A Persistent epidural mass in a child with B‐lineage ALL

Abstract

Epidural spinal cord compression as the initial presentation of acute lymphoblastic leukemia (ALL) is a rare and serious complication. Extramedullary disease is rarely reported in patients with ALL. The most common sites are bone, followed by soft tissue, skin and lymph nodes. We describe a child with common B-lineage ALL who presented with a mass in the spinal epidural space. She was initially treated with intrathecal chemotherapy and intravenous dexamethasone with total resolution of her clinical symptoms but a persistent epidural mass. An open biopsy of the residual epidural mass was performed 7 months after diagnosis. The histological examination did not reveal any tumor infiltration, only fibrosis. We conclude that a persistent epidural mass in patients with ALL may not indicate resistant disease and may require over a year for resolution, even when response to therapy is adequate.

Spinal Cord Compression as Clinical Presentation of Malignant Hematopoietic Diseases in Pediatric Patients

“…Most malignant hemopoietic diseases in childhood show a high degree of chemosensitivity, in consequence, early diagnosis and timely treatment should be emphasized, to avoid the progression of neurological symptoms and the eventual sequelae 8,16,19,20,29 . Nevertheless, strict control of the patient in induction is necessary due to the possibility of a slow response and the need for decompressive neurosurgery.…”

“…The diagnosis of leukemia or lymphoma can be revealed by bone marrow examination, and this prevents unnecessary surgical intervention. Laminectomy, with or without mass resection, does not appear to be necessary in patients with correctly diagnosed leukemias or lymphomas, who can receive timely treatment and respond adequately to it 8,16,19,29,30 . The role of surgery should be limited to diagnostic biopsy in patients with localized epidural lymphoma, who do not present bone marrow involvement, considering that a bone marrow aspirate should be performed urgently in suspected malignant etiology 31 .…”

Development of acute promyelocytic leukemia in a patient with tetraplegia while in inpatient rehabilitation: A case report

“…[10][11][12] In addition, there have been other cases of leukemia infiltrating the epidural space resulting in compression of the spinal cord. [13][14][15] Lastly, there have been numerous case reports regarding patients with spinal cord compressions caused by lymphoma. [16][17][18] According to a cross-sectional study by Saunders et al, the lifetime prevalence of cancer in those with spinal cord injury is 6.3%.…”