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Fujikawa T, Kishimoto K, Inoue S, Nishimura A, Tojo R, Uemura S, Nakamura S, Saito A, Kozaki A, Ishida T, Mori T, Higashino M, Koyama J, Kawamura A, Hasegawa D, Kosaka Y. Epidural Spinal Cord Compression as the Presenting Manifestation of Acute Myeloid Leukemia: A Case Report and Literature Review. Intern Med 2023; 62:453-457. [PMID: 35793962 PMCID: PMC9970809 DOI: 10.2169/internalmedicine.9580-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We herein report a rare case of spinal cord compression due to epidural involvement of acute myeloid leukemia (AML). A 14-year-old boy presented with a 7-day history of back pain, paraplegia and hypoesthesia. Contrast-enhanced computed tomography revealed an epidural mass. Emergency laminectomy and resection of the mass were performed. Histopathologically, the resected mass was comparable to an extramedullary mass of AML. Chemotherapy was initiated, and complete remission was achieved. Neurological sequelae remained after the treatment. Based on the present and previous reports, spinal cord compression from epidural AML involvement may progress rapidly.
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Affiliation(s)
- Tomoko Fujikawa
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Kenji Kishimoto
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Shotaro Inoue
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Akihiro Nishimura
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Ryunosuke Tojo
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Suguru Uemura
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Sayaka Nakamura
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Atsuro Saito
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Aiko Kozaki
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Toshiaki Ishida
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Takeshi Mori
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | | | - Junji Koyama
- Department of Neurosurgery, Kobe Children's Hospital, Japan
| | | | | | - Yoshiyuki Kosaka
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
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Shah K, Panchal H, Patel A. Spine Myeloid Sarcoma: A Case Series with Review of Literature. South Asian J Cancer 2021; 10:251-254. [PMID: 34984205 PMCID: PMC8719965 DOI: 10.1055/s-0041-1742079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Myeloid sarcoma (MS) is a malignant extramedullary tumor consisting of immature cells of myeloid origin. It may precede, present concurrently or follow acute myeloid leukemia (AML) in de novo case or may also be present and might be the only manifestation of recurrent AML, myelodysplastic syndrome, or chronic myeloid leukemia. It frequently involves skin, orbit, bone, periosteum, lymph nodes, and gastrointestinal tract, soft tissue, central nervous system, and testis. Because of its different localization and symptoms, and the lack of diagnostic algorithm, MS is a real diagnostic challenge particularly in patients without initial bone marrow involvement. The correct diagnosis of MS is important for optimum therapy, which is often delayed because of a high misdiagnosis rate. We reported three cases of MS derived from spine presented with back pain, paraplegia, paraparesis, respectively, and reviewed the relevant literature.
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Affiliation(s)
- Kajal Shah
- Department of Medical Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujrat, India
| | - Harsha Panchal
- Medical Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujrat, India
| | - Apurva Patel
- Medical Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujrat, India
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Bai CR, Li X, Wang JS, Li JJ, Liu N, Fei Q, Li D, Yang Y. Diagnosis and surgical treatment of primary isolated aggressive lumbar myeloid sarcoma: a rare case report and review of the literatures. BMC Musculoskelet Disord 2021; 22:220. [PMID: 33627110 PMCID: PMC7905608 DOI: 10.1186/s12891-021-04066-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 02/09/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Myeloid sarcoma is a rare, extramedullary, solid tumor derived from immature myeloid cell precursors. It is most frequently accompanied by acute myelogenous leukemia, though infrequently found in non-acute myelogenous leukemia patients. The tumor may involve any part of the body, but the lumbar spine is seldom involved. The present case study aims to understand the diagnosis and surgical treatment of a rare primary isolated myeloid sarcoma of the lumbar spine causing aggressive spinal cord compression in a non-acute myelogenous leukemia patient. CASE PRESENTATION A 29-year-old man complained of an aggressive radiating pain to the lower extremities and moderate dysuria with a Visual Analogue Scale score that gradually increased from 3 to 8. Lumbar enhanced magnetic resonance imaging and computed tomography revealed a lumbar canal lesion at lumbar spine L2 to L4 with spinal cord compression. A whole body bone scan with fused single photon emission computed tomography/computed tomography demonstrated abnormal 99mTc-methylene diphosphonate accumulation in the L3 lamina and spinous process. No evidence of infection or hematology disease was observed in laboratory tests. Due to rapid progression of the symptoms and lack of a clear diagnosis, decompression surgery was performed immediately. During the operation, an approximately 6.0 × 2.5 × 1.2 cm monolithic, fusiform, soft mass in the epidural space and associated lesion tissues were completely resected. The radiating pain was relieved immediately and the dysuria disappeared within 1 week. Intraoperative pathological frozen section analysis revealed a hematopoietic malignant tumor and postoperative immunohistochemistry examination confirmed the diagnosis of myeloid sarcoma. CONCLUSIONS The primary isolated aggressive lumbar myeloid sarcoma is rarely seen, the specific symptoms and related medical history are unclear. Surgery and hematological treatment are effective for understanding and recognizing this rare tumor.
