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.

No abstract

Graft-versus-host disease (GVHD) after liver transplantation is uncommon and the outcome is often fatal. A firm diagnosis of GVHD is difficult because the clinical triad of skin rash, marrow failure and diarrhoea can be indistinguishable from drug reaction or viral infection, and the presence of donor lymphocyte chimerism is not specific. We describe a case of severe GVHD in a female patient after liver transplantation from a male cadaveric donor. Skin biopsy showed characteristic changes of GVHD. Using Y-chromosome-specific fluorescent in situ hybridisation (FISH), male lymphocytes were demonstrated in 10% of marrow cells and in 90% of lymphocytes infiltrating the dermal epidermal junction. Donor human leucocyte antigens (HLAs) were detected in the peripheral blood, buccal mucosa and skin by polymerase chain reaction. The GVHD subsided with steroid and anti-thymocyte globulin, but recurred on tailing off of treatment. Despite maximum supportive therapy, including random donor leucocyte infusion, and marrow infusion from a HLA-identical sibling, the patient succumbed to sepsis. Our results showed the utility of combining morphological features with molecular techniques using FISH and HLA typing in confirming a diagnosis of GVHD.

Summary:in the marrow. The possible relevance of these findings to the treatment of GS post-BMT is also discussed. Isolated extramedullary relapses as granulocytic sarcomas (GS) following allogeneic bone marrow transplantation (BMT) for acute myeloid leukemia (AML)Materials and methods are rare events. We describe three such patients who presented with a unique pattern of GS relapse postCase reports BMT. The clinical features included repeated relapses in multiple sites, absence of marrow involvement, andCase 1: A 29-year-old man with AML M1 relapsed 5 years prolonged survival. Fluorescence in situ hybridization after first complete remission (CR), and entered a second (FISH) demonstrated persistence of donor hematopo-CR with salvage chemotherapy. He received an allogeneic iesis despite disseminated GS. The findings indicatedBMT from an HLA-identical sister, with Bu-CY-TBI that a graft-versus-leukemia (GVL) effect might operate (busulphan 7 mg/kg, cyclophosphamide 50 mg/kg, total more strongly in the marrow than in peripheral sites.body irradiation 12 Gy) as conditioning, and cyclosporin A Finally, our observations suggest that isolated GS (CsA) 1.2 mg/kg/day from day −1 and methotrexate (MTX) relapses after BMT might be compatible with long sur-(15 mg/m 2 on day 1, 10 mg/m 2 on days 3, 6 and 11) as vivals, and that in patients with marrow hematopoiesis graft-versus-host disease (GVHD) prophylaxis. He of donor origin, augmentation of the GVL effect might engrafted with grade I acute GVHD. Moderate chronic be of use.GVHD involving the liver and skin developed later, and Keywords: granulocytic sarcoma; acute myeloid leukewas controlled by steroids and CsA. Fourteen months postmia; bone marrow transplantation; extramedullary disease BMT he presented with jaundice, a right breast mass, right tonsillar enlargement and hearing deficit on the right side. A biopsy of the nasopharynx showed granulocytic sarcoma Allogeneic bone marrow transplantation (BMT) is a cura-(GS). The bone marrow was normal. A computerized tomotive treatment for some patients with acute myeloid leukegraphic (CT) scan showed a tumor at the portal area. Radiomia (AML), with a 5-year disease-free survival varying therapy (RT) was given to the tonsil, breast, nasopharynx from 30 to 50%.1 The curative effect is attributed partly to and abdomen, with resolution of the masses. Subsequently, the conditioning chemotherapy and radiotherapy, and partly recurrent lesions developed over the penile shaft and bilatto a putative graft-versus-leukemia (GVL) effect exerted eral thighs, and were controlled by intermittent cytosine by the transplanted donor immunocompetent cells.2 This is arabinoside (Ara-C, 100 mg/m 2 /day × 5) and thioguanine reflected by the low rates of relapse in allogeneic BMT as (TG, 100 mg/m 2 /day × 5). At 30 months post-BMT, biopsycompared with syngeneic and T cell-depleted BMT, where proven GS recurred in the right temporoparietal region, as the GVL effect may be absent or weakened. The exact well as the left thigh and right breast. At thi...