Related Experiment Video

Updated: Jun 25, 2026

Assessment of the Metabolic Profile of Primary Leukemia Cells
06:21

Assessment of the Metabolic Profile of Primary Leukemia Cells

Published on: November 21, 2018

Mediastinal mass and malignant pleural effusion in an aleukemic case with pre-B acute lymphoblastic leukemia

Sung-nan Pei1, Ching-yuan Kuo, Ming-chun Ma

  • 1Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Journal of Pediatric Hematology/Oncology
|February 6, 2009
PubMed

Insights

A young man presented with a pleural effusion and mediastinal mass, initially suspected as lymphoma. Diagnosis confirmed pre-B acute lymphoblastic leukemia (ALL) via immunophenotyping, a rare presentation preceding overt leukemia.

Area of Science:

  • Hematology
  • Oncology
  • Immunology

Background:

  • Malignant pleural effusions and mediastinal masses can be presenting signs of hematologic malignancies.
  • Acute lymphoblastic leukemia (ALL) is a cancer of the blood and bone marrow.

Observation:

  • A 20-year-old male presented with a pleural effusion and mediastinal mass, but a normal hemogram.
  • Initial pleural fluid cytology suggested lymphoma.
  • Immunophenotypic analysis of the effusion revealed TdT+, CD34+, CD19+, CD7(-), CD33(-), CD10(-), sIgM(-), and cytoplasmic mu heavy-chain positive.

Findings:

  • The immunophenotypic profile led to a diagnosis of pre-B acute lymphoblastic leukemia (ALL) after bone marrow examination.
  • This case represents the first reported instance of a malignant pleural effusion and mediastinal mass preceding a pre-B ALL diagnosis.
  • The patient achieved complete remission and remained disease-free for 7 years after standard ALL therapy.

Implications:

  • Highlights the importance of comprehensive immunophenotypic analysis in diagnosing hematologic malignancies, especially with atypical presentations.
  • Suggests that pleural effusions and mediastinal masses can be early indicators of pre-B ALL, even with normal peripheral blood counts.
  • Demonstrates the efficacy of standard ALL therapy in patients with this rare initial presentation.

Related Concept Videos

Pleural Effusion II: Symptoms and Management01:28

Pleural Effusion II: Symptoms and Management

Pleural Effusion Overview
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
Pleural Effusion I: Introduction01:25

Pleural Effusion I: Introduction

Pleural effusion is an abnormal fluid accumulation in the pleural cavity, a narrow space between the lungs and the chest wall. It is not a disease per se but rather a symptom or indication of an underlying disease. In normal circumstances, this space contains a small amount of fluid (5 to 15 mL), a lubricant facilitating the non-frictional movement of the pleural surfaces.
There are two main types of pleural effusion: transudative and exudative. They are differentiated using Light's criteria,...
Pulmonary Tuberculosis III01:31

Pulmonary Tuberculosis III

Tuberculosis (TB) is a contagious infection primarily affecting the lung parenchyma but which can also affect other body parts. TB can be classified based on disease development, presentation, and the affected anatomical site.
The first classification is based on the development of the disease, and it includes the following categories:
Disorders of Leukocytes01:27

Disorders of Leukocytes

Leukocyte disorders can lead to either leukopenia, characterized by an abnormally low leukocyte count, or leukocytosis, marked by a very high leukocyte number.
Leukopenia may result from bone marrow disorders, autoimmune diseases, and infectious diseases. For example, conditions such as multiple myeloma and aplastic anemia can impair the bone marrow's ability to produce adequate leukocytes. Similarly, autoimmune diseases like lupus and viral infections such as HIV can prompt the immune system...