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Affiliation(s)
- Cheng-Rui Bai
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, 95 Yong An Rd, Beijing, 100050, China
| | - Xiang Li
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, 95 Yong An Rd, Beijing, 100050, China
| | - Jing-Shi Wang
- Department of Hematology, Beijing Friendship Hospital Affiliated of Capital Medical University, 95 Yong An Rd, Beijing, 100050, China
| | - Jin-Jun Li
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, 95 Yong An Rd, Beijing, 100050, China
| | - Ning Liu
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, 95 Yong An Rd, Beijing, 100050, China
| | - Qi Fei
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, 95 Yong An Rd, Beijing, 100050, China
| | - Dong Li
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, 95 Yong An Rd, Beijing, 100050, China
| | - Yong Yang
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, 95 Yong An Rd, Beijing, 100050, China.
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4
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Spinal promyelocytic sarcoma as the initial manifestation of acute promyelocytic leukaemia. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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5
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Villaseñor-Ledezma J, Amosa-Delgado M, Ruíz-Ginés JA, Álvarez-Salgado JA. Spinal promyelocytic sarcoma as the initial manifestation of acute promyelocytic leukaemia. Neurologia 2017; 33:558-560. [PMID: 28431836 DOI: 10.1016/j.nrl.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/29/2017] [Accepted: 02/04/2017] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - M Amosa-Delgado
- Servicio de Neurocirugía, Complejo Hospitalario de Toledo, Toledo, España
| | - J A Ruíz-Ginés
- Servicio de Neurocirugía, Complejo Hospitalario de Toledo, Toledo, España
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Liang Y, Gao J, Wu D, Li S, Chen H, Ding L, Tong J, Xu Y. Long-Term Remission following Autologous Hematopoietic Cell Transplantation in a Patient with Multiple Nonleukemic Myeloid Sarcoma and a Review of the Literature. Acta Haematol 2017; 137:117-122. [PMID: 28301836 DOI: 10.1159/000455998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/09/2017] [Indexed: 12/18/2022]
Abstract
Multiple nonleukemic myeloid sarcoma (MS) is a rare form of MS that is developed in multiple anatomic sites other than bone marrow at diagnosis, without a preceding myeloid neoplasm. The prevalence, prognosis, and optimal management of multiple nonleukemic MS have not been addressed. The role of allogenic or autologous hematopoietic cell transplantation (HCT) for nonleukemic MS is also less well defined. We present a case of MS characterized by systemic lymphadenopathies and multiple effusions, which presumably had a very poor prognosis. The patient was treated with acute myeloid leukemia-type induction chemotherapy and autologous peripheral blood stem cell transplantation, and, unexpectedly, she has remained disease free for more than 6 years. We also reviewed the literature on this rare disease, and found that multiple nonleukemic MS was associated with younger age and a worse prognosis when compared with the overall nonleukemic MS population. We suggest that autologous HCT represents a valid option for young patients with chemosensitive disease and should be performed at the status of minimal residual disease-negative complete remission.
