Bilateral orbital myeloid sarcoma preceding acute myeloid leukemia in an adult: a case report and review of the literature

Orbital Involvement in Acute Adult Leukemias: Case Series and Review of Literature

Orbital involvement in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) is well-described in children but is uncommon in adults. This series reports 2 adult patients with orbital leukemic involvement and summarizes the existing literature. A 37-year-old male with recently diagnosed AML underwent induction therapy and subsequently developed a tan-pink colored sub-conjunctival lesion in the left eye. Incisional biopsy confirmed AML. A 35-year-old male with history of ALL presented with left-sided orbital mass. Fine needle aspiration biopsy confirmed ALL. Literature review of adult-onset orbital leukemia yielded 29 cases of AML and 3 cases of ALL. Orbital involvement of acute adult-onset leukemia tends to be unilateral, presents in the extraconal space and can occur at any point during systemic leukemic disease. Chemotherapy is the mainstay of treatment, often in combination with radiation and/or hematopoietic stem cell transplant.

[Bilateral orbital myeloid sarcoma: the circumstance of the discovery of acute myeloid leukemia (a case report)]

Le sarcome myéloïde est une forme rare parmi les manifestations oculaires au cours de la leucémie aiguë myéloïde. Le caractère bilatéral et précédant tout signe clinique de la leucémie est d´autant plus rare. Nous rapportons le cas d´un patient de 16 mois consultant pour une exophtalmie aigue bilatérale d´allure inflammatoire, rapidement progressive, avec une kératite d´exposition. La tomodensitométrie oculo-cérébrale montrait une infiltration d´allure tissulaire bilatérale occupant la cavité orbitaire. Le bilan sanguin montrait un syndrome inflammatoire biologique, une bicytopénie et une blastose circulante à 83%. La présence de blastes circulant a motivé la réalisation d´un myélogramme qui a permis d´établir le diagnostic de leucémie aiguë myéloïde 4. Devant une exophtalmie, même bilatérale, il faut penser au sarcome myéloïde et étudier minutieusement les résultats de l´hémogramme.

Acute unilateral proptosis in childhood: suspect myeloid sarcoma

As the first and only presenting feature of acute myeloid leukemia (AML), unilateral proptosis in children is uncommon. We report the cases of two girls who had no systemic clinical manifestations of AML. Orbital imaging showed space-occupying infiltrating lesions without surrounding bone erosion. Incisional biopsy and immunohistochemistry were diagnostic for myeloid sarcoma. Systemic workup and bone marrow examination showed features of AML. Systemic chemotherapy was administered to both children, who responded well to the treatment. Myeloid sarcoma should be kept in the differentials of the children presenting with isolated proptosis. Immunohistochemistry may provide an accurate diagnosis and early treatment may lead to a prompt recovery with a good prognosis.

Isolated myeloid sarcoma as the first manifestation of acute myeloid leukemia: a case study

This case report brings awareness to the diverse extramedullary manifestations of isolated myeloid sarcoma, as well as the importance and difficulties that are associated with establishing a rapid diagnosis and initiating treatment.