Spinal epidural granulocytic sarcoma in non-leukemic patient

Abstract

A previously healthy 24-year-old male presented with a 3-month history of progressive backache and weakness in both legs. Magnetic resonance imaging of the spine showed a large soft tissue mass infiltrating paraspinal musculature of lumbosacral area, sacral laminas, last lumbar and all sacral vertebra, protruding into the spinal canal, and with propagation into pelvis. Baseline laboratory data were normal. Decompressive laminectomy and tumor removal were performed resulting in neurological improvement. Histological examination identified granulocytic sarcoma (GS). Bone marrow biopsy showed normal findings. The patient underwent adjuvant chemotherapy and radiotherapy, resulting in the elimination of residual lesion, followed by autologous transplant. Immediate diagnosis and adequate systematic treatment are essential to achieve optimal results in patients with isolated GS. The patient is alive and free of the disease 14 months from the diagnosis.

Prognostic Factors of Treatment Outcomes in Patients with Granulocytic Sarcoma

“…The most common locations for GS include soft tissue, skin, bone and lymph nodes [7,8,9], whereas less commonly they may occur in the spine, conjunctiva, mediastinum, gastrointestinal tract, genitourinary tract, orbit, brain, breast, heart and great vessels [7,8,10,11,12,13]. Soft tissue and skin were the most commonly involved sites in our series followed by bone involvement.…”

“…GS can occur at any age and in any organ or tissue throughout the body, especially soft tissues, skin, bones and lymph nodes [7,8,9]. However, it also rarely occurs at other sites such as the male and female genitourinary system, gastrointestinal tract, heart, orbit and central nervous system [7,8,10,11,12,13]. The diagnosis of GS is made difficult by its variable locations, wide range in age, rare incidence, as well as the relatively immature nature of the tumor cells, especially in nonleukemic patients.…”

Sacral canal myeloid sarcoma as initial manifestation of granulocytic leukemia: MRI features and differential diagnosis (with a case report)

“…Myeloid sarcoma is a local neoplasm consisting of immature myeloblasts, which often occurs secondary to AML, with an incidence of 2.5-9.1% myelogenous leukemia, and more commonly in the AML-M2 subtype (1,3,4). Myeloid sarcoma might precede abnormalities of bone marrow and peripheral blood, and can be detected by CT or MRI as a solitary mass.…”

Isolated Myeloid Sarcoma of the Gastrointestinal Tract

“…The term granulocytic sarcoma to describe MS was first suggested by Rappaport in 1966 (3), then, in 2002, the World Health Organization adopted the use of the term myeloid sarcoma (4). Cases have been reported of MS in the lymph nodes, skin, periosteum, genital system, central nervous system, heart, and gastrointestinal (GI) tract (5)(6)(7)(8)(9). F i g u r e 2 .…”