Abstract Details

Title B Lymphoblastic Leukemia/Lymphoma Presenting as Fifth and Seventh Cranial Nerves Palsy. Case Report

Topic Neuro-oncology

Presentation(s) P07 - (-)

Poster/Presentation
Number 008

Objective

Background BACKGROUND: B Lymphoblastic Leukemia/Lymphoma (B-LBL) typically presents with symptoms related to anemia, thrombocytopenia, and neutropenia. Central nervous system (CNS) involvement is not uncommon during the course of this disease, it can be accompanied by cranial neuropathies or other neurological symptoms, predominantly meningeal, related to increased intracranial pressure, but it is considered rare as initial presentation.

Design/Methods DESIGN/METHODS: A 27-year-old, previously healthy woman had a 7-week history of right-sided facial weakness and paresthesia. Initially, she was evaluated at an outside facility for right facial tingling and numbness involving the lower lip, difficulty in closing her right eye and right facial droop. She was diagnosed with Bell's palsy, and treated with acyclovir and oral prednisone without clinical improvement. Five weeks later, she was referred to MD Anderson Cancer Center (MDACC) for further evaluation of her symptoms and leukocytosis.

Results RESULTS: A bone marrow biopsy showed B-LBL. Several cerebrospinal fluid samples were negative for neoplastic cells. Brain MRI demonstrated enhancement of the right cranial nerve VII and VIII complex, extra-axial nodular enhancement in the right middle cranial fossa, and lymphomatous infiltration in the right angle of mandible. The patient was treated with high dose intravenous steroids, systemic chemotherapy with PEG-asparaginase, rituximab, cyclophosphamide, doxorubicin, and vincristine; intrathecal methotrexate twice weekly and a single course of intrathecal cytarabine. Ten days later, she was discharged with slight improvement of her right facial palsy, remaining on systemic chemotherapy.

Conclusions CONCLUSIONS: This is the first reported case that we know of B-LBL presenting with multiple cranial neuropathies. This presentation illustrates the importance in differentiating between Bell's palsy and multiple cranial neuropathies, which may indicate an alternative diagnosis.

Authors/Disclosures
Pedro Garciarena, MD (Collier Neurologic Specialist, LLC) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
Eric Pearlman, MD	Dr. Pearlman has received personal compensation for serving as an employee of Eli Lilly and Co. Dr. Pearlman has received stock or an ownership interest from Eli Lilly and Co.
	No disclosure on file
John F. De Groot, MD (UC San Francisco Medical Center)	An immediate family member of Dr. De Groot has received personal compensation for serving as an employee of Ziopharm Oncology. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Celldex. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Deciphera Pharmaceuticals. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AbbVie. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for FivePrime Therapeutics, Inc.. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GW Pharma. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Carthera. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Eli Lilly. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Kadmon. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Biomedical Inc.. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Taiho Pharmaceuticals. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Kairos Venture Investments. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Syneos Health. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Monteris. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Agios. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Mundipharma Research. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GenomiCare. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Blue Earth Diagnostics. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Del Mar Pharmaceuticals. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Insightec. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Voyager Therapeutics, Inc.. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merck & Co.. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Tocagen. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bioasis Technologies, Inc.. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for ResTORbio, Inc.. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celldex. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Foundation Medicine, Inc.. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novogen. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Deciphera. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astrazeneca. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Insys Therapeutics. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck & Co.. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lily. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novella Clinical. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Karyopharm Therapeutics. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Blue Earth Diagnostics. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kiyatec. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vanquish Oncology. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Orsenix, Insightec. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Prelude Therapeutics. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Debiopharm Therapeutics, Inc.. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen Global Services, LLC. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for VBL Therapeutics. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novella. Dr. De Groot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for VBI Vaccines, Inc.. An immediate family member of Dr. De Groot has received stock or an ownership interest from Ziopharm Oncology. An immediate family member of Dr. De Groot has received stock or an ownership interest from Gilead. The institution of Dr. De Groot has received research support from Carthera. The institution of Dr. De Groot has received research support from HaiHe Pharma. The institution of Dr. De Groot has received research support from Taiho Pharma.

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