Granulocytic sarcoma in nonleukemic patients

Abstract

Sixteen patients presenting with granulocytic sarcoma without evidence of acute leukemia were seen and diagnosed at The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston from 1962 to 1985. Seven of them (44%) did not develop acute leukemia. Of these seven, four are alive with no evidence of disease 3.5 to 16 years after initial presentation; the remaining three patients died of their disease within 2 to 8 months of presentation. Two of 16 patients were diagnosed within the last 15 months and do not have adequate follow-up. The seven remaining patients developed acute leukemia within 1 week to 13 months of the diagnosis of granulocytic sarcoma. Six of them died 5 weeks to 16 months after diagnosis; one patient has been in complete remission for 8 years. Twelve of these 16 cases (75%) were initially misdiagnosed, most frequently as large cell lymphoma. The remaining four cases were correctly diagnosed as granulocytic sarcoma. The naphthol-ASD-chloroacetate esterase stain was required to make the correct diagnosis in all cases. Contrary to findings in other series, granulocytic sarcoma arising in nonleukemic patients does not necessarily progress to acute leukemia. At least four of 16 (25%) patients in this series did not develop acute leukemia during the 3.5 to 16 years they have been followed. No prognostic factors were identified in this series to predict which patients would develop acute leukemia and which ones would not.

Comparison in treatments of nonleukemic granulocytic sarcoma

“…On the contrary, 25 (58%) of 42 patients given chemotherapy remained in the nonleukemic stage for more than 11 months. Meis et al 5 reported that at least 4 (25%) of 16 patients who received chemotherapy did not develop ANLL during a follow-up period of 3.5-16 years after diagnosis of GS. Among the cases reviewed here, most misdiagnosed patients were treated with cytotoxic agents used for NHL, sarcoma, or multiple myeloma, and most patients who initially were diagnosed with GS received aggressive chemotherapy coincident with ANLL.…”

“…3,4 On rare occasions, it evolves before the onset of ANLL, and among these cases it often is misdiagnosed as malignant lymphoma. 3,5 We report two patients with GS of left testicular and intestinal involvements, respectively, that preceded leukemic involvement of the peripheral blood and bone marrow. To our knowledge, there has been no previous review comparing treatments for patients with GS in the nonleukemic stage preceding ANLL.…”

Sarcoma granulocítico em órbita: relato de caso

“…Alguns autores relatam intervalos prolongados entre o aparecimento da lesão orbitária e o acometimento sistêmico, variando de 1 a 16 anos (14)(15) .…”

Myeloid Sarcoma: Presenting with Massive Cervical and Inguinal Lymphadenopathy

“…In patients with AML, MS is present in 2-8 % of these patients [5]. In adults, the true incidence of MS is unknown, although in roughly one third of cases it may occur concurrently with other myeloid diseases including myelodysplastic syndrome (MDS), myeloproliferative neoplasm (MPN) or MDS/MPN [6][7][8][9][10][11], but such an association is not required. In pediatric AML however, MS occurs in approximately 10 % of cases [11].…”