LEUKEMIC MENINGITIS IN B-CELL PROLYMPHOCYTIC LEUKEMIA - A CLINICAL, PATHOLOGICAL, AND ULTRASTRUCTURAL CASE-STUDY AND A REVIEW OF THE LITERATURE

Background. Leukemic meningitis is rare in B-chronic lymphocytic leuke mia (CLL) and B-prolymphocytic leukemia (PLL); a MEDLINE search for re ports published 1960 and after disclosed only nine prior reports. A pa tient with stable Rai Stage II CLL/PL developed mental status changes. Lumbar puncture revealed a lymphocytic pleocytosis with prolymphocyte s containing intracytoplasmic inclusions. Methods. The patient's cereb rospinal fluid lymphocyte population was analyzed by immunophenotyping and electron microscopy. Results. The studies revealed a clonal popul ation of B prolymphocytes, with typical immunophenotypic and ultrastru ctural characteristics. The patient was treated with intrathecal chemo therapy with eventual resolution of the cerebrospinal fluid pleocytosi s and return to his normal neurologic status. Prior studies also have revealed the efficacy of intrathecal chemotherapy. Conclusion. Leukemi c meningitis in CLL or PLL is responsive to treatment with intrathecal chemotherapy.