Spinal Epidural Granulocytic Sarcoma in a Child Precedent to Clinical Manifestation of Acute Myeloid Lymphoma  -Case Report-

Takeda, Masaaki; Yamaguchi, Satoshi; Eguchi, Kuniki; Kajiume, Teruyuki; Nishimura, Shin‐Ichiro; Kobayashi, Masao; Kurisu, Kaoru

doi:10.2176/nmc.49.221

Cited by 14 publications

(8 citation statements)

References 22 publications

(30 reference statements)

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“…Approximately 1% of AML patients develop MS, most of whom are misdiagnosed with lymphoma (8). Among the rare manifestations of MS, spinal epidural tumors are extremely rare, and only few patients have been reported to have paraplegia as the first symptom (17). Although some patients achieve a complete recovery from paraplegia after the administration of chemotherapy, our patient did not recover from the paraplegia, even after undergoing emergency laminectomy, and complete hematological remission was achieved with subsequent intensive chemotherapy.…”

Section: Discussionmentioning

confidence: 58%

Acute Myeloid Leukemia Concurrent with Spinal Epidural Extramedullary Myeloid Sarcoma Accompanied by a High CD25 Expression and the <i>FLT3-ITD</i> Mutation

et al. 2014

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Myeloid sarcoma (MS) is an extramedullary myeloid tumor that sometimes presents with antedating systemic leukemia, leading physicians to the misdiagnosis of lymphoma. CD25 is expressed in 13% of patients with acute myeloid leukemia (AML), and its expression is associated with FLT3-ITD mutations, an elevated serum soluble interleukin 2 receptor (sIL-2R) level and a lower survival rate. However, there are no reports concerning the relationship between MS and the CD25 expression. We herein report a case of AML accompanied by thoracic epidural MS with a high CD25 expression, the FLT3-ITD mutation and an extremely elevated serum sIL-2R level in a 59-year-old man who presented with paraplegia.

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Section: Discussionmentioning

confidence: 58%

Acute Myeloid Leukemia Concurrent with Spinal Epidural Extramedullary Myeloid Sarcoma Accompanied by a High CD25 Expression and the <i>FLT3-ITD</i> Mutation

et al. 2014

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“…110 These tumors tend to respond rapidly to first-line therapies (ie, chemotherapy and radiation). 108 Unlike the high T1 signal intensity seen in the bone marrow of healthy children, the bone marrow in children with lymphoma and leukemia is low in signal intensity on T1-weighted images (Fig 13). It is unclear if this is the result of leukemic infiltration and/or increased activity of the bone marrow or is secondary to treatment.…”

Section: Lymphoma and Leukemiamentioning

confidence: 97%

“…106,107 Several cases of granulocytic sarcomas have been reported in patients without leukemia. 108,109 Chloromas are highly vascularized lesions composed of immature granulocytes. 110 On MR imaging, these lesions are isointense to hyperintense on T1-weighted images and isointense to hypointense on T2-weighted images (Fig 12) and may demonstrate moderate-to-marked contrast enhancement.…”

