Ovarian relapse in a child with B-ALL: a case report

Area of Science:

• Pediatric Oncology
• Hematology
• Genetics

Background:

• B-cell acute lymphoblastic leukemia (B-ALL) is a common childhood cancer.
• Favorable genetic markers, like chromosome 12 deletion associated with ETV6-RUNX1, can still carry a risk of late relapse.
• Extramedullary relapses, particularly in the ovary, are exceptionally rare in pediatric B-ALL.

Observation:

• An 8-year-old girl with B-ALL and chromosome 12 deletion presented with an asymptomatic ovarian relapse after achieving remission.
• Pelvic pain was the initial clinical symptom, leading to diagnosis via pelvic ultrasound.
• The ovarian relapse showed a partial response to standard B-ALL chemotherapy.

Findings:

• This case documents an extremely rare instance of ovarian extramedullary relapse in pediatric B-ALL.
• The patient's chromosome 12 deletion, typically favorable, was associated with a late relapse.
• Early detection of extramedullary relapse was delayed due to asymptomatic presentation.

Implications:

• Highlights the importance of considering extramedullary relapse in pediatric ALL patients with atypical symptoms post-remission.
• Suggests routine pelvic ultrasound may aid early detection of ovarian and other extramedullary relapses.
• Emphasizes the need for vigilant, targeted surveillance in ALL survivors, even those with initially favorable genetic profiles, to identify late relapses.