Granulocytic sarcoma (chloroma) of the sacrum: initial manifestation of leukemia

Abstract

We present an unusual case of a granulocytic sarcoma (chloroma) of the sacrum which predated the initial clinical manifestation of acute myelogenous leukemia. Although granulocytic sarcomas occur in up to 9.1% of cases of acute myelogenous leukemia they usually present concurrently with the leukemic presentation. Although granulocytic sarcomas can involve several different organ systems, bone is the most common site.

Granulocytic Sarcoma of the Spine: MRI and Clinical Review

“…As described by Novick et al [7], granulocytic sarcoma of any organ is associated with 3.1-9.1% of cases of acute myeloid leukemia. At our institution, the prevalence of granulocytic sarcoma in any organ was 2.9% among all patients with acute and chronic myeloid leukemia.…”

Diagnosis of Granulocytic Sarcoma by Fine-Needle Aspiration Cytology

“…Since the first description of GS in 1811 by Burns several reports about GS or so-called chloromas have been published [10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22]. The term ‘chloroma’ is used to describe the green color created by the intracellular enzyme myeloperoxidase.…”

“…In contrast to extramedullary hematopoiesis, cells of the megakaryocytic and erythroid lines are lacking in GS. However, GS, often referred to as chloroma or extramedullary myeloblastoma, is rare [10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22]. GS are solid tumors composed of immature cells of the granulocytic lineage [23]and occur during either leukemic relapse or remission or may be the only presentation of the disease.…”

Unusual case of paraplegia

“…[6] Surgery is generally preferred for cases of acute spinal cord compression in cases with out systemic evidence of leukemia. [78] Early diagnosis followed by appropriate combined chemotherapy and radiation may obviate surgical intervention and eventually prevent leukemic transformation. Chloroma, though rare, should be considered in the differential diagnosis of any epidural mass lesion and peripheral smear examination and bone marrow study, if necessary, should be done in all cases.…”