A Case of Acute Lymphoblastic Leukemia with Eyeball Deviation in the Early Stage

ABSTRACT

PURPOSE: Orbital infiltration secondary to leukemia arises from acute myelogenous leukemia (AML). In most cases, it occurs late in the disease. We report one case of acute lymphoblastic leukemia (ALL) who presented with right eyeball deviation in the early stage. METHODS: A boy presented with a 3-weeks history of upward deviation of the right eye and limitation of motion of right gaze. CT scan of the orbits revealed a right inferior orbital mass with obscure, border extending, into the maxillary sinus, ethmoid sinus and nasal cavity. and Bony destruction was presented. Biopsy specimens from the maxillary sinus and ethmoid sinus were obtained for examination and peripheral blood smear, bone marrow aspiration and biopsy were done. RESULTS: Laboratory studies showed normal leukocyte count. Histopathologic specimens from the maxillary sinus showed B-cell lymphoblastic lymphoma. Bone marrow aspiration and biopsy showed blast cells, and immunophenotyping showed ALL with L1/L2 (L2 over 60%). The results supported the diagnosis of ALL with B-cell lymphoma. CONCLUSIONS: Ed- there is only one conclusion here. In cases of leukemia, exophthalmos can be the first manifestation without abnormality of peripheral blood. Therefore we must observe exophthalmos in children carefully in spite of normal peripheral blood with plenty of time and when necessary perform bone marrow aspiration and biopsy.