Isolated Recurrence of Granulocytic Sarcoma of the Brain: Successful Treatment with Surgical Resection, Intrathecal Injection, Irradiation and Prophylactic Systemic Chemotherapy

Abstract

We describe a 40-year-old male who developed an isolated recurrence of granulocytic sarcoma (GS) of the brain 2 years following successful treatment of acute myeloblastic leukemia (AML; M2). Computed tomography (CT) scans and magnetic resonance (MR) images demonstrated a homogeneously enhanced tumor mass in the left temporal lobe and massive peritumoral edema. There was no evidence of relapse in the bone marrow. The patient underwent an emergency surgical resection of the tumor. Five courses of injection with cytarabine and prednisolone through an Ommaya reservoir and whole brain irradiation (total 40 Gy) were performed. Furthermore, prophylactic systemic chemotherapy with cytarabine and etoposide was added. He has been in complete remission for 21 months. Our results, together with other reported cases, indicate that a favorable outcome could be obtained by intensive and combined treatment for an isolated recurrence of GS of the brain if the bone marrow remained in complete remission.

Isolated Recurrence of Granulocytic Sarcoma Manifesting as Extra- and Intracranial Masses

“…13) Review of eight reported cases concluded that immediate prophylactic systemic chemotherapy for granulocytic sarcoma during bone marrow remission would lead to favorable outcomes. 38) Our patient received systemic chemotherapy and whole neural axis irradiation, and achieved complete remission. Although surgical excision remains controversial, 26,33,36,38) we think there is no advantage following chemotherapy and irradiation, except in the presence of progressive neurological deficits such as increasing intracranial pressure or disturbance of consciousness which are uncontrollable by the conservative treatment.…”

“…38) Our patient received systemic chemotherapy and whole neural axis irradiation, and achieved complete remission. Although surgical excision remains controversial, 26,33,36,38) we think there is no advantage following chemotherapy and irradiation, except in the presence of progressive neurological deficits such as increasing intracranial pressure or disturbance of consciousness which are uncontrollable by the conservative treatment. Surgery would increase the risk of infection and central nervous system dissemination.…”

“…36,38) Two courses of systemic chemotherapy with highdose cytarabine were given followed by whole neural axis irradiation (whole brain 16 Gy, total spinal 24 Gy). She is now free from symptoms and both the bone marrow and extra-and intracranial lesions have remained in complete remission (Fig.…”

Isolated Recurrence of Intracranial Granulocytic Sarcoma Mimicking a Falx Meningioma in Acute Myeloblastic Leukemia

“…Moreover, surgery would increase the risk of infection and CNS dissemination 11) . However, some reports noted that surgical decompression might provide rapid improvement and lead to a long symptom-free period 19) . In our case, because of depressed mental state, he underwent surgical resection followed by radiotherapy.…”

Isolated Recurrence of Granulocytic Sarcoma -Two Case Reports-

“…20) Anti-leukemic chemotherapy containing high-dose cytarabine might provide good results. 10) Cytology and histology can identify the pathological classification and provide guidance for chemotherapy.…”