Symptom Of Acute Lymphoblastic Leukemia Research Articles

Vertebrae compression fracture due to osteonecrosis as initial sign of childhood acute lymphoblastic leukemia: A case report

BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common cancer in children. Manifestations of ALL vary from pallor, organomegaly, fever, and pancytopenia. Bone pain caused by vertebrae fracture is an uncommon manifestation of ALL, approximately only 16% of all bone pain occurrences. Fractures in ALL could occur at diagnosis and following treatment initiation. This case report described vertebrae compression fracture due to osteonecrosis as the initial sign of childhood acute lymphoblastic leukemia. CASE: An 8-year-10-month girl was referred to an orthopedic because of worsened low back pain since 1 month before, with no history of trauma. The pain was throbbing and radiated to the lower extremities. The patient was non-ambulant due to the pain. Physical examination revealed the visual analog scale was 8, tenderness in the spine, decreased strength, and range of movement in the lower extremities. There was no organomegaly in this patient. Serial laboratory examination revealed mild pancytopenia (leukopenia, mild normochromic normocytic anemia, mild thrombocytopenia) with dominancy of lymphocytes (68.1-81.9%). No blast was found in the peripheral blood smear. Magnetic Resonance Imaging of the spine revealed compression of the vertebral corpus with a pincer fracture and bone infarction. Bone marrow aspiration showed ALL-L2 with lymphoblast 50%. The patient started chemotherapy with ALL standard risk protocols and got zoledronic acid during the treatment. The patient's condition gradually improved, and able to undergo chemotherapy protocol. No side effects of zoledronic acid occurred. CONCLUSION: Vertebrae compression fracture without trauma and pancytopenia can be an early symptom of ALL. Zoledronic acid can be given concurrently with chemotherapy for bone mineralization.

Unilateral periorbital swelling as initial rare presentation of pediatric leukemia

Background: Acute lymphoblastic leukemia (ALL) is considered the most typical type of cancer in children, representing around 26% of childhood cancer. Case Presentation: A 13-month-old girl was presented to our clinic who developed unilateral periorbital swelling as her initial sole symptom of ALL. In this report, we described this case with a summary of previously reported cases. The patient previously medically free, was presented with left periorbital swelling and inferior globe displacement, progressing over the preceding 3 weeks. At the initial presentation, slit lamp examination revealed a normal anterior segment with characteristic leukemic retinopathic changes in both eyes with no detected hepatosplenomegaly or enlarged lymph nodes. On investigation, a peripheral smear and bone marrow biopsy showed 80% blast cells. A CT scan showed varying degrees of bilateral extraocular/ocular muscle infiltration. ALL was diagnosed, and the patient immediately underwent induction chemotherapy. Conclusion: This case highlights the importance of understanding and considering rare, aggressive diseases potentially masquerading as simple periorbital edema.

Osteoarticular manifestation of acute lymphoblastic leukemia in adults: a literature review.

Osteoarticular manifestations such as arthritis and bone pain are scarce among adults with acute lymphoblastic leukemia (ALL). We present a systematic review of osteoarticular first clinical manifestation related to ALL in adults, and we report a case of an adult patient with a B-cell ALL revealed by refractory pygalgia and arthritis. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the MEDLINE database, including case reports and case series describing osteoarticular manifestations revealing ALL in adults. There were 29 patients with osteoarticular manifestations, revealing ALL (including our case). The mean age was 34.00 ± 13.29years. Osteoarticular manifestations were peripheral articular signs (7 cases), axial manifestations (17 cases), and osteolytic lesions (21 cases). Vertebral fractures were reported in 4 cases. MRI was performed in 15 cases, showing heterogeneous signal changes in the vertebra, skull, and sacroiliac bones. It showed avascular necrosis of the femoral head in one case. PET scan, performed in 7 cases, showed diffuse or localized FDG uptakes in the bone marrow. Hypercalcemia was noted in 9 cases. The treatment was based on chemotherapy (23 patients) and radiotherapy (4 cases). During the follow-up, remission was noted in 14 cases, death in 9 cases, and was not available in 6 patients. Our review showed that axial manifestations, joint swelling, bone pain, and hypercalcemia could be the first and only symptoms of ALL in adults, making the diagnosis of ALL difficult to recognize, leading to a diagnosis delay. Key Points • Acute lymphoblastic leukemia in adults revealed by osteoarticular manifestations can be misdiagnosed as rheumatic diseases. •Axial manifestations, joint swelling, bone pain, and hypercalcemia could be the first and only symptoms of acute lymphoblastic leukemia in adults. • Complete blood count and calcium blood test should be performed as first-line investigations in adults with axial or peripheral articular symptoms. •Physicians should be aware of this clinical presentation to avoid diagnosis delay and improve prognosis.

