Myeloid Sarcoma Presenting with Leukemoid Reaction in a Child Treated for Acute Lymphoblastic Leukemia

Abstract

Background. Myeloid sarcoma is an extramedullary neoplasm of immature myeloid cells. Our study reports a presentation of myeloid sarcoma which presented with severe leukemoid reaction as a secondary malignancy in a patient who was treated for acute lymphoblastic leukemia previously. The case emphasizes the difficulties in diagnosis of patients who do not have concomitant leukemia. Case Presentation. A 6-year-old girl who was treated for acute lymphoblastic leukemia previously presented with fatigue, paleness, and hepatosplenomegaly. Peripheral blood smear and bone marrow aspirate examination did not demonstrate any blasts in spite of severe leukemoid reaction with a white cell count 158000/mm3. FDG/PET CT revealed slight uptake in cervical and supraclavicular lymph nodes. Excisional lymph node biopsy was performed from these lymph nodes and it showed myeloid sarcoma. Conclusion. Myeloid sarcoma can develop as a secondary malignancy in children who are treated for acute lymphoblastic leukemia. It can be associated with severe leukemoid reaction and diagnosis may be difficult if there is not concomitant leukemia. PET/CT is helpful in such cases.

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

“…In four patients with prior marrow leukemia, the presence of extramedullary tumor was not recognized before scan was performed. One child with high LDH and anemia and unremarkable marrow 4 years after ALL was found on scan to have extramedullary involvement with AML . Three with prior AML underwent scans for rising minimal residual disease markers (CBFΒ‐MYH11, WTI transcript) that revealed extramedullary leukemia in lymph nodes, hepatic nodules, GI tract, and diffusely .…”

Myeloid Sarcoma as an Extramedullary Manifestation of Acute Myeloid Leukemia Detected with 18F-FDG PET/CT: Case Report

“…10 Aschoff et al, studied the efficacy of FDG/PET in the evaluation of 52 untreated or recurrent granulocytic sarcoma (GS) lesions which are extramedullary manifestations of myeloid or lymphoblastic leuka emia. They sho wed that changes in FDG uptake after therapy correlated well with clinical outcome and proposed that PET was more reliable than CT assessment alone.…”

Leukemoid Reaction-An Update

“…The major causes of Leukemoid reaction are severe infections, intoxications, malignancies, severe hemorrhage or acute hemolysis [7].…”