Granulocytic sarcoma of the urinary bladder in a pediatric patient

Abstract

Granulocytic sarcoma (GS) is a rare tumor consisting of immature cells of granulocytic lineage. It is also called chloroma, referring to the green color of the tumor caused by high levels of myeloperoxidase in the cells. GS is often associated with acute myeloblastic leukemia. We report the case of a 4-year-old boy with a diagnosis of acute myeloblastic leukemia. Abdominal ultrasonography demonstrated a solid, vascularized, heterogeneous, polypoid formation involving the posterior wall of the bladder. Further studies confirmed the etiology of the tumor. On control ultrasonography, a marked decrease in tumor size 15 days after treatment was revealed. We describe the imaging findings in this patient and review the literature about this infrequent entity. Although imaging findings are not specific and considering that extramedullary involvement in leukemia is very sensitive to treatment, inclusion of GS in the differential diagnosis and awareness of the possible sites of occurrence and imaging features is essential to avoid unnecessary therapeutic measures.

Discovery of A Myeloid Sarcoma in A Hemodialysis Patient: Don’t Miss the Prior Hematological History!

“…It may also reflect the relapse of such syndromes, which was the case of our patient [2,5]. The incidence of MS ranges from 2 to 9% in adults; it is similar for both genders and frequently seen in young individuals (under the age of 15 years) [1,5].…”

“…Described for the first time in 1811 by Burns, MS was initially called chloroma, referring to the green color of the tumor caused by high levels of myeloperoxydase in the cells [1,3]. However, considering the fact that this type of tumor is not always green, the term granulocytic sarcoma seems to be a more appropriate term [4].…”

“…It is a rare tumor, consisting of immature cells from granulocytic lineage, occurring in any extramedullary organ [1]. According to WHOM 2016, it is considered as a form of myelodysplastic syndrome [2,5].…”

“…The clinical presentation is variable, as an extra-medullar mass, preferentially in the bone, but also in other tissues [1,5]. The diagnosis of MS is based on histological analyses: upon optical microscopy, a proliferation of myeloid cells at different stages of maturation is observed, with a positive myeloperoxydase immunofluorescence, which is pathognomonic [1,3,[5][6][7]. Other immunostainings may be required, such as anti-CD 20 and anti-CD 117 in order to rule out the diagnosis of lymphoma, the main differential diagnosis [3,[6][7][8].…”

“…Myeloid sarcoma (MS), also called granulocytic sarcoma, is a rare tumor consisting of immature cells from granulocytic lineage. It often affects bones but other localizations are exceptional, making its diagnosis difficult in the absence of ongoing hematological disorders [1,2].…”