Very Late Central Nervous System Relapse in a Patient with B Cell Lymphoblastic Lymphoma

Abstract

Very late relapse of lymphoblastic lymphoma (LBL) is very rare. We report a case of a patient who developed central nervous system (CNS) relapse of LBL 16 years after the onset of the primary disease. An 8-year-old girl was hospitalized with a skin tumor in the occipital region on November 27, 1984. Examination of a biopsy of the skin tumor showed typical features of non-Hodgkin’s lymphoma (diffuse medium-sized cell type). She received multiagent chemotherapy and went into remission. On July 4, 2000, she was hospitalized with persistent headache. Cranial magnetic resonance imaging showed a cerebellar lesion, which was hypointense on T1-weighted images and of heterogeneous intensity on T2-weighted images. A midline suboccipital craniotomy was performed and pathological examination revealed a diffuse proliferation of lymphoid cells, which were positive for terminal deoxynucleotidyl transferase, but negative for CD45RO, CD3 and CD20. Tumor cells stained positively for CD10, CD22, CD38 and HLA-DR. Revised immunohistochemistry of the primary specimens of skin tumor obtained 16 years earlier revealed a phenotype similar to that of the CNS disease. Polymerase chain reaction products for the immunoglobulin gene from both the skin and cerebellar specimens were an identical size. Thus, the original diagnosis of diffuse medium-sized lymphoma was revised to B cell LBL. An isolated CNS relapse of LBL was apparent in the present case. After salvage chemotherapy, the patient underwent high-dose chemotherapy with autologous peripheral blood stem cell support and subsequent craniospinal irradiation. She went into a lasting complete remission.

Precursor B-cell lymphoblastic leukemia of the arm mimicking neurogenic tumor: case report

“…T-cell type usually presents with a mediastinal mass and cervical lymphadenopathy. However, B-LBL often occurs within skin and bone involvement, except for a small proportion involving soft tissue and presenting with a mass lesion [5,6]. Localized invasion of peripheral nerves of extra-nodal LBL, a unique uncommon subtype, was termed as neurolymphomatosis [7].…”

Skin Involvement by Hematological Neoplasms with Blastic Morphology: Lymphoblastic Lymphoma, Blastoid Variant of Mantle Cell Lymphoma and Differential Diagnoses

“…This report aims to provide insights into the cutaneous manifestations of neoplasms with a blastic morphology, focusing on the blastoid variant of mantle cell lymphoma (MCL) 23,[23][24][25][26][27][28][29][30][31][31][32][33][34][35][36][37][38][39][40][41][42], T-cell acute lymphoblastic leukemia/lymphoma (T-ALL/LBL), and B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/LBL) [43][44][45][46][47][48][49][50][51][52][53]53,54,[54][55][56][57][58], through an accurate review of the pertinent literature.…”