CASE REPORTS: Isolated lacrimal gland enlargement as a presenting sign of relapse of B-cell acute lymphoblastic leukemia in an adult

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Abstract
A 25-year-old woman with a history of acute lymphoblastic leukemia with Philadelphia chromosome (BCR 22q11.2-ABL1 (9q34)) presented with two months of progressively worsening swelling and pain of her left upper eyelid. Magnetic resonance imaging showed a heterogeneously enhancing mass lesion in the left lacrimal gland. An incisional biopsy was performed; histopathology showed atypical lymphocytic cells and flow cytometry revealed a similar immunophenotype to her previously diagnosed cancer. Her presentation was consistent with recurrence of acute lymphoblastic leukemia in the lacrimal gland. The lacrimal gland can rarely be involved in relapse of acute lymphoblastic leukemia.

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