ISOLATED CHOROIDAL RELAPSE DURING COMPLETE REMISSION IN ACUTE LYMPHOCYTIC LEUKEMIA (ALL)

Abstract

Leukemic opthalmopathy is often reported at autopsy. Antemortem diagnosis of ocular leukemia is much less common and has been reported associated with central nervous system (CNS) &/or multiple bone marrow (BM) relapses. Leukemia was diagnosed in the choroid of a patient (pt) with ALL in complete remission (CR) during therapy. An 11 yo Black girl had null cell ALL, CaLLa and Ia positive. The CNS had no evidence of disease. Initial therapy was "standard treatment". Six mos after diagnosis the pt complained of decreased visual acuity and was found to have perivascular leukemic deposition in the ocular fundi. Fluorescein angiography and ultrasonography of the globe verified infiltration with bilateral thickening of the choroid layer. BM and spinal fluid examination were normal. Cranial radiotherapy (XRT), was administered to the whole brain, including the posterior pole of the eyes. The pt continued systemic therapy. In the 9 mos since XRT: vision has improved, fluorescein angiography shows residual pigmentary changes, ultrasonography reveals normalization of the choroid, & the pt remains in CR. Leukemic relapse of the choroid is a dangerous sanctuary not accessible to biopsy. Standard opthalmoscopic examination provides an adequate view of only the posterior pole; without dilation, peripheral lesions cannot be seen. Since peripheral fundal lesions are generally asymptomatic, opthalmologic consultation is indicated at diagnosis, periodically throughout treatment, & at termination of therapy for ALL.