary sites like the pericardium.
- It highlights the need for thorough investigation, including cytology of effusions, in patients with suspected ALL relapse presenting with atypical symptoms.
- Early detection of extramedullary ALL relapse is crucial for timely and effective therapeutic interventions.
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