Relapse of Acute Lymphoblastic Leukemia as a Conjunctival Mass in a 9-Year-Old Girl
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A rare sign of relapsed acute lymphoblastic leukemia (ALL) is conjunctival infiltration, even with normal blood counts. This case highlights the importance of considering extramedullary relapse in ALL patients with unusual symptoms.
Area of Science:
- Oncology
- Ophthalmology
- Hematology
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Remission in ALL typically involves normalization of blood cell profiles.
- Extramedullary relapse, or relapse outside the bone marrow, can occur.
Purpose of the Study:
- To report a rare case of conjunctival relapse in a child with ALL.
- To emphasize the diagnostic challenges of extramedullary relapse with normal blood counts.
- To highlight the importance of thorough evaluation for ALL relapse.
Main Methods:
- Case report of a 9-year-old girl with ALL in remission.
- Clinical presentation: subconjunctival mass and preauricular lymphadenopathy.
- Diagnostic procedures: excisional biopsy, histopathology, bone marrow aspiration.
Main Results:
- Histopathology confirmed leukemic cell infiltration of the conjunctiva.
- Bone marrow aspiration revealed medullary relapse of ALL.
- Conjunctival leukemic infiltration occurred despite a normal blood cell profile.
Conclusions:
- Conjunctival leukemic infiltration can be a rare manifestation of relapsed ALL.
- Normal blood cell profiles do not exclude extramedullary relapse.
- Prompt diagnosis and treatment are crucial for managing ALL relapse.
Abstract:
A 9-year-old girl with a history of acute lymphoblastic leukemia in remission presented with a right subconjunctival mass and ipsilateral preauricular lymphadenopathy despite normal findings on blood cell profile. Excisional biopsy of the lesion was performed to exclude extramedullary relapse of acute lymphoblastic leukemia. Histopathologic examination showed infiltration of leukemic cells at the conjunctival substantia propria. The patient was referred to her oncologist, and bone marrow aspiration showed medullary relapse of acute lymphoblastic leukemia for which systemic and intrathecal chemotherapy was administered. Leukemic infiltration of the conjunctiva in the presence of normal findings on blood cell profile can be a rare manifestation of relapsed acute lymphoblastic leukemia.