Granulocytic Sarcoma of Colon in a Patient with Acute Promyelocytic Leukemia

Damodar, Sharat; Prashantha, B; Gangoli, Aparna; Gopalakrishnan, Gayathri; Jayanthi, K

doi:10.1007/s12288-012-0152-0

Cited by 8 publications

(12 citation statements)

References 7 publications

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“…An additional patient with small bowel tumor had relapse in both marrow and organ sites and was well 2 years after salvage chemotherapy and autologous transplant . Of the 52 patients who did not undergo local treatment, 9 were reportedly surviving with response after chemotherapy alone for 2 to 10 years . Three of the long survivors had also had stem cell transplants: one after pancreatic tumor, one after duodenal tumor, and one after retroperitoneal tumor that compressed duodenum .…”

Section: Resultsmentioning

confidence: 99%

Leukemia in gastrointestinal organs as cause of treatment failure: 378 cases analyzed

Cunningham

Worthley

2018

American J Hematol

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Leukemia growing as tumors in gastrointestinal organs is an under-investigated cause of treatment failure and death. These present with symptoms often mistaken for common toxicities but may grow large before symptoms. To synthesize experience available only in case reports, 378 were analyzed. Invasive and metastatic behavior typical of solid GI tumors was revealed even when marrow was uninvolved. Within 3 months of diagnosis, 33% had died, 47% within 1 year. Survivals of 4 to 18 years after involvement suggest cure is possible. Evidence is presented that combined local and systemic therapy has successfully treated GI leukemic tumors when identified early.

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Section: Resultsmentioning

confidence: 99%

Leukemia in gastrointestinal organs as cause of treatment failure: 378 cases analyzed

Cunningham

Worthley

2018

American J Hematol

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“…Chloromas are rather rare at first presentation but occur more frequently in patients with relapsing disease ( 9 – 13 ). To date, only few reports on primary extramedullary manifestation of APL exist ( 5 , 14 – 29 ), e.g. the clinical courses of a 29-year-old male presenting with hematochezia resulting from a chloroma in the colon ( 14 ), and a 38-year-old female patient complaining about gingival bleeding, abnormal uterine bleeding and headache emanating from an extensive intracranial chloroma.…”

Section: Discussionmentioning

confidence: 99%

“…To date, only few reports on primary extramedullary manifestation of APL exist ( 5 , 14 – 29 ), e.g. the clinical courses of a 29-year-old male presenting with hematochezia resulting from a chloroma in the colon ( 14 ), and a 38-year-old female patient complaining about gingival bleeding, abnormal uterine bleeding and headache emanating from an extensive intracranial chloroma. Of note, in both cases pancytopenia prompted bone marrow examination yielding extensive expansion of blasts and proof of PML-RARA translocation confirming the presence of APL.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Extramedullary Acute Promyelocytic Leukemia: An Unusual Case and Mini-Review of the Literature

et al. 2022

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BackgroundAcute promyelocytic leukemia (APL) constitutes a serious hematological emergency necessitating rapid diagnosis and therapy to prevent lethal bleedings resulting from APL-induced thrombocytopenia and coagulopathy. Atypical manifestations of APL, such as extramedullary disease at first presentation, pose diagnostic challenges and delay the onset of appropriate therapy. Nevertheless, extramedullary manifestations of APL are mostly accompanied by blood count alterations pointing to an underlying hematological disease. In this report, we present the first case of APL bearing close resemblance to a metastasized laryngeal carcinoma with normal blood counts and absent coagulopathy.Case PresentationA 67-year-old man with a previous history of smoking was admitted to our hospital with progressive hoarseness of voice, odynophagia, dysphagia and exertional dyspnea. Laryngoscopy revealed a fixed right hemi larynx with an immobile right vocal fold. Imaging of the neck via magnetic-resonance imaging (MRI) and positron emission tomography–computed tomography (PET/CT) with F-18-fluordeoxyglucose (FDG) showed a large hypermetabolic tumor in the right piriform sinus and tracer uptake in adjacent lymph nodes, highly suspicious of metastasized laryngeal carcinoma. Surprisingly the histological examination revealed an extramedullary manifestation of acute promyelocytic leukemia. Remarkably, blood counts and coagulation parameters were normal. Moreover, no clinical signs of hemorrhage were found. PML-RARA fusion was detected in both laryngeal mass and bone marrow. After diagnosis of APL, ATRA-based chemotherapy was initiated resulting in complete remission of all APL manifestations.ConclusionsThis is the first case report of APL initially presenting as laryngeal chloroma. Additionally, we performed a comprehensive literature review of previously published extramedullary APL manifestations. In aggregate, a normal blood count at first presentation constitutes an extremely rare finding in patients initially presenting with extramedullary APL manifestations.

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“…Its clinical features and prognosis may be different from those of EMD, and the disease free survival may be shorter than MS occurring in APL relapse. To date, a total of 28 cases of APL with MS as the initial presentation have been reported worldwide (Table 1 )[ 17 - 41 ]. The average age of onset was 35 (1-77) years, and sex-bias phenomenon (only 8 female) was difficult to explain due to the limited number of patients.…”

Section: Discussionmentioning

confidence: 99%

Myeloid sarcoma of the colon as initial presentation in acute promyelocytic leukemia: A case report and review of the literature

Wang

Cai

Lin

2021

WJCC

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BACKGROUND Myeloid sarcoma (MS) rarely occurs in acute promyelocytic leukemia (APL) at onset, but it can develop in relapse cases, especially after APL treated with all-trans retinoic acid (ATRA). Therefore little is known about the clinical features and suitable treatment for APL related MS due to the rarity of the disease, although this may be different from the treatment and prognosis of MS in the relapse stage. To our best knowledge, this is the second case report of APL initial presentation as colon MS. CASE SUMMARY A 77-year-old woman complained of intermittent right lower abdominal pain, black stool, and difficult defecation for 2 mo. Physical examination showed diffuse tenderness during deep palpation and an anemic appearance. Laboratory findings showed positivity for fecal occult blood testing; white blood cell count: 3.84 × 10 9 /L; hemoglobin: 105 g/L; platelet count: 174 × 10 9 /L; and negativity for tumor markers. Abdominal enhanced computed tomography showed a space occupying lesion in the colon (1.9 cm). Fibrocolonoscopy revealed a polypoid and ulcerated mass measuring 2.5 cm. The tumor was removed. To our surprise, MS was confirmed by immunohistochemistry. PML/RARα fusion gene was detected in colon specimens by fluorescent in situ hybridization and real-time reverse transcription polymerase chain reaction, which was consistent with the bone marrow. She was diagnosed as having APL related MS. A smooth and unobstructed intestinal wall was found by fibrocolonoscopy, and continuous molecular remission was confirmed in both the bone marrow and colon after four courses of ATRA + arsenic trioxide (ATO). ATRA + ATO showed a favorable therapeutic response for both APL and MS. CONCLUSION Early use of ATRA can benefit APL patients, regardless of whether MS is the first or recurrent manifestation.

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Granulocytic Sarcoma of Colon in a Patient with Acute Promyelocytic Leukemia

Cited by 8 publications

References 7 publications

Leukemia in gastrointestinal organs as cause of treatment failure: 378 cases analyzed

Leukemia in gastrointestinal organs as cause of treatment failure: 378 cases analyzed

Case Report: Extramedullary Acute Promyelocytic Leukemia: An Unusual Case and Mini-Review of the Literature

Myeloid sarcoma of the colon as initial presentation in acute promyelocytic leukemia: A case report and review of the literature

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