MLLrearranged acute lymphoblastic leukaemia presenting as a maxillary sinus mass with a discordant immunophenotypic profile from the bone marrow

Abstract

We describe an unusual case of pre-B lymphoblastic leukaemia presenting with a unilateral maxillary sinus mass in which biopsies of the primary mass and the bone marrow demonstrated conflicting immunophenotyping results. The extramedullary mass was consistent with a precursor B-cell malignancy, while the bone marrow was initially reported as a possible mature B-cell malignancy. The treatments for the two are fundamentally different, which necessitated a delay in the initiation of his chemotherapy until a clear diagnosis was made. Mixed lineage leukaemia gene rearrangement was confirmed by fluorescence in situ hybridisation in both the primary mass and bone marrow, which unified the diagnosis as pre-B acute lymphoblastic leukaemia given the common cytogenetic feature.

When nasal cytology detects acute lymphoblastic leukaemia: New diagnostical implications

“…Moreover, extramedullary leukaemic infiltration typically manifests as soft tissue masses, which can be the initial presentation of a haematopoietic malignancy. 4 The patient in question did not present appreciable masses either on physical examination or radiological investigations. Probably the conspicuous nasal lymphocytic infiltrate was caused by the vasomotor rhinitis from which the patient suffered.…”

“…Actually, the involvement of the nose or the paranasal sinuses in patients suffering from leukaemia is a rather rare event. Moreover, extramedullary leukaemic infiltration typically manifests as soft tissue masses, which can be the initial presentation of a haematopoietic malignancy 4 . The patient in question did not present appreciable masses either on physical examination or radiological investigations.…”

B-cell Lymphoblastic Lymphoma Presenting as a Sinonasal Mass: A Case Report

“…Both patients had palpable masses on their cheeks as well as supraclavicular lymphadenopathy [ 10 ]. Wang et al also presented a case of a patient with primary B-cell lymphoblastic leukemia that initially presented as a progressively enlarging maxillary sinus mass without further symptoms [ 11 ]. Burton et al published a case of a 19-year-old who had a relapse of ALL, which occurred in the ethmoid sinus and presented as facial pain and a supraorbital and paranasal mass [ 12 ].…”

Protean Neuroophthalmic Presentations of Common Childhood Malignancies—A Report of Two Cases

“…They often puzzle clinicians and pose interesting diagnostic challenges. [1][2][3][4][5][6][7] We describe two unique neuroophthalmological presentations of common childhood malignancies in this report.…”