The lesion of the osteo-articular system in the onset of acute leukemia in childhood

According to different authors, the osteoarticular syndrome is observed in every third patient with acute leukemia. The polymorphism of the clinical manifestations presents a diagnostic difficulty, while the abnormal x-ray findings are not traditional characteristics of patients with leukemia. In some cases, bone manifestations may be the first and only symptom of acute lymphoblastic leukemia, complicating the diagnosis and postponing the correct diagnosis. The article describes 3 clinical cases of patients with a lesion of the osteo-articular system in the onset of acute leukemia. Despite the current complex laboratory and instrumental research methods, a particular attention should be paid to the difficulties of differential diagnosis between acute leukemia and other lesions of the osteo-articular system.

Orthopedic manifestation as the presenting symptom of acute lymphoblastic leukemia

IntroductionThe diagnosis of Acute lymphoblastic leukemia (ALL) is delayed due to vague presentation and normal hematological investigations. ObjectiveThe objectives were to identify the frequency of ALL cases presented to the orthopedic department and with normal hematological investigations. Material and methods250 consecutive ALL cases were retrospectively evaluated to identify cases with musculoskeletal manifestations, and laboratory investigations. ResultsTwenty-two patients (4- vertebral compression fractures, 12- joint pain, 6- bone pain), presented primarily to the orthopedic department. Six patients had a normal peripheral smear. ConclusionThe primary physician should maintain a high index of suspicion despite a normal peripheral smear.

Hypereosinophilia as a Presenting Symptom of Acute Lymphoblastic Leukemia in a Child

Hypereosinophilia is rare in children and represents primary or secondary conditions, the latter of which is associated with other diseases (parasitic infections and allergic, autoimmune, and neoplastic diseases). In small number of cases (< 1%) it is a part of the clinical presentation of acute lymphoblastic leukemia, the most common malignancy in children. More often hypereosinophilia precedes the symptoms of leukemia and hinders timely diagnosis, exposing patients in a high risk. In this report, a case of a child with acute lymphoblastic leukemia and hypereosinophilia is presented. The patient is a 30-month-old female, whose leukemia is preceded 2 weeks after hypereosinophilia. This symptom made the exact and timely diagnosis of oncological disease difficult. The further course of the disease was standard despite of delayed diagnosis and incomplete induction treatment due to the hepatic chemotoxicity. We present this case due to the rarity of hypereosinophilia in pediatric acute lymphoblastic leukemia. Every experience with such cases would be very useful for the improvement of the diagnosis of these patients. Moreover in our patient we did not find typical cytogenetic or molecular genetic abnormalities for this type of leukemia, and did not observe any clinical signs of organ complications specific for hypereosinophilia. Int J Clin Pediatr. 2020;9(2):59-63 doi: https://doi.org/10.14740/ijcp365

Nephrotic syndrome and acute renal failure as a presenting symptom of acute lymphoblastic leukemia

Nephrotic syndrome and acute renal failure as a presenting symptom of acute lymphoblastic leukemia

Physical, Psychological and Social Symptoms, Activity and Education of Children and Adolescents with Acute Lymphoblastic Leukemia Receiving Maintenance Chemotherapy

