Objective: ALL is the most common type of acute leukemia in children, after AML in adults. At the time of diagnosis, there may be weakness due to anemia, signs of bleeding due to thrombocytopenia, signs of infection related to neutropenia. There may be bone pain due to expansion of the medullary cavity by the leukemic process. However, low back pain due to vertebral body collapse is one of the rare symptoms at the time of diagnosis. We are reporting an adult male patient with acute lymphoblastic leukemia who presented with paraparesis and multiple osteolytic lesions in lomber and thoracal vertebra.
Case report: A 63-year-old male patient had a complaint of back pain for 4 months, spreading to the left leg, accompanied by numbness and loss of strength. The patient without incontinence and painful walking was operated by the neurosurgery department. The patient with pancytopenia was consulted to us. In physical examination peripheral LAP was not detected and spleen size was determined as 16.5cm by ultrasound. In the laboratory examination was remarkable for Hb: 9g/dL, MCV: 79fL, plt: 13*103/uL, sedim 76mm/h LDH: 1092u/L. Other biochemical tests are normal. The L2 corpus pathological fracture biopsy result was determined as CD45+, Cd19+, Cd10+, TDT+, PAX 5+, c myc 30%+, Kİ 67% 50+, and was compatible with B lymphoblastic lymphoma infiltration. In bone marrow biopsy, 98% cellularıty, 99% blastic infiltration was detected. Blasts were CD34+, CD19+, PAX 5+, 80% CD10+, 80% TDT+, 50% CD22+, 30% CD20+, CD123+, respectively. Cytogenetics and fluorescence in situ hybridization (FISH) panel for ALL were normal; Philadelphia chromosome was not present. HyperCVAD chemotherapy was started for the patient who was diagnosed with B-ALL+ bone involvement. Intrathecal chemotherapies were given. After Hyper CVAD 2B chemotherapy, the patient was clapped due to sepsis.
Conclusion: Skeletal lesions can occur in a variety of malignant hematological conditions. In diseases such as multiple myeloma and waldenstrom macroglobulinemia, bone involvement is a common finding in diagnosis. Acute lymphoblastic leukemia and lymphomas can rarely present with osteolytic lesions and neurological involvement. ALL is a chemosensitive tumor, so chemotherapy is the main treatment option. In patients with bone involvement, radiotherapy and surgical resection are the other treatment options that can be applied.
