101
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Abstract
Primary myelosarcomas, also called leukemia cutis, granulocytic sarcomas or chloromas, are rare extramedullary manifestations of acute myeloid leukemia (AML) which precede bone marrow involvement. Skin infiltration was the most frequent localization associated with a myelomonocytic differentiation. Although first remission was achieved by most children, risk of relapse seemed to be increased. This might be caused by the specific biology of myelosarcomas, but also may be the result of delayed or reduced treatment. During the AML-BFM-studies 87/93/98 (11/1987-7/2000) 37 children with isolated myelosarcomas were diagnosed. Eighteen of the 37 patients survived with a 5-year overall survival estimation of 0.54+/-0.09 compared to 0.59+/-0.02; p(log rank) = 0.94. However, reduced or delayed treatment in 17 children led to an increased relapse rate of 71% compared to 35% in children treated soon after diagnosis. The 5-year overall survival in these patients was 0.41+/-0.11. According to our experience and review of the literature, an early diagnostic workup is needed in children with unusual skin lesions or tumors, considering myelosarcoma as primary manifestation of AML. Intensive AML-specific chemotherapy is generally recommended soon after diagnosis.
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Affiliation(s)
- D Reinhardt
- Pediatric Hematology/Oncology, University Muenster, Germany.
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102
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Guermazi A, Feger C, Rousselot P, Merad M, Benchaib N, Bourrier P, Mariette X, Frija J, de Kerviler E. Granulocytic sarcoma (chloroma): imaging findings in adults and children. AJR Am J Roentgenol 2002; 178:319-25. [PMID: 11804886 DOI: 10.2214/ajr.178.2.1780319] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- A Guermazi
- Department of Radiology, Saint-Louis Hospital, AP-HP, 1 ave Claude Vellefaux, 75010 Paris, France
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103
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Ohta Y, Shichinohe H, Nagashima K. Spinal cord compression due to extramedullary hematopoiesis associated with polycythemia vera--case report. Neurol Med Chir (Tokyo) 2002; 42:40-3. [PMID: 11902077 DOI: 10.2176/nmc.42.40] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 69-year-old woman with a 14-year history of polycythemia vera suffered progressive paraparesis due to epidural involvement of hematopoietic tissue. Magnetic resonance (MR) imaging demonstrated extensive epidural masses. Decompressive surgery and radiotherapy were performed and she made an almost complete clinical recovery. Serial MR imaging showed no regrowth of the other epidural masses. Extramedullary hematopoiesis occurs in patients with various hematologic disorders involving a chronic increase in the production of red blood cells, and is often associated with thalassemia, but is less common with polycythemia vera. The most frequent sites are the spleen, liver, and kidney. Extramedullary hematopoietic tissue occurring within the spinal canal and causing cord compression is very rare. Total surgical excision is not usually feasible because of the diffuse nature of extramedullary hematopoietic tissue and the possibility of recurrence, but acute neurological deterioration does require emergency surgery. Extramedullary hematopoiesis is radiosensitive and displays a rapid response to low dosages, so radiation therapy is recommended for residual tumors. Considering the possibility of central nervous system extramedullary hematopoiesis in patients with polycythemia vera, an early diagnosis is necessary for a favorable prognosis.
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Affiliation(s)
- Yuzuru Ohta
- Department of Neurosurgery, Yakumo General Hospital, Hokkaido.
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104
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Psiachou-Leonard E, Paterakis G, Stefanaki K, Mikraki-Christou V, Haidas S. Cerebellar granulocytic sarcoma in an infant with CD56+ acute monoblastic leukemia. Leuk Res 2001; 25:1019-21. [PMID: 11597737 DOI: 10.1016/s0145-2126(01)00068-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Granulocytic sarcoma (GS) is a form of extramedullary leukaemia (EML). The presence of the neural cell adhesion molecule (NCAM) on the surface of the blasts, which is recognized by the CD56 monoclonal antibody, enhances their propensity for tissue penetration. GS within the central nervous system (CNS), in particular within the cerebellum, is extremely uncommon. We review the literature and describe an infant with isolated cerebellar GS relapse, which antedated a CD56+ acute monoblastic leukaemia bone marrow (BM) relapse.
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Affiliation(s)
- E Psiachou-Leonard
- Department of Haematology-Oncology, Aghia Sophia Children's Hospital, Thivon & Papadiamanto-poulou, 11527, Athens, Greece.
