Breast and dorsal spine relapse of granulocytic sarcoma after allogeneic stem cell transplantation for acute myelomonocytic leukemia: A case report

Abstract

BACKGROUND Granulocytic sarcoma (GS) is a rare malignant tumor, and relapse is even rarer in the breast and dorsal spine following allogeneic hematopoietic stem cell transplantation. Currently, a standard treatment regimen is not available. CASE SUMMARY A rare case of GS of the right breast and dorsal spine after complete remission of acute myelogenous leukemia is reported here. A 55-year-old female patient presented with a palpable, growing, painless lump as well as worsening dorsal compressive myelopathy. She had a history of acute myelomonocytic leukemia (AML M4) and achieved complete remission after chemotherapy following allogeneic hematopoietic stem cell transplantation. Imaging examinations showed the breast lump and C7-T1 epidural masses suspected of malignancy. Histologic results were compatible with GS in both the right breast and dorsal spine, which were considered extramedullary relapse of the AML treated 4 years earlier. CONCLUSION A rare case of GS relapse following allogeneic hematopoietic stem cell transplantation and guidelines for treatment are discussed.

Extramedullary relapse of acute myeloid leukemia in the breast: A radiological case report

“…An additional analysis by Harris et al [ 2 ], reported an incidence of isolated extramedullary relapse in 9% of patients with AML status postallogeneic stem cell transplant. Leukemic infiltration of the breast often suggests a propensity for further extramedullary spread and often poor prognosis [ [2] , [4] , [6] , [7] , [8] ]. Although extramedullary relapse has been reported to occur later than bone marrow relapse, approximately 10.1 versus 3.6 months respectively, once a single site of disease has been found, progression to other sites and bone marrow typically occurs within one year [ 4 , 5 ].…”

“…Although there are no clear established guidelines for clinical decision-making in the treatment of extramedullary relapse of AML after allogeneic stem cell transplantation, treatment often involves a combination of systemic chemotherapy, immunotherapy with donor lymphocyte infusions, repeated transplant, and localized treatments such as radiation based on the patient's overall health and previous treatment history [ [1] , [4] , [5] , [6] , [8] ].…”