Isolated Intracranial Myeloid Sarcoma Occurring as Relapse in Acute Myeloid Leukemia

Abstract

Myeloid sarcoma (MS) or chloroma is a rare extramedullary tumor composed of extramedullary proliferation of blasts of granulocytic, monocytic, erythroid, or megakaryocytic lineage occurring at sites outside the bone marrow. MS occurs in 2%–8% of patients with acute myeloid leukemia (AML), sometimes it occurs as the presenting manifestation of relapse in a patient in remission. We describe the case of a young male with AML in remission for 6 years presenting with central nervous system symptoms. Magnetic resonance imaging showed an extra-axial altered intensity lesion in the parasagittal parietal region, infiltrating anterosuperiorly into anterior falx, and posterosuperior aspect of the superior sagittal sinus. A biopsy from the lesion was diagnostic of MS which was positive for myeloperoxidase. He did not have any other sites of disease. He has received chemotherapy with FLAG (Fludarabine, Cytosine arabinoside) followed by cranial irradiation and is in complete remission.

Myeloid sarcoma in brain and optic nerve presented as a relapse of acute myeloid leukemia: A case report

“…The incidence of central nervous system (CNS) involvement in MS is relatively rare, 7 accounting for only 0.4% of cases involving cranial bone marrow, vertebrae, or orbital bones. Its migration to the brain parenchyma is attributed to the disruption of the blood–brain barrier 8,9 . While orbital involvement as an initial manifestation of AML is uncommon, it is less than 3% of cases 10 .…”

“…Its migration to the brain parenchyma is attributed to the disruption of the blood–brain barrier. 8 , 9 While orbital involvement as an initial manifestation of AML is uncommon, it is less than 3% of cases. 10 In our case, brain MRI revealed a heterogeneous mass measuring 9 × 7.5 × 3 cm in the left temporal region, extending into the left sphenoid wing and causing destruction of the pilgrims.…”

An unusual headache: CSF negative APML relapse in the brain

“…As demonstrated in this case, APML can also less commonly form a discrete tumour mass with benign-looking radiological features (e.g. absence of vasogenic cerebral oedema or lytic bone destruction) [ 10 ]. As such, it is important to maintain a high suspicion of CNS infiltration during follow-up and reassuring radiological appearances alone should not deter from performing a lumbar puncture and CSF analysis.…”

Isolated recurrence of acute myeloid leukemia in the cerebellum: illustrative case

“…9,18 The standard therapy for myeloid sarcoma involves treatment of the underlying neoplasia. 10 In adult patients with CNS involvement of AML, systemic therapy in addition to intrathecal chemotherapy and/or cranial irradiation is considered. 5 No randomized controlled trials have been performed to compare the use of these treatment modalities in patients with CNS leukemia.…”

“…To date, only a handful of case reports and small case series have described CNS myeloid sarcoma. 1,2,5,6,[9][10][11][12][13] We present a unique case of an adult male with AML in remission relapsing with an isolated, diffuse myeloid sarcoma of the cerebellum.…”