Multiple Granulocytic Sarcomas: A Rare Presentation of Acute Myeloid Leukemia

Abstract

Dear editor, A 16-year-old boy, presented with gradually progressive, painless swelling over the back for 1-month duration followed by similar swellings over head and chest. He also noticed bulging of the right eyeball with double vision in last 1 week. Clinical examination revealed a thin built and cachexic young boy. He had multiple swellings over scalp (6 9 4 cm), chest wall (8 9 5 cm) and sacrum (5 9 2 cm, 3 9 2 cm) that were firm to hard, non-tender and adherent to the underlying structure (Fig. 1a, c, d). He also had proptosis of the right eye (Fig. 1b). Ocular movements and pupillary reflex were preserved. Rest of the clinical examination was unremarkable. His complete blood count showed, Hemoglobin 138 g/ L, WBC 3.6 9 10 9 /L, and Platelets 260 9 10 9 /L with a normal peripheral blood smear. A Whole-body PET CT showed intense FDG avid lesions corresponding to the clinically apparent sites along with a retro-orbital mass (Fig. 2). The histopathology report of the biopsied tissue from the sacral swelling was suggestive of non-Hodgkin lymphoma. Bone marrow aspiration-biopsy showed 26% MPO negative blast, which was positive for CD13, CD33, CD34, CD38, CD117 and HLA DR and Cytogenetic studies revealed t (8:21) (AML/ETO or RUNX1/ RUNX1T1). Diagnosis of Acute myeloid leukemia with recurrent cytogenetic abnormality t (8:21

The clinical profile, management, and outcome of febrile neutropenia in acute myeloid leukemia from resource constraint settings

“…20 However, previous studies published from India suggest that AML patients are younger than their western counterparts, with their age ranging from 30 to 36 years. 2,9 One of the reasons for this may be the lower life expectancy in India, while there may be other selection biases in the study. Another reason for the lower median age in our cohort may be due to enrolment at a lower age (>12-year) in our study compared with many western world reports (>18-year).…”

“…2,[5][6][7] Delayed diagnosis of AML due to non-specific clinical features, underlying immunocompromised state and comorbidities, results in a predisposition to acquire infections and inferior outcomes with standard induction therapy. [8][9][10] Acute leukemia management is more challenging in the developing world. Delays in presentation, due to a lack of awareness, sparsity of evaluation facilities, and the cost constraints of therapy are some of the challenges that clinicians come across in resource-constraint settings.…”

“…2,5–7 Delayed diagnosis of AML due to non-specific clinical features, underlying immunocompromised state and comorbidities, results in a predisposition to acquire infections and inferior outcomes with standard induction therapy. 8–10…”