Isolated Recurrence of Granulocytic Sarcoma Manifesting as Extra- and Intracranial Masses

Abstract

A 30-year-old female presented with a rare case of isolated recurrence of granulocytic sarcoma manifesting as extra-and intracranial masses 16 months after successful treatment of acute myeloblastic leukemia (M-2). She presented with a swelling located on her forehead that had appeared just after hitting her forehead, and never diminished in size. The mass was elastic hard and not freely mobile. Computed tomography and magnetic resonance imaging demonstrated enhanced masses in the right frontal extra-and intracranial region with no bone destruction. There was no evidence of relapse in the bone marrow. Needle aspiration biopsy of the subscalpal mass was performed. Fluorescence in situ hybridization revealed AML1/MTG8 fusion gene associated with t(8; 21). Two courses of systemic chemotherapy with high-dose cytarabine and total neural axis irradiation resulted in complete remission.

Isolated Recurrence of Granulocytic Sarcoma -Two Case Reports-

“…On the other hand, surgery could increase the risk of infection and central nervous system dissemination, so there is no advantage over chemotherapy and irradiation. 13) The present two cases demonstrate that neurosurgeons should pay attention to the occurrence of isolated recurrence of intracranial or extra-and intracranial GS, especially in patients with a history of hematologic neoplasms.…”

“…A 30-year-old female presented with isolated recurrence of GS manifesting as extra-and intracranial masses 16 months after complete remission of M2. 13) A 34-year-old female with AML-M3 in remission developed unilateral hearing loss caused by cerebellopontine angle GS identified by MR imaging 27 months after remission, but histological examination of the GS specimen revealed AML-M4. 8) A 45-year-old male patient diagnosed with AML-M4 who remained in complete remission for 16 years, then a large subdural GS was found, and the final histological examination showed AML-M0.…”

Extramedullary Relapse Presenting as Trigeminal Neuralgia and Diplopia after Allogeneic Hematopoietic Stem Cell Transplantation

“…Granulocytic sarcoma, also termed "chloroma" for the green color, is an extramedullary solid tumor composed of immature myeloid cells or myeloblasts and it can occur in leukemia, myeloproliferative and myelodysplastic disorders (3). It can occur anywhere in the body and at any age, involving bone, periostium, lymph nodes, skin, breast, ovary, rectum, pancreas, urinary bladder, or the central nervous system (4).…”

Isolated Recurrence of Intracranial Granulocytic Sarcoma Mimicking a Falx Meningioma in Acute Myeloblastic Leukemia

“…The advantage of surgical excision still remains controversial. It has been reported that surgical excision has no benefit following chemotherapy and irradiation, except in the presence of progressive neurological deficits such as increasing intracranial pressure or disturbance of consciousness which are uncontrollable by the conservative treatment 11) . Surgical resection and/or irradiation, although highly effective in local control, do not influence survival 6) .…”

“…Surgical resection and/or irradiation, although highly effective in local control, do not influence survival 6) . Moreover, surgery would increase the risk of infection and CNS dissemination 11) . However, some reports noted that surgical decompression might provide rapid improvement and lead to a long symptom-free period 19) .…”