We report the case of a 24-year-old woman with a history of
radiotherapy for a cerebellar
medulloblastoma 2 years prior to detection of a
lymph node metastasis of the former disease and a
pancytopenia in the peripheral blood. On bone marrow (BM) examination promyelocyte
leukemia vs. a reactive 'promyelocyte arrest' were discussed. The translocation t(15;17) was found in some nuclei and there was a
PML-RARalpha gene rearrangement detectable by RT-PCR. Furthermore, there was BM infiltration by the primary
cancer. All these results led to the diagnosis of a relapse of the
medulloblastoma and of a beginning promyelocyte
leukemia. As the patient was pregnant, she had to be parted with the baby to facilitate intensive
chemotherapy. She did not respond to a therapeutic regimen specific for promyelocytic
leukemia but achieved complete remission of the
medulloblastoma as well as the
leukemia after the administration of
polychemotherapy specific for
medulloblastoma. One year later, she suffered from a relapse of her
leukemia. Now nearly all cells showed a t(15;17) aberration. Immunophenotype analyses showed a shift to a more undifferentiated blast phenotype that was, however, still
HLA-DR negative. The patient again received
chemotherapy for
leukemia but developed a
sepsis 3 months later and died of
pancytopenia ensuing her
leukemia. There was no clinical evidence for recurrence of the
medulloblastoma.