Purpose: This study was to identify the physical, psychological and social symptoms of ALL (acute lymphoblastic leukemia) children and adolescents receiving maintenance chemotherapy to build a basic data set to produce effective nursing intervention and ultimately help their early return to school and social adaptation. Methods: Fifty ALL children and adolescents between 4 and 18, who were receiving maintenance chemotherapy were surveyed on days 2, 7, and 28. For younger children, between the age of 4 and the 3rd year in elementary school, their primary caregivers answered the survey and those between the 4th year in elementary school and the age of 18 answered the survey themselves. Results: During maintenance chemotherapy, ALL children and adolescents experience diverse physical, psychological and social symptoms. On days 7 and 28, physical and social symptoms were greater than physical symptoms. Physical symptoms were greatest on day 2 and the most psychological and social symptoms were observed on day 7. During the maintenance chemotherapy period, 40% of the children and adolescents could not attend regular educational institutions. Conclusion: Since each point in the maintenance chemotherapy period shows different symptomatic characteristics, nursing intervention can be provided appropriately for each specific point to help the patients’ social adaptation and early return to school.

A successful treatment of hypercalcemia with zoledronic acid in a 15-year-old boy with acute lymphoblastic leukemia.

Severe hypercalcemia in children is a rare medical emergency. We present a case of a 15-year-old boy with hypercalcemia (total calcium level, 14.2 mg/dL) with a normal complete blood count, no circulating blasts in the peripheral blood film, and no other signs of acute lymphoblastic leukemia (ALL), including no signs of lymphadenopathy or hepatosplenomegaly. The hypercalcemia was successfully treated with zoledronic acid. As hypercalcemia can be the only presenting symptom of ALL in children, the diagnosis is often delayed. In children presenting with hypercalcemia, malignancies must be considered in the differential diagnosis.

Bilateral Facial Palsy a rare presenting symptom of acute lymphoblastic leukemia with CNS and BM Relapses.

Bilateral Facial Palsy a rare presenting symptom of acute lymphoblastic leukemia with CNS and BM Relapses.

Approach to prediagnostic clinical semiology, noticed by mothers, of childhood acute lymphoblastic leukemia.

Recognizing early symptoms of acute lymphoblastic leukemia (ALL) may help to make an early diagnosis. The objective of this study is to identify clinical manifestations preceding the diagnosis of childhood ALL from the maternal perspective and to establish the time elapsed from the first manifestation to the diagnosis. Six hospitals located in Bogotá and Bucaramanga (Colombia) participated. Cases consisted of children under 15 years old with incidental diagnosis of ALL between January 2000 and March 2005. Data on sociodemographic characteristics, pre diagnostic clinical manifestations, first symptom, and time to diagnosis were collected during interviews with mothers. Medians, ranges and proportions were estimated. P values below 0.05 were considered significant. One hundred and twenty-eight cases were analyzed. Pallor (83.6%), loss of appetite (72.6%), weight loss (62.5%), andbleeding into the skin (39.1%) were the most common symptoms preceding diagnosis. The delay between the occurrence of the first symptom and the diagnosis of ALL depends on what the first manifestation is, and it maybe shorter when there is evidence of hemorrhage (median= 14 days). The presence of palpable lymph nodes in the armpits was more significant in girls than in boys (p= 0.04). Childhood ALL symptomatology in the prediagnostic stage is not specific to this disease; however, the clinical sign and time since its occurrence may serve as a guide in the early stage of this disease.

Leukemia Cutis and Facial Nerve Palsy as Presenting Symptoms of Acute Lymphoblastic Leukemia

Leukemia cutis and facial nerve palsy are rare presenting symptoms of leukemia. This report describes a case of acute T-cell lymphoblastic leukemia (ALL) presenting with only these two symptoms, a presentation of ALL that, to our knowledge, has not been previously described. It serves to alert physicians to look for underlying malignancy in the setting of cutaneous findings associated with facial nerve palsy.

