Chloroma of the Bladder: A Case Report of Leukemia Progression Presenting as Hematuria

Abstract

Myeloid sarcoma (MS) is a rare extramedullary manifestation of acute myelogenous leukemia (AML). The mass is composed of primitive myeloid cells that can occur in a variety of organs, most commonly the skin, lymph nodes, GI tract, bone, breast, and CNS. Involvement of the genitourinary tract is rare. Consensus on treatment of MS has not been established, but management typically involves systemic therapy, such as chemotherapy or allogeneic hematopoietic stem cell transplant as well as palliative local therapies such as radiation or surgery. Outcomes of MS using novel AML therapies, such as BCL-2 inhibitors or IDH inhibitors, remain undescribed. We describe a rare case of a 70-year-old man presenting with MS of the urinary bladder complicating known secondary AML (RUNX1 and IDH2 mutated). Prior to development of bladder MS, the patient had received decitabine, enasidenib, and venetoclax. Following diagnosis, he was treated with cytarabine and venetoclax. To our knowledge, this is the first case of bladder MS treated with a BCL-2 inhibitor.

Pediatric acute myeloid leukemia with breast chloromas

“…Myeloid sarcoma (MS; also known as granulocytic sarcoma or chloroma) is a solid extramedullary mass composed of primitive myeloid cells that disrupts the normal architecture of the tissue in which it is found. MS can present concurrently with acute myeloid leukemia (AML), precede the diagnosis of AML without evidence of leukemia in the blood or bone marrow or as a relapse in a patient with previously treated AML [ 1 , 2 , 3 ]. In children, the overall incidence of MS in association with AML varies, but has been reported to be as high as 24% [ 4 , 5 , 6 , 7 , 8 ].…”

“…In children, the overall incidence of MS in association with AML varies, but has been reported to be as high as 24% [ 4 , 5 , 6 , 7 , 8 ]. The most frequently involved anatomic sites are the skin, lymph node, testis, gastrointestinal tract, bone, and central nervous system (CNS) [ 1 , 2 , 3 , 9 , 10 ].…”

“…Breast MS is very rare and only accounts for approximately 8% of MS cases [ 1 , 10 ], with the majority of cases of breast MS diagnosed in adults [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. There have been three reported cases in adolescents with previously treated AML [ 22 , 23 , 24 ] and only one case of concurrent diagnosis of a breast MS at the time of AML diagnosis [ 25 ].…”

“…There is no consensus about the optimal treatment of MS. High‐dose chemotherapy, radiation, surgical resection, and allogeneic stem cell transplantation are all modalities that can be incorporated into the therapy of MS [ 1 , 27 ]. It appears appropriate to treat chloroma with AML‐type chemotherapy protocols even in the absence of systemic manifestations since AML is almost always present [ 28 ].…”