Relapsing acute myeloid leukemia beginning with a penile localization

Abstract

We report the case of a 52-year-old man who was diagnosed for an acute myeloid leukemia (FAB classification: M1) with abnormalities in conventional caryotype showing trisomy 7 and recombination of MLL-AML 1 . His leukemia was discovered in front of neutropenic fever and circulating blastic cells. He was first treated with three cycles of intensive chemotherapies using high doses of cytarabine and idarubicine in association, followed by a nonmyeloablative allogeneic bone marrow-related transplantation based on busulfan and fludarabine conditioning. He relapsed 2 months later with pancytopenia and was, therefore, treated with a myeloablative bone marrow-related transplantation using melphalan 200 mg/m 2 conditioning. He stayed in complete clinical and cytological remission for 16 months, without any signs of GVHD.He then started to complain of a painfull spot on his penis. On examination, he had first a nodular painful lesion of the dorsal side of the penis, with no contiguous lymph nodes. No peripherical or medullar blastic infiltration was seen. Axial and sagittal fused FDG PET-CT images showed an intense and isolated FDG uptake of the distal corpus cavernosa (Image 1A). A surgical excision with anatomopathological analysis confirmed the leukemic origin of the lesion showing myeloblastic cells CD34 1 (Image 1B). The margins were safe from leukemia cells. However, even before beginning a treatment, he relapsed with a bilateral infiltration of corpus cavernosa, the penile skin, and an inguinal adenopathy.Because surgery did not limit the extension of leukemia as already report, treatment consisted in an association of a systemic donor lymphocytes injection with gemtuzumab ozogamicin (at 3 mg/ṁ ) and a local radiotherapy at 40 Gy on penis and 30 Gy onto the inguinal lymph node areas, seen on sagittal CT-scan (Image 1C). A complete local remission was observed, but 3 months later, a new relapse in the gums was observed. A palliative therapy was begun, but he died 2 months later from a severe dyspnoea, due to a blastic localization in oropharynx and blastic hyperleucocytosis at 50G/L.To date, only five cases of penile localization of acute leukemia have been listed: two of them were AML [1,2]. There were all FAB M4 subtype, and the penile metastasis was seen at relapse. The first patient was treated with radiotherapy exclusively and the second by surgery, but the two patients died for disseminated disease. Three others

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 .…”

Penile secondary lesions: a rare entity detected by PET/CT

“…However, we also detected PSL in patients with NSCLC, DLBCL, AML, and pelvic leiomyosarcoma. PSL have previously been recognized in lung cancer, lymphomas, AML, and pelvic leiomyosarcoma, though more than 90% originate in cancers of the genitourinary and gastrointestinal tracts [23][24][25][26] . Our 4 patients with lymphoma had DLBCL, corroborating reports that while found in both T-and B-cell lymphomas, PSL appear most commonly in DLBCL 27,28 .…”