Isolated leukemic infiltration of peripheral nervous system

Wang, Tingzhong; Miao, Yuan; Meng, Yanli; Li, Ailin

doi:10.1002/mus.24435

Cited by 19 publications

(28 citation statements)

References 24 publications

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“…A blood–nerve barrier (BNB), similar to the blood–brain barrier (BBB), separates the circulating blood from the peripheral nerves [ 6 - 7 ]. The BNB is comprised of endoneurial vascular endothelial cells, a basement membrane and is surrounded by pericytes [ 6 ]. The tight intercellular junctions make it difficult for leukemic cells to penetrate.…”

Section: Discussionmentioning

confidence: 99%

“…Wang, et al suggested that in patients with isolated neuroleukemiosis, a hematogenous spread of blast cells into the PNS is more likely than longitudinal dissemination from nerve root [ 6 ]. They proposed that pathogenic cells can penetrate an impaired BNB, and leukocytes can enter the PNS irrespective of any disturbance in the BNB [ 6 , 9 ]. Once the leukemic cells make it into the PNS they are in an ideal location to thrive, making them very difficult to treat.…”

Section: Discussionmentioning

confidence: 99%

“…Differential diagnosis for neuroleukemiosis includes Guillain-Barre syndrome (GBS), neurotoxicity from chemotherapy, and abscess [ 3 , 6 ]. Nerve conduction studies can help differentiate axonal damage from demyelination, but the most helpful tests are radiological exams, specifically MRI and positron emission tomography (PET) [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Extramedullary tumors composed of myeloblasts or monoblasts have been referred to as chloromas and occur in around 5% of AML cases [ 2 - 3 ]. When they involve the peripheral nervous system (PNS), the condition is called neuroleukemiosis [ 3 - 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…The literature contains only a handful of case reports of isolated leukemic masses infiltrating the PNS. Such masses usually appear after patients are in remission and there are no other signs of relapse [ 6 ]. We report two cases of patients diagnosed with AML who later presented with neurological symptoms due to neuroleukemiosis.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Neuroleukemiosis: Two Case Reports

Voin¹,

Khalid

Shrager

et al. 2017

Cureus

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Extramedullary tumors composed of myeloblasts or monoblasts can present in various locations. Patients with a history of acute myeloid leukemia (AML) can present with neuropathic pain and no evidence of relapse of their leukemia. Neuroleukemiosis is a form of extramedullary tumor present in the peripheral nervous systems (PNS) of leukemia patients. We report two AML patients who were in remission and later presented with neurological symptoms due to neuroleukemiosis with negative bone marrow biopsies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Neuroleukemiosis: Two Case Reports

Voin¹,

Khalid

Shrager

et al. 2017

Cureus

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Isolated peripheral nervous system relapse after allogeneic hematopoietic cell transplantation for T‐cell acute lymphoblastic leukemia

Willemsen,

Smeets,

de Coninck

2024

American J Hematol

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Isolated peripheral neuroleukemiosis mimicking Guillain‐Barré syndrome in an adolescent with relapsed B‐lymphoblastic leukemia

Edmondson,

Pauli,

Punia

et al. 2024

Annals of the Child Neurology Society

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BackgroundNeuroleukemiosis, leukemic infiltration of the peripheral nervous system (PNS), is rare. Very few cases of isolated neuroleukemiosis, PNS leukemic infiltration without leukemia blasts in the blood or bone marrow, have been reported in pediatrics. Most cases have occurred in adults with acute myelogenous leukemia (AML) in remission who presented with peripheral neuropathy. We describe a pediatric patient presenting with isolated neuroleukemiosis mimicking Guillain‐Barré syndrome.Patient descriptionA 15‐year‐old boy presented 1 month after IVIG treatment for Guillain‐Barre syndrome with worsening ataxia and weakness. He had a past medical history of B‐cell acute lymphoblastic leukemia (B‐ALL) in remission for 8 years. Examination revealed distal greater than proximal weakness of the bilateral lower extremities, areflexia at the Achilles tendon, and 1+ patellar and upper extremity reflexes. Initial magnetic resonance imaging (MRI) of the brain and spine were normal, and lumbar puncture revealed increased protein with uninterpretable white count due to excessive red blood cells. Repeat MRI brain and spinal cord showed extensive enlargement of all nerve roots and enhancement of the cauda equina and portions of cranial nerve VII bilaterally. Repeat lumbar puncture with cytology revealed leukemic blast cells. Blasts were not detected in peripheral blood smear or by flow cytometry. Bone marrow biopsy was also free of blast cells, confirming the diagnosis of relapsed B‐ALL restricted to the nervous system.ConclusionsNeuroleukemiosis is a rare entity with typical clinical features of mono‐ or polyneuropathy. It most often occurs in adults in remission from AML. However, neuroleukemiosis should also be on the differential for pediatric patients in remission from ALL presenting with neuropathy.

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Isolated leukemic infiltration of peripheral nervous system

Cited by 19 publications

References 24 publications

Neuroleukemiosis: Two Case Reports

Neuroleukemiosis: Two Case Reports

Isolated peripheral nervous system relapse after allogeneic hematopoietic cell transplantation for T‐cell acute lymphoblastic leukemia

Isolated peripheral neuroleukemiosis mimicking Guillain‐Barré syndrome in an adolescent with relapsed B‐lymphoblastic leukemia

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