Clinicopathological and genetic study in cerebral aspergillosis and leukemic infitration in ALL

An 11-year-old neutropenic female child with acute lymphoblastic leukemia (ALL) developed a large right frontal mass a month following the induction of chemotherapy. A well encapsulated mass on surgical excision turned out to be aspergilloma with metastatic infiltration in frontal lobe. A genetic defect in form of microsatellite instability was also demonstrated in frontal mass. A possibility of fungal granuloma in a neutropenic child treated for ALL (on chemotherapy) remained strong on clinico-radiological evaluation. However, the cranial involvement in ALL also amounts to be 50 to 80% in untreated children. The child under discussion had a rare manifestation of both leukemic infiltration and fungal granuloma formation. Though the microsatellite instability was demonstrated in the mass, but further genetic studies would be required to establish the role of genetic defect in evolution of such cerebral masses/leukemic deposits. (J Pediatr Neurol 2004; 2(1): 39-43).