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Affiliation(s)
- Yun Liang
- Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Orbito-ocular granulocytic sarcoma and posterior mediastinal sarcoma in a child. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2016. [DOI: 10.1016/j.phoj.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Lekovic GP, Schwartz MS, Go JL. Multifocal granulocytic sarcoma of the spine mimicking neurofibromatosis Type 2: case report. J Neurosurg Spine 2016; 25:523-527. [PMID: 27176110 DOI: 10.3171/2016.2.spine151044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In this report the authors report on a patient with a very indolent course of granulocytic sarcoma, characterized by steroid-induced remission of spinal and cranial tumors and recurrence over a period of several years. This 24-year-old man with history of leukemia presented with rapid-onset quadriparesis secondary to multiple extraaxial masses of the cervicothoracic spine, from C-5 to T-3, and lumbosacral spine, from L-5 to the coccyx. Although the imaging features were highly suggestive of neurofibromatosis Type 2, the patient's history and clinical course were consistent with granulocytic sarcoma; repeat imaging and, later, needle biopsy definitively established the diagnosis of granulocytic sarcoma. Laminectomy and surgical decompression of the spine were not required and, arguably, could have posed unnecessary risk to the patient. This case illustrates that the successful management of a patient presenting with profound neurological deficits due to intradural spinal cord tumors may sometimes be nonsurgical.
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Affiliation(s)
| | | | - John L Go
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California
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N’Dri Oka D, Bah AB, Tokpa AV, Derou L. Epidural spinal cord compression as initial clinical presentation of an acute myeloid leukaemia: case report and literature review. Chin Neurosurg J 2016. [DOI: 10.1186/s41016-015-0020-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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10
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Xiao RZ, Long ZJ, Xiong MJ, Wang WW, Lin DJ. Diagnosis and treatment of a patient with isolated spinal granulocytic sarcoma: A case report. Oncol Lett 2013; 5:1229-1232. [PMID: 23599768 PMCID: PMC3629162 DOI: 10.3892/ol.2013.1203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 01/29/2013] [Indexed: 11/06/2022] Open
Abstract
A previously healthy 34-year-old female presented with a 5-month history of progressive backache and weakness in the left fingers. Magnetic resonance imaging (MRI) showed soft tissue masses in the spinal canal distributed along the nerve course. The patient's baseline laboratory data were normal. Surgical intervention was performed and histological examination identified isolated spinal granulocytic sarcoma (GS). A bone marrow biopsy also presented normal findings. However, the patient developed numbness and pain in the right lower limb two months later. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) showed FDG uptake in the left trapezius muscle, cervix uteri, iliac bone, lymphadenectasis of the pelvic wall and left axillary fossa. Cerebrospinal fluid (CSF) examination allowed a diagnosis of central nervous system leukemia (CNSL). The patient underwent chemotherapy and intrathecal injection, resulting in the elimination of the residual lesion. Correct diagnosis and adequate treatment are essential to achieve optimal results in patients with isolated spinal GS.
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Affiliation(s)
- Ruo-Zhi Xiao
- Department of Hematology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China ; ; Sun Yat-sen Institute of Hematology, Sun Yat-sen University, Guangzhou, P.R. China
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Lee JM, Song HN, Kang Y, Kim H, Min JH, Suh YS, Ahn JH, Lee SH, Jo YW, Cheon YH, Kim MJ, Lee GW. Isolated mediastinal myeloid sarcoma successfully treated with chemoradiotherapy followed by unrelated allogeneic stem cell transplantation. Intern Med 2011; 50:3003-7. [PMID: 22185993 DOI: 10.2169/internalmedicine.50.6125] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 22-year-old man was diagnosed with isolated mediastinal myeloid sarcoma which radiologically mimicked primary mediastinal lymphoma. Despite administration of standard remission induction chemotherapy with daunorubicin and cytarabine, and three cycles of intensive high-dose cytarabine-based consolidation, chemo-resistant hypermetabolic lesions were persistently detected in the highest mediastinum and in the supraclavicular area. However, complete remission and long-term survival were achieved by curative radiotherapy followed by unrelated allogeneic stem cell transplantation.
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Affiliation(s)
- Jeong Mi Lee
- Division of Oncology and Hematology Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Korea
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