Fatal intramedular tumor of the cervical spinal cord during remission of acute lymphoblastic leukemia.

An adult male with acute lymphoblastic leukemia including meningeal leukemia was in complete clinical remission for more than one year after initiation of chemotherapy including intrathecally methotrexate and irradiation towards the brain and spinal cord. Signs of central nervous system involvement developed with symptoms primarily from the lower limbs and the urinary bladder but the cerebrospinal fluid was consistently without lymphoblasts. By magnetic resonance imaging an intramedular tumor of the cervical spinal cord was demonstrated and malignant cells compatible with lymphoblasts were obtained from the tumor at laminectomy. Despite immediate irradiation towards the tumor the patient died within two weeks.