Intraparenchymal Myeloid Sarcoma and Subsequent Spinal Myeloid Sarcoma for Acute Myeloblastic Leukemia

Abstract

Myeloid sarcoma is a solid, extramedullary tumor composed of leukemic myeloblasts or immature myeloid cells. Intraparenchymal myeloid sarcoma without the involvement of the skull or meninges is extremely rare. Here, we present the case of a 49-year-old man who developed intraparenchymal myeloid sarcoma on the left cerebellum after allogeneic bone marrow transplantation (BMT). He received radiotherapy after complete removal of intraparenchymal myeloid sarcoma, but he was diagnosed spinal myeloid sarcoma three month later. Nine months after the operation, new intracranial and spinal myeloid sarcoma were diagnosed and the patient's condition had been worsened rapidly. Although the spinal myeloid sarcoma was not histologically diagnosed, this report provides valuable insights into the clinical course of progression of intraparenchymal myeloid sarcoma.

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

“…It is noteworthy that this patient had received six courses of chemotherapy and continued well at 3 years . Eight relapses occurred first in further extramedullary sites and two in marrow . At least five patients treated for isolated tumor had no clinical response to chemotherapy alone and four died on therapy .…”

Intracranial CNS Manifestations of Myeloid Sarcoma in Patients with Acute Myeloid Leukemia: Review of the Literature and Three Case Reports from the Author’s Institution

“…Of those, 13 lesions (54%) were described in the intra-axial compartment of the brain and 11 lesions (45%) in the extra-axial brain compartment. One patient had sequential lesions develop in more than one anatomic site in the brain [ 7 ]. Another patient had concurrent intra-axial lesions described in the left occipital lobe, right temporal lobe and left cerebellum [ 8 ].…”

Rare Intramedullary Myeloid Sarcoma Mistaken as Acute Transverse Myelitis

“…All levels of the spine can be affected, but more frequently in the lumbosacral spine, followed by the thoracic spine and cervical level 7,[15][16][17] . The clinical manifestation of spinal myeloid sarcoma varies, and it largely depends on the tumor location and size 4,5,9,14) . Most spinal myeloid sarcoma that arises in the epidural or paraspinal tissues can present with signs of cord compression due to mass effect 2,9,11) .…”

“…. On MRI examination, spinal myeloid sarcoma yields a similar signal intensity to muscle on T1-weighted images (WIs) and intermediate signal intensity on T2-WIs with subtle to intermediate enhancement with Gadolinium 1,4,14) . Immunohistochemistry is the most accurate method for establishing the diagnosis of myeloid sarcoma, and a series of markers can be used for diagnosis confirmation and further lineage characterization 6,9,15,16) .…”

“…If the patient has established leukemia, the diagnosis of myeloid sarcoma is relatively easy and it is suggested to always be included in the differential diagnosis for patients with leukemia with a soft tissue mass 6,13) . The diagnosis of myeloid sarcoma could be difficult if there is no clinical history of leukemia and every effort should be made to obtain a pathologic diagnosis 4,7,9) . In the present case, the patient underwent repeated open biopsy and immunohistochemical stains showed positive staining in the atypical, which helped to confirm the diagnosis.…”