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105
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Ooi GC, Chim CS, Khong PL, Au WY, Lie AK, Tsang KW, Kwong YL. Radiologic manifestations of granulocytic sarcoma in adult leukemia. AJR Am J Roentgenol 2001; 176:1427-31. [PMID: 11373207 DOI: 10.2214/ajr.176.6.1761427] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study was conducted to summarize the clinical and radiologic presentations including pertinent imaging features of granulocytic sarcoma, a rare extramedullary tumor of acute myeloid leukemia, in 11 adult patients. CONCLUSION In patients in our study, the clinical and radiologic manifestations of granulocytic sarcoma were variable and occurred most commonly as disease progression in acute myeloid leukemia (73% of the patients). Granulocytic sarcoma lesions were multiple soft-tissue masses with variable enhancement, recurring in nearly 50% of patients at different sites and points of time during the course of the disease. Lesions in the central nervous system, subcutaneous tissues, and genitourinary system accounted for nearly 52% of all lesions. In general, granulocytic sarcoma masses were isodense to muscle on CT scans, and isointense and hyperintense (mild to moderate) on T1- and T2-weighted MR images, respectively. The presence of peripheral rim enhancement with hypodense or hypointense centers on T1-weighted images may, however, mimic an abscess.
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Affiliation(s)
- G C Ooi
- Department of Diagnostic Radiology, The University of Hong Kong, Queen Mary Hospital, Rm. 405, Block K, Pokfulam Rd., Pokfulam, Hong Kong
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106
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Buckland ME, Scolyer RA, Donellan MB, Brew S, McGee-Collett M, Harper CG. Spinal chloroma presenting with triplegia in an aleukaemic patient. Pathology 2001. [DOI: 10.1080/00313020126312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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107
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Schoeggl A, Reddy M, Matula C, Chott A, Koos W. Myelosarcoma of the cavernous sinus in a nonleukemic patient--case report. Neurol Med Chir (Tokyo) 2000; 40:173-5. [PMID: 10842489 DOI: 10.2176/nmc.40.173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Myelosarcomas are rare, solid extramedullary tumors composed of granulocyte precursors in most cases associated with leukemia. A 38-year-old nonleukemic female presented with a myelosarcoma of the cavernous sinus. After surgical removal of the cavernous sinus tumor she was treated by chemotherapy and whole brain radiation therapy. Despite this aggressive therapy, she died 4 months after surgical intervention.
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Affiliation(s)
- A Schoeggl
- Department of Neurosurgery, University of Vienna, Austria
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108
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Abstract
A five year old boy presented with progressively increasing proptosis of the left eye. CT scan showed bilateral extra-conal homogeneously enhancing soft tissue masses, larger on the left side. A possibility of granulocytic sarcoma of the orbit was considered. Diagnosis was confirmed by peripheral smear and bone marrow aspiration. Patient responded to chemotherapy.
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Affiliation(s)
- B N Lakhkar
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka
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109
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110
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Affiliation(s)
- Homan Mostafavi
- Division of Neurosurgery, University of Iowa, Iowa City, Iowa
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111
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Yamamoto K, Hamaguchi H, Nagata K, Hara M, Tone O, Tomita H, Ito U. Isolated recurrence of granulocytic sarcoma of the brain: successful treatment with surgical resection, intrathecal injection, irradiation and prophylactic systemic chemotherapy. Jpn J Clin Oncol 1999; 29:214-8. [PMID: 10340046 DOI: 10.1093/jjco/29.4.214] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We describe a 40-year-old male who developed an isolated recurrence of granulocytic sarcoma (GS) of the brain 2 years following successful treatment of acute myeloblastic leukemia (AML; M2). Computed tomography (CT) scans and magnetic resonance (MR) images demonstrated a homogeneously enhanced tumor mass in the left temporal lobe and massive peritumoral edema. There was no evidence of relapse in the bone marrow. The patient underwent an emergency surgical resection of the tumor. Five courses of injection with cytarabine and prednisolone through an Ommaya reservoir and whole brain irradiation (total 40 Gy) were performed. Furthermore, prophylactic systemic chemotherapy with cytarabine and etoposide was added. He has been in complete remission for 21 months. Our results, together with other reported cases, indicate that a favorable outcome could be obtained by intensive and combined treatment for an isolated recurrence of GS of the brain if the bone marrow remained in complete remission.
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Affiliation(s)
- K Yamamoto
- Department of Hematology, Musashino Red Cross Hospital, Tokyo, Japan
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112
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Abstract
The clinical evaluation can often suggest the level of a visual pathway lesion; however, several different types of pathological processes, can produce the same visual field deficit. Imaging evaluation with CT and/or MRI can help to localize and characterize these diverse types of pathology. A radiological differential diagnosis can then be suggested which, in turn, facilitates patient management. In certain instances, the specific cause of a visual field defect can be identified with the radiological evaluation.
