Diagnosis and treatment of a patient with isolated spinal granulocytic sarcoma: A case report

Extramedullary tumors remain an obstacle to curing more acute leukemia patients. Their incidence is unknown because the presence of occult tumors that contribute to relapse is not routinely sought as in other cancers. No standard approach exists for treating tumors at most sites, apparent clinical response is typically followed by further tumors, and achievement of lengthy remission is uncommon. Body scanning with 18 FDG PET/CT now provides a means to identify the extent of occult tumors that enables directed tumor eradication and a way to evaluate tumor response. To evaluate its potential benefits, analysis was undertaken of 124 published cases scanned after apparent tumors were diagnosed. Clinical and radiologic exams underestimated extent of disease in over half of 100 cases. Among 70 cases that reported scans after various treatments, 70% achieved negative scans. Half relapsed subsequently but disease-free survivals up to 6 years were documented. These reported cases add to our knowledge of extramedullary leukemia in showing that further tumors are more likely than marrow relapse, clinical and radiologic evaluation of response is inadequate, intensive chemotherapy alone generally does not prevent progression and is associated with significant mortality, and tumor-directed plus systemic therapies appears the most effective approach, particularly to AML tumors. This analysis suggests this technology could increase our ability to eradicate all foci of leukemia, and identify tumors responsible for refractory, residual, and relapsed disease.

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“…Among 57 AML cases, scans documented treatment resistance in 13 and only partial tumor response in 6 . Negative scans were achieved in 38.…”

Section: Resultsmentioning

confidence: 99%

¹⁸FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

Cunningham

Kohno

2016

American J Hematol

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“…Although non-AML MS may have a better survival rate in comparison with AML, the presence of MS is often associated with poor prognosis [ 2 , 7 , 26 ]. The mean survival time for patients with MS ranges between 2.5 and 22 months and is even worse for untreated patients [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and surgical treatment of primary isolated aggressive lumbar myeloid sarcoma: a rare case report and review of the literatures

Bai

Wang

et al. 2021

BMC Musculoskelet Disord

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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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“…MS is a rare tumor of immature granulocytic cells that appears concomitantly in 15–35% of cases with AML. It can affect any organ system, such as in the head, neck, bone and skin, and is less commonly found in the central nervous system (CNS) ( 8 ), particularly spinal MS associated with spinal cord compression ( 7 , 9 – 12 ). MS in the sacral region migrating towards the CNS is even more rare.…”

Section: Discussionmentioning

confidence: 99%

Sacral myeloid sarcoma involving multiple metastases to the brain: A case report

Lama

Lui

Xiao

et al. 2015

Experimental and Therapeutic Medicine

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The presentation of myeloid sarcoma (MS) in the bone is common; however, rarely does the tumor occur in the sacral spine, and in a normal patient with no history of acute myeloid leukemia. The present study describes the rare case of a previously healthy 24-year-old male patient, who presented with a history of six months of repeated pain in the right leg and hip and limping for less than a month, who was diagnosed with sacral MS. Despite receiving surgical management and chemotherapy promptly subsequent to the diagnosis and undergoing close observation following the treatment, the patient still developed metastases to multiple sites of the brain. Taking into account the similar presentation of this rare disease to other entities, the early and accurate diagnosis of MS is vital, and the condition should be considered as a threatening manifestation with the possibility of metastasis to other sites of the body.

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Diagnosis and treatment of a patient with isolated spinal granulocytic sarcoma: A case report

Cited by 8 publications

References 12 publications

¹⁸FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

¹⁸FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

Diagnosis and surgical treatment of primary isolated aggressive lumbar myeloid sarcoma: a rare case report and review of the literatures

Sacral myeloid sarcoma involving multiple metastases to the brain: A case report

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Diagnosis and treatment of a patient with isolated spinal granulocytic sarcoma: A case report

Cited by 8 publications

References 12 publications

18FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

18FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

Diagnosis and surgical treatment of primary isolated aggressive lumbar myeloid sarcoma: a rare case report and review of the literatures

Sacral myeloid sarcoma involving multiple metastases to the brain: A case report

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Product

Resources

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¹⁸FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

¹⁸FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases