Isolated optic nerve involvement in chronic myeloid leukemia

Ophthalmologic manifestations as the initial presentation of chronic myeloid leukemia: A review

The presentation of chronic myeloid leukemia (CML) can be variable and related to the phase of the disease. It can manifest a wide range of symptoms and signs; ocular involvement is reported in patients with leukemia at the time of diagnosis. We describe ophthalmic manifestations as an initial presentation in patients with CML. We identified 38 publications between 1971 and 2020 describing ocular manifestations in CML. Ophthalmic problems occur either from direct or indirect infiltration of neoplastic cells or from secondary causes. Although nearly all ocular structures may be affected, leukemic retinopathy is the most frequent clinical manifestation. Others include iris infiltration, anterior uveitis, hypopyon, exudative/serous retinal detachment, and optic nerve infiltration.

Ophthalmologic Manifestations as Initial Presentation of Patients with Chronic Myeloid Leukemia: Report of Two Cases

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm, classically described as triphasic disease (chronic, accelerated, and blast). Despite the significant efforts made by different groups to optimize treatment and outcome, there are still unmet needs and unanswered questions. Ophthalmologic manifestations are among the therapeutic challenges. The best available therapy for patients presenting with ophthalmologic manifestations is still unclear. Here we present two cases of CML (chronic phase) with ophthalmologic manifestations as initial presentation, trying to shed light on this important type of presentation and proposing recommendations for hematologists in view of the current literature.

A Rare Monocytic Crisis of Chronic Myelogenous Leukemia Presenting with Unusual Extramedullary Manifestations and an Atypical (14;22)(q24;q11.2) Translocation in the Bone Marrow

A 48-year-old man was admitted due to marked leukocytosis. Bone marrow examinations resulted in a diagnosis of Philadelphia (Ph) chromosome-positive chronic myeloid leukemia. One month later, massive muscle and bone invasion by leukemic cells was detected. After induction chemotherapy, he complained of a headache and visual loss, which was caused by a leukemic infiltration in the central nervous system. After temporary remission in response to chemotherapy, the disease relapsed in the form of an intracranial tumor. The unusual t(14;22)(q24;q11.2) translocation of the Ph-chromosome and the significant increase in monocytes observed might have contributed to the unique and aggressive clinical course.

Fluorescence in situ hybridization (FISH) detects clonal instability in an optic nerve relapse of acute lymphoblastic leukemia

PURPOSE

We report a case of an isolated optic nerve relapse 3.5 years after diagnosis of hyperdiploid acute lymphoblastic leukemia (ALL) in a 6-year-old boy who had been off treatment for 3 months. The use of interphase fluorescence in situ hybridization (FISH) for clonal identification of chromosome abnormalities is described.

PATIENT AND METHODS

An asymptomatic lesion over the right optic nerve head was identified on routine funduscopic exam. Fine needle aspiration of the optic nerve infiltrate provided tissue for morphologic, immunohistochemical, and FISH analyses.

RESULTS

FISH showed similar but not identical chromosome makeup of the leukemic blasts at the time of relapse as compared to tissue samples obtained at the time of diagnosis.

CONCLUSION

Despite antimetabolite therapy, hyperdiploid ALL can rarely recur isolated to an optic nerve. FISH is a useful adjunct for confirming relapse when low numbers of white blood cells are obtained with fine needle aspiration.