Facial bone lesions as the first manifestation of acute leukemia in children and adolescents

Abstract

Acute leukemia takes the first place in the incidence of malignant tumors among children and adolescents. The clinical manifestations of the disease are well studied and are related to the proliferation and infiltration of organs by leukemic cells with or without dysfunction, as well as to the secondary inhibition of normal hematopoiesis and immunopoiesis in bone marrow. However, focal lesions of facial bone by blast cells with a picture of solid neoplasm occur very rare. It is important to note that such lesions may be the first and singular disease manifestation or its recurrence before appearing a classical clinical picture. Objective. To study features of acute leukemia manifestation in children and adolescents in facial bones lesions. Patients and methods. The results of examinations of 5 patients with facial bone lesion, who were treated in Dmitry Rogachev National Medical Research Center of pediatric hematology, oncology and immunology for the period from 2012 to 2023 yr. have been analyzed. All patients underwent computer or magnetic resonance tomography of facial bone due to their main complaints. Patients were performed complete blood count, biochemical analysis of blood, biopsy of maxilla neoplasm, biopsy of altered lymph nodes, bone marrow puncture to clarify the diagnosis. Results. Patients’ complaints are non-specific and are caused by localization of infiltration focus by blast cells. Common symptoms were found in 33.3% of patients. The presence of lesion in the facial bones and skull precedes appearing blast cells in peripheral blood in 83% of cases. The number of patients equal 5 (83%) had maxilla lesion. Magnetic resonance tomography with contrast enhancement made it possible to visualize extramedullary AC lesions. The key point of extramedullary AC lesions diagnosis is BM puncture. A biopsy of primary lesion may be considered as an option to verify the diagnosis, but is not essential. Conclusion. The atypical course of acute leukemia, the necessity of differential diagnosis and lack of suspicion lead to a loss of time from the first disease manifestations to diagnosis establishment. The knowledge of physicians of different specialties can reduce this interval and improve the treatment efficacy of this patients’ group.