Leukemic Subdural Effusion Associated with Leptomeningeal Leukemia —A Case Report—

Abstract

A six month old male infant was admitted because of pallor, large head and multiple skin nodules at the frontoparietal region. Hemoglobin concentration was 7.3 g/dl, white blood count 17,200/cmm with 42% malignant cells. Bone marrow smear had malignant cells, accounting for 59% of the total. Spinal fluid cytology revealed an infiltration of tumor cells into the leptomeninges. In addition, brain CT scan revealed the existence of bilateral subdural effusion, which was also infiltrated with malignant cells. We also noted that the mitotic index of the cells in the subdural effusion was higher than that in the CSF and bone marrow. Biopsied specimen of the skin nodules was identified to be a lymphoma or leukemia cutis. Subsequently, the patient was diagnosed as leukemia/lymphoma due to the difficulty in differentiating these two malignancies.
Complete remission was achieved after one month of chemothrapy, and drainage surgery was performed to remove subdural fluids. However, the patient relapsed and finally died at age of 11 months. Autopsy revealed an infiltration of malignant cells into the dura matter, leptomeninges and other organs.
A very uncommon assocation of leptomeningeal leukemia and leukemic subdural effusion is discussed.