Isolated granulocytic sarcoma followed by acute myelogenous leukemia type FAB-M2 associated with inversion 16 and trisomies 9 and 22 Leukemia (2002) 16, 2458-2459. doi:10.1038/sj.leu.2402593 TO THE EDITOR Granulocytic sarcoma (GS), also known as chloroma, are extramedullary tumors composed of immature myeloid cells. They have been described in a wide variety of anatomical sites, including breast, ovary, brain, gastrointestinal tract and skull.1,2 They occur at the onset of acute myelogenous leukemia (AML) or during its evolution. They may also be the first sign of acute transformation of myelodysplastic syndromes and chronic myeloproliferative disorders. They are rarely the first manifestation of AML. GS are observed in only 2 to 8% of AML, mainly of M2 morphology, although they have also been associated with M3, M4, M5, and M7 morphology.A 37-year-old man was referred to our hospital in June 1999. He had a history of ascitis and intestinal occlusion due to three stenotic lesions of the jejunum. A large peritoneal mass was noted. The patient had surgery in March 1999 during which a partial resection of the proximal jejunum was performed. The histologic examination of the surgical piece was interpreted as a massive lymphomatous infiltration of the whole intestine wall. In May 1999, he had surgery again because of necrosis of the tumor with cutaneous fistula. A bone marrow biopsy and a complete blood count were normal. The patient received two courses of anti-lymphoma chemotherapy.Because of the lack of response, he was admitted to the hematology service. The patient had ileus, ascitis, severe deterioration of his health status and a 13 kg weight loss. A blood count showed a hemoglobin of 10.5 g/dl, a white blood cell (WBC) count of 4.4 × 10 9 /l and a platelet count of 343 × 10 9 /l. The leukocyte differential showed 84% neutrophils, 15% lymphocytes and 1% monocytes.A review of the original histology found the malignant cells to be blasts. These cells were shown to contain myeloperoxidase and to express CD34 and CD68 antigens. Furthermore, immunophenotyping was partially positive for CD15 and lysozyme. A retrospective diagnosis of isolated granulocytic sarcoma was made. Unfortunately, no material was available for cytogenetic studies.The bone marrow aspirate and the blood cell count were still normal. At the end of July 1999, chemotherapy with aracytidine and idarubicin was started, leading to the disappearance of all abdominal signs and a complete remission. No complementary radiotherapy was performed because of the small bowel localization of the granulocytic sarcoma. Then, the patient received a consolidation therapy with high Hematopoietic reconstruction was incomplete, without any signs of acute leukemia. The patient was hospitalized again at the end of August 2000 because of the presence of 39% circulating blasts. A bone marrow aspirate showed hypercellularity with 72% myeloblasts, some containing Auer rods and showing discrete abnormal granular maturation, leading to the diagnosis of AML type 2. The bl...
