Download: Neuroimagingin Pediatric Leukemia and Lymphoma: Differential Diagnosis

… with the imag-ingfindingsis essential for proper diagnosis of neurologic symptoms in … CNS central nervous system Index terms: Leukemia, complications, .34 2 ? Leukemia, in infants and … EDUCATION EXHIBIT 1411 Neuroimagingin Pediatric Leukemia and Lymphoma: Differential Diagnosis 1 ONLINE-ONLY CME LEARNING OBJECTIVES After reading this article and takin g the test, the reader will be able t o:* List themainneuro- logic pathologic conditions seen in pediatric patients with leukemia or lymphoma.

Lymphoreticular malignancies account for about 40%ofallmalignant disorders in children. Leu- kemiarepresents nearly 30%of all malignancies, with 75%ofcases corresponding to acute lymphoblastic leukemia (ALL). Lymphoma constitutes 11%ofpediatric malignancies (6%non- Hodgkinlymphoma and 5%Hodgkindisease) (1). In the past, central nervous system (CNS) complications were rarely seen due to the rapid course of the disease. Recent therapeutic ad- vancessuchas aggressive polychemotherapy, intrathecal cytostatic prophylaxis, and cranial irradiation have improved the prognosis of acute leukemia and high-grade lymphoma, with survival in up to 60%ofpatients, but complications and adverse effects have also increased (2). Bone marrow transplantation, with the possi- bilityof eradicating remaining malignant cells and suppressing the recipient ’simmunesystem, has also revolutionized the treatment of these patients. The typical conditioning regimen used for this purpose includes cytotoxic drugs (usually cyclophosphamide) followed by total body irra- diationgivenin several fractions. Significant acute side effects such as graft-versus-host disease, infections, veno-occlusive disease of the liver, and the more unusual neurologic complica- tionsduetothe associated total body irradiation and cytotoxic agents are well established (3). We retrospectively evaluated the results of cra- nialandspinalneuroimaging studies in all pediat- ricpatientswith leukemia or lymphoma referred to our department for investigation of neurologic symptoms and signs. Abnormal imaging findings were subsequently correlated with medical records ora histopathologic diagnosis, when available. The diverse pathologic entities that can affecttheCNSin these patients have been grouped to simplify the approach (Table), and representative cases are presented. The pathologic entities are classified into three main categories: CNS manifestations of primary hematologic disease, side effects of therapeutic measures, and infectious complications. Early recognition and diagnosis of CNS complications in these patients is important to establish proper treatment and increase the chance for overall survival….

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