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Affiliation(s)
- O Ortiz
- Department of Radiology, Winthrop-University Hospital, Mineola, NY 11501, USA
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113
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Abstract
AIM Orbital granulocytic sarcoma is a localised tumour composed of cells of myeloid origin. Histological diagnosis can be difficult in patients with poorly differentiated orbital tumours and no evidence of systemic leukaemia. The naphthol AS-D chloracetate esterase (Leder stain) and immunohistochemical stains for lysozyme and MAC387 were used to determine the staining characteristics of these tumours. A case series of seven patients with orbital granulocytic sarcoma is presented. METHODS Seven patients with orbital granulocytic sarcoma were studied. Haematoxylin and eosin, Leder, and lysozyme stained sections were available in seven cases. Unstained formalin fixed paraffin embedded sections of seven cases were available for immunohistochemical evaluation using the avidin-biotin-complex technique for MAC387. RESULTS The mean age of presentation of the orbital tumour was 8.8 years. Four patients presented with an orbital tumour before any systemic manifestations of leukaemia. In two cases the diagnosis of the orbital tumour and systemic leukaemia was made simultaneously. There was one case of established systemic myeloid leukaemia in remission with the subsequent development of orbital granulocytic sarcoma. Six of seven cases (86%) were positive for the Leder stain. Five of seven cases (71%) showed positive immunoreactivity with lysozyme. The immunohistochemical stain for MAC387 was positive in all seven cases (100%) including one case that was negative for both lysozyme and Leder stains. CONCLUSIONS Orbital granulocytic sarcoma is a tumour that affects children and can present with rapidly progressive proptosis. This tumour may develop before, during, or after the occurrence of systemic leukaemia. The combination of Leder and lysozyme stains is useful in the diagnosis of orbital granulocytic sarcoma. MAC387 may be a more reliable marker for orbital granulocytic sarcoma.
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Affiliation(s)
- F A Stockl
- Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
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114
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Parker BR. LEUKEMIA AND LYMPHOMA IN CHILDHOOD. Radiol Clin North Am 1997. [DOI: 10.1016/s0033-8389(22)00736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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115
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116
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117
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Sajjad Z, Haq N, Kandula V. Case report: granulocytic sarcoma (GS) presenting as acute cord compression in a previously undiagnosed patient. Clin Radiol 1997; 52:69-71. [PMID: 9022586 DOI: 10.1016/s0009-9260(97)80311-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Z Sajjad
- North Staffordshire Hospitals, Stoke-On-Trent, UK
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118
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Karnak I, Ciftci AO, Senocak ME, Göğüş S. Granulocytic sarcoma of the scapula: an unusual presentation of acute myeloblastic leukemia. J Pediatr Surg 1997; 32:121-2. [PMID: 9021590 DOI: 10.1016/s0022-3468(97)90115-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The unusual presentation of acute myeloblastic leukemia as a scapular granulocytic sarcoma in an infant without systemic manifestations is reported for the first time. Granulocytic sarcoma as a presentation of leukemia should be considered in the differential diagnosis of scapular masses during childhood. Surgery is limited to obtain sufficient tissue for histopathologic diagnosis.
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MESH Headings
- Biopsy
- Bone Neoplasms/diagnosis
- Bone Neoplasms/pathology
- Bone Neoplasms/surgery
- Diagnosis, Differential
- Follow-Up Studies
- Humans
- Infant
- Leukemia, Myeloid/diagnosis
- Leukemia, Myeloid/pathology
- Leukemia, Myeloid/surgery
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/surgery
- Male
- Scapula/pathology
- Scapula/surgery
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Affiliation(s)
- I Karnak
- Department of Pediatric Surgery, Hacettepe University Medical Faculty, Ankara, Turkey
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119
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Tsetis D, Bhattacharya J, Cavenagh J, Thakkar CH. Case report: CT and MRI demonstration of hypothalamic and infundibular relapse in childhood acute lymphoblastic leukaemia. Br J Radiol 1996; 69:269-71. [PMID: 8800873 DOI: 10.1259/0007-1285-69-819-269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The central nervous system is affected in up to 10% of patients with acute lymphoblastic leukaemia, usually in the form of leptomeningeal infiltration. Parenchymal spread is rare. We report a case in which CT and MRI demonstrated hypothalamic and infundibular relapse.
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Affiliation(s)
- D Tsetis
- Department of Radiology, Royal London Hospital, UK
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120
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Bulas RB, Laine FJ, Das Narla L. Bilateral orbital granulocytic sarcoma (chloroma) preceding the blast phase of acute myelogenous leukemia: CT findings. Pediatr Radiol 1995; 25:488-9. [PMID: 7491213 DOI: 10.1007/bf02019079] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Granulocytic sarcoma (chloroma) is an uncommon malignant neoplasm associated with myelogenous leukemias. Its appearance may precede the clinical manifestations of the acute leukemic phase by months to years. We report the CT findings of a case of bilateral intraorbital granulocytic sarcoma which preceded the blast phase of acute myelogenous leukemia (AML) and led to its diagnosis. An awareness of granulocytic sarcoma and its CT appearance may expedite the diagnosis of AML or prompt close monitoring of those cases of granulocytic sarcoma antedating the appearance of AML.
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Affiliation(s)
- R B Bulas
- Department of Radiology, University of Cincinnati, Ohio, USA
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