Isolated granulocytic sarcoma: report of a case and review of the literature.

Abstract

Granulocytic sarcoma (GS) is an extramedullary tumor composed of granulocytic precursor cells. The tumor usually develops during the course of myelogenous leukemia or myeloproliferative disorders and may represent the initial manifestation of leukemia. Rarely, GS is recognized as an isolated tumor without any evidence of leukemia. However, in such cases, leukemia generally develops within 1 to 2 years of the diagnosis of GS. We are reporting a case of a 45-year-old woman who was diagnosed as having an isolated GS of the right breast in August 1980. She was treated with a partial mastectomy followed by 1 year of combination chemotherapy as used in the cases of acute myeloblastic leukemia and has remained free of disease to the present time. That is, she has not developed leukemia or recurrence of GS for 64 months. Based on this experience and on the review of the literature, we recommend that all cases of GS be treated with combination chemotherapy as in cases of acute myeloblastic leukemias.

Comparison in treatments of nonleukemic granulocytic sarcoma

“…2,3 This review revealed that the other preferential sites were small intestine, mediastinum, epidural site, uterus, and ovary, i.e., sites often difficult for the detection and diagnosis.…”

“…In addition, 55 patients who developed GS at least 1 month before the blood or bone marrow evidence of ANLL 4 -34 and 17 patients without leukemic transformation during the follow-up period 3,[35][36][37][38][39][40][41][42][43][44][45] were gathered through a literature search on MEDICINE. Granulocytic sarcoma was diagnosed in these patients either by the positive results of naphtol ASD chloroacetate esterase (NCAE), by immunoperoxidase stainings with monoclonal antibodies for myeloperoxidase, by lysozyme or CD34 antigen, 34 by electron microscopic findings of the tumor cells, or retrospectively by the transformation to ANLL.…”

“…1,2 It usually occurs concomitantly with or after the onset of 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.…”

“…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.…”

“…To our knowledge, there has been no previous review comparing treatments for patients with GS in the nonleukemic stage preceding ANLL. In addition to these 2 patients, we reviewed the cases of 55 patients with GS preceding ANLL 4 -34 and 17 patients without the transformation during the follow-up period 3,[35][36][37][38][39][40][41][42][43][44][45] that were well documented in the literature. Our review focused an analysis of the clinical characteristics and the relation between the therapeutic regimens of GS and the nonleukemic period.…”