Hypercalcemia and osteolytic lesions as presenting symptoms of acute lymphoblastic leukemia in childhood. The use of zoledronic acid and review of the literature

Hypercalcemia is rare in children with etiology different from adults. We report an 11.5-year-old boy with developmental delay that presented with difficulty in walking and vomiting. Laboratory investigations revealed hypercalcemia (Ca 13.8 mg/dL) with low serum parathormone, normal full blood count and no circulating blasts. Osteolytic lesions were discovered on radiological survey. Bone marrow examination was consistent with the diagnosis of common B acute lymphoblastic leukemia (ALL). Hypercalcemia was successfully treated with zoledronic acid. Hypercalcemia is a rare but well-recognized complication of ALL, usually present at the time of initial diagnosis. We reviewed the literature and analyzed the clinical and laboratory data in 36 cases of childhood ALL presenting with hypercalcemia. In conclusion, hypercalcemia alone or combined with osteolytic lesions can be the only presenting symptom of ALL in children.

Isolated Primary Testicular B Lymphoblastic Lymphoma

Acute lymphoblastic leukemia (ALL) is the most common cancer in children and adolescents. Clinical presentation often reflects bone marrow involvement and consequences of bone marrow failure. Microscopic involvement of the testis is rare, occurring in about 2% of cases. We present a case of a 3-year-old child who displayed unilateral macroorchidism as the only clinical symptom of ALL. Although the patient presented with localized disease, he was treated with systemic chemotherapy without recurrence. In this report, we review the current literature on ALL testicular involvement, diagnosis, and treatment.

Bilateral Nephromegaly as a Presenting Symptom of Acute Lymphoblastic Leukemia

Bilateral Nephromegaly as a Presenting Symptom of Acute Lymphoblastic Leukemia

Acute lymphoblastic leukemia in children: Correlation of musculoskeletal manifestations and immunophenotypes

Studies on musculoskeletal manifestations (MSM) of childhood acute lymphoblastic leukemia (ALL) have yielded variable findings with regard to their clinical impact. We investigated the significance for differential diagnosis, treatment and outcome of musculoskeletal complaints as presenting symptoms of ALL, and their correlation with leukemia immunophenotypes, for which data is lacking. Data on 783 children in the national study for childhood ALL between 1984 and 2003 were reviewed retrospectively. Statistical analysis examined possible relationships between MSM at the time of diagnosis and demographic and clinical data, biological features of leukemia (peripheral blood counts, immunophenotype and main cytogenetic aberration), response to initial prednisone treatment, and outcome. Of 765 children with data on orthopaedic complaints, 240 presented with MSM (31.4%). Among these children, B cell precursor (BCP) was much more common (209/576, 36.3%) than T cell ALL (25/176, 14.2%). Patients with MSM had lower white blood cell counts (WBC) (median of 9 vs. 20 x 10(9)/L, P < 0.001) and percentage of blast cells in the peripheral blood at diagnosis compared to those without (median of 27 vs. 53%, P < 0.001). Hepatomegaly and splenomegaly were less common in MSM group (67 vs. 53% <3 cm, P < 0.001, and 63 vs. 50% <3 cm, P < 0.001, respectively). Poor response to initial treatment with prednisone was recorded in 7.1% of patients with MSM versus 11.5% of those without (P = 0.086). The analysis revealed no independent effect of MSM on event-free survival (EFS), after correcting for differences in EFS related to immunophenotype or initial WBC. MSM occur mostly in children with BCP ALL who present with less involvement of extramedullary organs, low peripheral blood blasts and white blood cells counts. These findings highlight the importance of including ALL in the differential diagnosis of MSM even in the presence of an apparently normal peripheral blood count. Our study also suggests that MSM are caused by leukemic cells with enhanced biological propensity to remain relatively confined within the intramedullary bone-marrow space.

Spontaneous splenic rupture as the initial manifestation of acute lymphoblastic leukaemia: Immunophenotype and cytogenetics

Spontaneous splenic rupture is a rare, though life-threatening complication of some hematological malignancies and is even more infrequent as the initial symptom of acute lymphoblastic leukemia. We describe the fourth case, to our knowledge, of acute lymphoblastic leukemia presenting as splenic rupture, and for the first time the immunophenotype and cytogenetic pattern observed.