A Case of Acute Lymphoblastic Leukemia with Isolated Orbital Relapse

Acute lymphoblastic leukemia (ALL) is the most common malignancy of childhood. Central nervous system is the most frequent place of both at the onset and relapse of the disease, but orbital involvement is rarely seen. A seven-year-old girl diagnosed with high risk ALL and Turkish ALL-Berlin Frankfurt Münster (BFM)-2000 high risk group treatment was given. However, after induction and consolidation treatments, before the maintenance treatment she had blindness in her right eye. Ophthalmologic examination her visual acuity was fingers to count in two meters. In her right eye there was exudative retinal detachment and her orbital magnetic resonance imaging (MRI) showed that, there was a mass lesion in the posterior of right orbital globe, on the neighbourhood of optic disc, consistent with metastasis. After ALL-REZ-BFM-2002 relapse protocol treatments and radiotherapy her visual acuity was increased to 6/10. In control orbital MRI regression of mass lesion size was established. Bone marrow transplantation was planned. Orbital involvement is rarely seen in leukemia, but it is responsive to chemotherapy and radiotherapy combination.

İzole Orbita Tutulumu ile Relaps Olan Akut Lenfoblastik Lösemi Olgusu

Akut lenfoblastik lösemi (ALL) çocukluk çağının en sık görülen malignitesidir. Tanı anında ve relaps olgularda santral sinir sistemi tutulumu sık görülmesine karşın orbital tutulum nadiren görülmektedir. Yedi yaşında kız hasta kliniğimizde yüksek risk ALL tanısı alarak Türk ALL-Berlin Frankfurt Münster (BFM)-2000 yüksek risk grubu protokol tedavisini almakta iken; indüksiyon ve konsolidasyon tedavileri ardından, idame tedavisi öncesi sağ gözde görememe şikayeti ile başvurdu. Hastanın oftalmolojik muayenesinde görme keskinliği iki metreden parmak sayma şeklindeydi. Hastanın sağ gözünde retinal dekolman mevcuttu ve orbital manyetik rezonans görüntülemesinde (MRG) sağ orbita arkasında metastaz ile uyumlu kitle lezyonu saptandı. Hastaya ALL-REZ-BFM-2002 relaps protokol tedavisi ve radyoterapi uygulandıktan sonra hastanın görme keskinliği 6/10 olarak saptandı ve kontrol MRG görüntülemesinde kitle lezyonda küçülme gözlendi. Hastaya kemik iliği nakli yapılması planlandı. Lösemide orbital tutulum nadiren görülmektedir, ancak bu durum kemoterapi ve radyoterapi kombinasyonuna yanıt vermektedir.

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