Chloroma (granulocytic sarcoma) without evidence of leukemia: facilitated light microscopic diagnosis

Abstract

Localized tumors composed of immature cells of the myelogenous series have been recognized for many years as an uncommon manifestation of granulocytic leukemia. The histologic diagnosis of chloroma (granulocytic sarcoma) may be extremely difficult when the myeloblastic cells are poorly differentiated and the tumor lacks the characteristic green color. The diagnostic difficulty may be further compounded when the granulocytic sarcoma develops before there is peripheral blood or bone marrow evidence of leukemia. Previous criteria for the diagnosis of chloroma have been ambiguous because of the capricious nature of the hydroperoxidase activity and the lack of definitive histochemical criteria. In this case, a combination of Sudan black B and myeloperoxidase histochemical staining and ultrastructural evaluation was applied. The light microscopic histochemical studies suggested the presence of Phi bodies and rods both in the formalin-fixed tumor and in the cells derived from the subsequent pleural effusion; this was confirmed by electron microscopy, which demonstrated the peridicity of the crystalline rod substructure. These observations show that light microscopic histochemical studies can facilitate the diagnosis of granulocytic sarcoma or chloroma in the absence of peripheral blood or bone marrow manifestations of leukemia.

Extramedullary leukemia in children presenting with proptosis

“…Auer rods may be absent in routine Romanowsky stained specimens. Mc Carty et al have reported that sudanophilic (Sudan black B) and myeloperoxidase staining can demonstrate fusiform and spindle shaped particles, phi bodies and rods on light microscopy in these patients [ 15 ]. The diagnosis is also dependant on the amount of granulocytic differentiation.…”

Nonleukemic granulocytic sarcoma of the heart: A report of a fatal case

“…It is well known that the diagnosis of granulocytic sarcoma can be difficult, especially in patients with no known hematologic abnormality [3,5], Cytochemical stains for enzymes in primary granules of myeloid precursor cells, notably naphthol AS-D chloroacetate esterase, contribute substantially to the successful diagnosis of myeloid leukemia in solid tissues, because this enzyme withstands the rigors of routine processing [2,3,5,6,30]. Additional cytochemical stains can be used to classify the myeloid leukemia only if air-dried imprint smears are available.…”

Vyelosarcoma without acute leukaemia: immunohistochemical and clinico‐pathologic characterization of eight cases

“…Myelosarcoma (granulocytic sarcoma, chloroma) is a rare extramedullary tumour of myeloid precursor cells, which sometimes appears in patients with acute myeloblastic leukaemia (AML) (Mason, Demaree & Margolis 1973, Seo, Hull & Pak 1977, Krause 1979, McCarty et al 1980, Abeler et al, 1983, Stork et al 1984, Muller et al 1986. A myelosarcoma can, however, also develop without bone marrow involvement and a leukaemic blood picture (Simon 1912, Brannan 1926, Comings, Fayen & Carter 1965, Moores 1965, Harford 1968, Hurwitz, Sutherland & Walker 1970, Wiernick & Serpick 1970, Cihak & Hamada 1974.…”