Granulocytic sarcoma of the head and neck: A case report

ObjectivesTo evaluate characteristic computed tomography (CT) and magnetic resonance (MR) imaging findings of granulocytic sarcomas of the head and neck.MethodsThe CT (n=11) and MR (n=1) images obtained from 11 patients (7 males and 4 females; mean age, 23.5 yr; age range, 1 to 69 yr) with histologically-proven granulocytic sarcomas of the head and neck were retrospectively reviewed. Histological confirmation was done by bone marrow biopsy in 9 patients, and/or local biopsy in 4 patients. The imaging findings were analyzed with particular attention to location, size, shape, margin, bone destruction, internal architecture, pattern and degree of enhancement, and multiplicity of the lesions.ResultsThe masses were most commonly located in the orbital cavity (n=8); other locations included lymph nodes (n=5) and palatine/pharyngeal/lingual tonsils (n=3). The mass sizes varied from a mean diameter of 1.3 to 5.8 cm (average, 2.6 cm). Multiple lesions were found in 6 patients. The shapes of the tumors were ovoid in 12 patients and irregular in 4 patients. Most lesions had poorly-defined margins (13/16) and invaded adjacent bony structures (5/16). On the pre-contrast CT images, the masses were iso- (5/8) or low-density (3/8) in comparison with muscle. The MRI, which was obtained in one patient in this study, showed that the mass was iso-signal intensity on T1-weighted images and iso-signal intensity on T2-weighted images compared to the gray matter of the brain. On the post-contrast CT images, there was homogenesous (n=12) or heterogeneous (n=4) enhancement, with mild (n=10), moderate (n=4), and marked (n=2) enhancement in the solid portions of the lesions.ConclusionAlthough rare, granulocytic sarcomas arise in various locations in the head and neck area (most commonly in the orbit) in the form of well-demarcated, and mildly- and homogenously-enhancing masses with adjacent bony invasion.

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“…Rare lesions have been reported in the maxilla, soft palate, paranasal sinus, nasopharynx, salivary gland, scalp, and temporal bone (1, 5-8). …”

Section: Discussionmentioning

confidence: 99%

“…Radiologic descriptions of granulocytic sarcomas in the head and neck area are rare in the medical literature (4, 5), and consist mainly of case reports (6-8). The aim of this article was to determine the most common and/or characteristic imaging findings of granulocytic sarcomas in the head and neck area.…”

Section: Introductionmentioning

confidence: 99%

Granulocytic Sarcoma in the Head and Neck: CT and MR Imaging Findings

Noh

Park

Chun

et al. 2009

Clin Exp Otorhinolaryngol

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“…From a therapeutic perspective, data from the literature suggest that GSs are extremely sensitive to focal irradiation or chemotherapy; however, their role is not well defined (13,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). The optimal treatment for the GS-AML association remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

Immunohistochemical patterns in the differential diagnosis of rhinopharyngeal granulocytic sarcoma

et al. 2016

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Abstract. Granulocytic sarcoma (GS) is a rare extramedullary manifestation of acute myeloid leukemia (AML). GS may develop simultaneously to AML or as a relapse of leukemia, particularly following allogeneic hematopoietic stem cell transplant. Subperiosteal bone, lymph nodes and skin are commonly involved, whereas rhinopharyngeal involvement is less common, with only 14 cases reported in the literature. Due to its rarity, rhinopharyngeal GS may lead to diagnostic pitfalls, particularly when it is poorly differentiated or is without concomitant marrow involvement. Thus, immunohistochemical findings play a key role in diagnosis. The current report describes a case of a 53-year-old female suffering from rhinopharyngeal GS and with a history of AML treated with chemotherapy and radiotherapy, focusing on the importance of the immunohistochemical pattern to assess the right diagnosis. Recent studies have demonstrated that the immunophenotype is of utmost importance for the diagnosis of GS. The high expression of myeloperoxidase (MPO) is common in GS; however, ~30% of GSs do not contain MPO. Therefore, the presence of other markers is required to confirm the diagnosis of GS.

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“…All of the reports utilized chemotherapy, and only 5 cases surgically excised the tumor. The presence of granulocytic sarcoma typically has a poor prognosis; review of the literature showed a 53% mortality rate, and average life expectancy for patients with AML diagnosed with granulocytic sarcoma is typically less than 12 months . Given the poor prognosis of the disease, aggressive systemic treatment is recommended, utilizing a chemotherapy regimen and possibly radiotherapy.…”

Section: Discussionmentioning

confidence: 99%