DOI: 10.12890/2024_004707
Extramedullary paravertebral mass: an unusual presentation of hairy cell leukaemia
Authors
valentinasmnsmn@gmail.com
Keywords
Hairy cell leukaemia, paravertebral mass, extramedullaryAbstract
Background: Hairy cell leukaemia (HCL) is an uncommon, indolent, B-cell, lymphoproliferative disorder typically involving peripheral blood, spleen and bone marrow. It is commonly presenting with pancytopenia, monocytopenia and massive splenomegaly, while accounting for 2% of lymphoid leukaemias. Cases of extranodal lesions caused by HCL are rare, although these have been reported. Here, we report a case of HCL presenting as a paravertebral mass without systemic involvement.
Case description: A 58-year-old man was admitted to our hospital due to progressive difficulty walking for a month, without any other symptoms. Blood examination noted mild anaemia with Hb=12.6 g/dl and mild thrombocytopenia of 140,000/ul. Magnetic resonance imaging (MRI) and computed tomography (CT) imaging demonstrated a T6 posterior paravertebral mass lesion, extending into the spinal canal with metastatic bone lesions along the thoracic and lumbar spine. Further imaging study with CT indicated mild splenomegaly (13.4 cm) and an enlarged abdominal lymph node (3.5 cm) near celiac trifurcation.
Conclusion: A core-needle biopsy from the paravertebral mass was performed. Results showed small-sized cells with round or oval nuclei, and pale cytoplasm with immunophenotype: B-cell origination with CD20+, Cyclin D1+, DBA.44+, Annexin+ and BRAF+, indicative of HCL.
References
- Campo E, Jaffe ES, Cook JR, Quintanilla-Martinez L, Swerdlow SH, Anderson KC, et al. The International Consensus Classification of Mature Lymphoid Neoplasms: a report from the Clinical Advisory Committee. Blood 2022;140:1229–1253.
- Tadmor T, Polliack, A. Hairy cell leukaemia: uncommon clinical features, unusual sites of involvement and some rare associations. Best Pract Res Clin Haematol 2015;28:193–199.
- Robak P, Jesionek-Kupnicka D, Kupnicki P, Polliack A, Robak, T. Bone lesions in hairy cell leukaemia: diagnosis and treatment. Eur J Haematol 2020;105:689–691.
- Rosen DS, Smith S, Gurbuxani S, Yamini B. Extranodal hairy cell leukaemia presenting in the lumbar spine. J Neurosurg Spine 2008;9:374–376.
- Maitre E, Cornet E, Troussard X. Hairy cell leukaemia: 2020 update on diagnosis, risk stratification, and treatment. Am J. Hematol 2019;94:1413–1422.
- Falini B, Martino G, Lazzi S. A comparison of the International Consensus and 5th World Health Organization classification of mature-cell lymphomas. Leukaemia 2023;37:18–34.
- Jehn U, Bartl R, Dietzfelbinger H, Haferlach T, Heinemann V. An update: 12-year follow-up of patients with hairy cell leukaemia following treatment with 2-chlorodeoxyadenosine. Leukaemia 2004;18:1476–1481.
- Herold CJ, Wittich GR, Schwarzinger I, Haller J, Chott A, Mostbeck G, et al. Skeletal involvement in hairy cell leukaemia. Skeletal Radiol 1988;17:171–175.
- Yonal-Hindilerden I, Hindilerden F, Bulut-Dereli S, Yildiz E, Dogan IO, Nalcaci M. Hairy cell leukaemia presenting with isolated skeletal involvement successfully treated by radiation therapy and cladribine: a case report and review of the literature. Case Rep Hematol 2015;2015:803921.
- Cailly L, Gruchet C, Maitre E, Guidez S, Delwail V, Systchenko T, et al. Hairy cell leukaemia with isolated bone lesions. Clin Case Rep 2023;11:e7343.
- Kimmel DW, Hermann RC Jr, O’Neil BP. Neurologic complication of hairy cell leukaemia. Arch Neurol 1984;41:202–203.
- Claves F, Carras S, Burroni B, Maitre E, Boutonnat J, Troussard X, et al. Atypical meningeal localization of classical hairy cell leukaemia with an impressive response to rituximab and cladribine association. A case report and literature review. EJHaem 2024;5:242–246.
- Venkatesan S, Purohit A, Aggarwal M, Manivannan P, Tyagi S, Mahapatra M, et al. Unusual presentation of hairy cell leukaemia: a case series of four clinically unsuspected cases. Indian J Hematol Blood Transfus 2014;30:413–417.
- Kraut EH. Clinical manifestations and infectious complications of hairy-cell leukaemia. Best Pract Clin Haematol 2003;16:33–40.