Korean J Pediatr Hematol Oncol.  2004 Apr;11(1):68-73.

Isolated Extramedullary Relapse of Acute Lymphoblastic Leukemia Presenting as an Paraspinal Mass

• Kim JY
• Kim HR
• Woo CO
• Lee JH
• Chung UY
• Lee KC

Abstract

Despite improvements in therapy, cases in which relapse occurs are still common in children with acute lymphoblastic leukemia (ALL). Most relapses occur in the bone marrow, and extramedullary relapse is most commonly in the central nerve system. Soft tissue mass lesion or spinal cord involvement is extremely unusual in ALL relapse. We experienced a 13-year-old boy who presented with extremity weakness and pain. He was diagnosed with ALL 4 years ago and achieved complete remission after systemic chemotherapy. Imaging study revealed a paraspinal mass which was invading the S1-2 vertebral body. Histopathologic examination revealed infiltrates composed of immature lymphoblasts with morphology identical with that of initially diagnosed bone marrow aspiration. Studies on bone marrow were negative for disease at this time. He was treated with irradiation and intrathecal chemotherapy, in addition to systemic chemotherapy. The mass has nearly disappeared, and he is planned for allogeneic bone marrow transplantation.

Keyword

Acute lymphoblastic leukemia; Extramedullary relapse; Paraspinal mass

MeSH Terms

Adolescent
Bone Marrow
Bone Marrow Transplantation
Child
Drug Therapy
Extremities
Humans
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma*
Recurrence*
Spinal Cord