Cutaneous granulocytic sarcoma in myelodysplastic syndrome

Abstract

Granulocytic sarcoma is an extramedullary tumor of immature cells of granulocytic series, generally associated to acute myelogenous leukemia. The skin is one of the most commonly affected sites. Granulocytic sarcoma can complicate myelodysplastic syndromes and is considered a sign of poor prognosis. They are often misdiagnosed with non-Hodgkin lymphoma of the lymphoblastic type, Burkitt lymphoma and large cell lymphoma. In children, the differential diagnoses also include small, round cell tumors. It is important to diagnose these lesions early because they can precede peripheral blood and bone marrow transformation to acute myelogenous leukemia. We report a case of an elderly patient with myelodysplastic syndrome who developed multiple cutaneous granulocytic sarcoma lesions and discuss prognostic and treatment implications.

Recurrence of a t(8;21)-Positive Acute Myeloid Leukemia in the Form of a Granulocytic Sarcoma Involving Cranial Bones: A Diagnostic and Therapeutic Challenge

“…Most often, GS happens to anticipate the full AML involvement of bone marrow and/or peripheral blood or can be the initial manifestation of relapse of previously treated AML. On rare occasions, it can occur in the context of a blastic transformation of chronic myeloproliferative disorders or myelodysplastic syndromes [17]. In a recent analysis of 92 adults with de novo GS, 35% and 38% had a concomitant or previous history of AML, respectively [18].…”

A Case of Multiple Cutaneous Granulocytic Sarcomas in an Elderly Patient

“…The role of systemic chemotherapy is well established in leukemic patients. In patients without concurrent leukemia, aggressive combination chemotherapy prolongs life and may prevent the onset of leukemia [7]. In our case, the patient did not accept further treatment, therefore treatment planning could not be made.…”

“…A high incidence of progression to AML and/or marrow failure has been also reported in patients with MDS [8,10]. The occurrence of cutaneous GS in the context of MDS is rare and often a sign of poor prognosis [7]. GS is an extramedullary solid tumor mass composed of immature myeloid cells.…”

“…While GS is reported in 0.7-9% of patients with AML or chronic myelogenous leukemia [5], extramedullary leukemia involving the skin has been described in approximately 2-3% of AML cases [6]. Cutaneous lesions usually occur on the trunk, scalp and extremities [7]. GS occurs more commonly in children and young adults [2].…”

Multiple Granulocytic Sarcomas in a Patient with Longstanding Complete Remission of Acute Myelogenous Leukemia

“…Granulocytic sarcoma clinically manifests as a solid nodular mass, which commonly affects the bone, periosteum, lymph node and skin. Granulocytic sarcomas usually occur during the course of AML and antecede blastic cirisis in myeloproliferative disease or myelodysplastic syndromes1-5. However, the tumor can also develop in patients who have either no prior history of hematological disease or have shown complete remission from acute myelogenous leukemia6-11.…”