Section: Lymphoma and Leukemiamentioning

confidence: 99%

Imaging of Back Pain in Children

Rodriguez¹,

Poussaint²

2009

AJNR Am J Neuroradiol

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SUMMARY:While back pain presents less frequently in children than in adults, it still poses a significant clinical challenge with respect to making a firm diagnosis and developing an effective treatment plan. When children have back pain and medical attention is sought, an underlying pathology is usually suspected. Pediatric patients are evaluated, first, with a complete clinical history and examination and, second, by an imaging work-up that is based on initial findings, including the child's age and size, signs and symptoms, and suspected etiology. This article describes 1) the epidemiology of back pain in children, 2) the imaging work-up used, and 3) the correlation of imaging findings with disease entities that may cause back pain in the pediatric patient. The list of diseases giving rise to back pain is not meant to be exhaustive but rather reflective of the most commonly identified pathologies and disorders among young children and adolescents, from athletic injuries to lethal cancers.ABBREVIATIONS: ALARA ϭ as low as reasonably achievable; ESR ϭ erythrocyte sedimentation rate; FSE ϭ fast spin-echo; 18 F ϭ fluorine 18; LCH ϭ Langerhans cell histiocytosis; LDH ϭ lactate dehydrogenase; MBP ϭ mechanical back pain; PET ϭ positron-emission tomography; RFA ϭ radio-frequency ablation, SPECT ϭ single-photon emission computed tomography; STIR ϭ short tau inversion recovery; 99m Tc-MDP ϭ technetium 99m methylene diphosphonate; WHO ϭ World Health Organization B ack pain in children presents less frequently than in adults. The incidence of back pain in adults has been estimated to be as high as 60%-80% 1 ; the actual incidence of back pain in children, however, is unknown. Back pain in children presenting to the emergency department was originally thought to be an uncommon complaint, 2 reflecting significant underlying pathology compared with adults. Although recent studies have shown an increased prevalence of back pain in children, [3][4][5][6][7] relatively few patients receive medical attention.

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“…Symptoms range from muscle weakness, paresthesias, hypoesthesia to fecal and urinary incontinence. Paraplegia due to epidural mass is an extremely rare presentation of undiagnosed leukemia [3]. The thoracic region is the most frequently involved region, followed by the lumbar region.…”

Section: Introductionmentioning

confidence: 99%

Paraplegia as initial presentation of acute myeloid leukemia: A case report

Ladu¹,

Mohammed²,

Talba³

et al. 2017

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Involvement of the central nervous system (CNS) may result acutely from the disease at the initial diagnosis, and the symptoms range from muscle weakness, paresthesias, and hypoesthesia to fecal and urinary incontinence. Paraplegia is an extremely rare initial presentation of undiagnosed leukemia. Case Report: A 15-year-old girl presented with acute urinary and fecal incontinence, and a day later developed inability to move both lower limbs. There was two weeks preceding history of fever, malaise and lower back pain, no associated history of paresthesias or numbness. Examination of both lower limbs revealed decreased tone and reflexes with bilateral extensor reflexes and power of 0/5. There was a loss of sensation around the perianal region with absent anal tone. Cranial nerve and sensory examination were normal. Both peripheral blood film and bone marrow aspiration cytology stained with Leishman stain were consistent with acute myeloid leukemia (AML) FAB M-4 subtype. Cerebrospinal fluid analysis was negative for malignant cells. Magnetic resonance imaging of the lumbosacral region was obtained; both T1-and T2-weighted sequences showed no signal intensity in the spinal cord, theca and cauda, with normal signal intensity involving the intervertebral disc. Patient was commenced on supportive therapy and induction chemotherapy using daunorubicin 45 mg/m2 days 1-3 and cytosine arabinoside 200 mg daily days 1-7. However, patient succumbed to her disease and passed away 10 days into treatment as a result of respiratory complication. Conclusion: Central nervous system involvement is a rare initial presentation of AML. Absence of abnormality on MRI scan does not rule out spinal cord involvement; consequently late recognition may delay treatment and lead to irreversible neurological complication.

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Spinal Epidural Granulocytic Sarcoma in a Child Precedent to Clinical Manifestation of Acute Myeloid Lymphoma -Case Report-

Cited by 14 publications

References 22 publications

Acute Myeloid Leukemia Concurrent with Spinal Epidural Extramedullary Myeloid Sarcoma Accompanied by a High CD25 Expression and the <i>FLT3-ITD</i> Mutation

Acute Myeloid Leukemia Concurrent with Spinal Epidural Extramedullary Myeloid Sarcoma Accompanied by a High CD25 Expression and the <i>FLT3-ITD</i> Mutation

Imaging of Back Pain in Children

Paraplegia as initial presentation of acute myeloid leukemia: A case report

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