Spinal chloroma presenting with triplegia in an aleukaemic patient

Buckland, Michael E.; Scolyer, Richard A.; Donellan, Michael B.; Brew, Stefan; McGee-Collett, Martin; Harper, Clive

doi:10.1080/00313020126312

Cited by 25 publications

(31 citation statements)

References 14 publications

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“…In three cases, chronic myelogenous leukemia was diagnosed. All presented with paraplegia, except one case that featured triparesis of the left arm and bilateral lower extremities [11]. Facial nerve paralysis was an additional finding in another case [12].…”

Section: Discussionmentioning

confidence: 99%

Paraplegia as the presenting manifestation of extramedullary megakaryoblastic transformation of previously undiagnosed chronic myelogenous leukemia

2006

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Extramedullary tumors, also known as granulocytic sarcomas (GS), occur most frequently in acute myelogenous leukemia (AML). They may signal the onset of the accelerated phase of chronic myelogenous leukemia (CML) or the blastic transformation of a myeloproliferative disorder. Occasionally, a GS may be the presenting sign of undiagnosed AML, and rarely the presenting sign of undiagnosed CML or aleukemic leukemia. Paraplegia due to a spinal cord GS is an extremely rare presentation of undiagnosed leukemia. This is the first case report of paraplegia as the presenting manifestation of extramedullary megakaryoblastic transformation of previously undiagnosed CML. A 53-year-old woman reported back pain for 6 days, rapidly progressing to paraplegia. Physical examination noted a large abdominal mass and flaccid paralysis in both lower extremities. Spinal MRI revealed a T4-T6 vertebral mass causing spinal stenosis and cord compression. Tumor debulking and laminectomy were performed emergently. The tumor consisted of noncohesive blast cells. The CBC revealed a leukocyte count of 238,300/ml and a differential consistent with CML. Reexamination of the patient found that the abdominal mass was a giant spleen. Further immunohistochemical studies of the tumor were consistent with extramedullary acute megakaryoblastic blast transformation of CML. Although extramedullary blast crises herald the accelerated phases in~10% of CML cases, megakaryoblastic blast transformation of CML accounts for less than 3% of these cases. The combination of acute paraplegia and megakaryoblastic transformation in a previously undiagnosed patient with CML is extremely rare and may pose a diagnostic dilemma. Am. J. Hematol. 82:150-154, 2007. V V C 2006 Wiley-Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

Paraplegia as the presenting manifestation of extramedullary megakaryoblastic transformation of previously undiagnosed chronic myelogenous leukemia

2006

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“…2,[5][6][7][9][10][11][12]14,[16][17][18][19][20][21][22][23][24][25][26][27][28]30) The male predominance could be associated with the higher incidence of acute myeloid leukemia in men. 4) The affected sites included two cases at cervical, 17 at thoracic, 10 at lumbar, and three at sacral spinal levels.…”

Section: Discussionmentioning

confidence: 99%

“…1) On the other hand, granulocytic sarcoma may occur in the absence of leukemia. 2,6,21) The correct diagnosis of granulocytic sarcoma is obtained only in about 50% of nonleukemic patients due to its rareness and the histological and radiological similarities to malignant lymphoma or Ewing sarcoma. 29) Spinal granulocytic sarcoma in aleukemic patients is rare but important because late bone marrow involvement may be related to blast crisis and cause death.…”

Section: Introductionmentioning

confidence: 99%

“…13) Granulocytic sarcoma most commonly occurs in the soft tissues of the head and neck, bone, and skin, 9) and less often in the central nervous system and spinal cord. 2,[5][6][7][9][10][11][12][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]30) Granulocytic sarcoma seldom manifests before the identification of leukemia in the peripheral blood or bone marrow. 2,[5][6][7][9][10][11][12][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]30) The finding of granulocytic sarcoma in p...…”

Section: Introductionmentioning

confidence: 99%

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Spinal Granulocytic Sarcoma Manifesting as Radiculopathy in a Nonleukemic Patient -Case Report-

Inoue

Takahashi

Shimizu

et al. 2008

Neurol. Med. Chir.(Tokyo)

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A 26-year-old nonleukemic woman presented with lumbosacral granulocytic sarcoma manifesting as progressive low back pain and numbness of her left lower leg persisting for 3 months. Physical examination revealed hypesthesia within the left S1 area of the sensory dermatome, decreased Achilles tendon reflex in the left lower extremity, and walking impairment due to severe pain in her left hip and leg. Magnetic resonance imaging confirmed an extradural mass in the spinal canal at the L5-S2 levels with invasion to the pelvis from the left sacral foramen. Positron emission tomography with [ 18 F]fluorodeoxyglucose (FDG-PET) showed hyperaccumulation indicating malignant tumor. Baseline laboratory data were normal. Decompressive laminectomy and tumor removal were performed. Histological examination identified granulocytic sarcoma. Bone marrow involvement was absent. She underwent adjuvant chemotherapy and radiotherapy, resulting in reduced residual lesion and neurological improvement. Immediate diagnosis and adequate systematic treatment are recommended for spinal granulocytic sarcoma in nonleukemic patients to prevent or delay progression to leukemia. The importance of immunohistochemical staining in the differential diagnosis from other types of spinal tumor, and the efficacy of FDG-PET for evaluation of the treatment are also emphasized.

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“…18,22) The histological diagnosis of granulocytic sarcoma can be difficult before the manifestation of AML, 4,8,17) and 47% of granulocytic sarcomas are initially misdiagnosed, mostly as malignant lymphoma, 26) but also as neuroblastoma, rhabdomyosarcoma, Ewing sarcoma, or peripheral neuroectodermal tumor. 3) Granulocytic sarcomas generally occur in the soft tissues, bone, and skin, 15,18) whereas the spinal column is much less commonly involved, with an incidence of 13% to 19%.…”

Section: Introductionmentioning

confidence: 99%

Spinal Epidural Granulocytic Sarcoma in a Child Precedent to Clinical Manifestation of Acute Myeloid Lymphoma -Case Report-

Takeda

Yamaguchi

Eguchi

et al. 2009

Neurol. Med. Chir.(Tokyo)

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A 13-year-old boy presented with an epidural thoracic granulocytic sarcoma manifesting as rapidly progressive paraplegia preceding clinical manifestation of acute myeloid leukemia (AML). Magnetic resonance imaging revealed a thoracic epidural tumor. He underwent emergent laminectomy and the tumor was totally resected. The initial histological diagnosis was malignant lymphoma. The correct diagnosis of epidural granulocytic sarcoma and AML was established based on cell-surface markers and a chromosomal study of the bone marrow cells. A combination of chemotherapy and bone marrow transfusion achieved complete remission of leukemia. No evidence of AML has emerged over the 18-month follow-up period. Granulocytic sarcoma should be considered in the differential diagnosis of an epidural mass in pediatric patients with or without acute leukemia. Immediate diagnosis and appropriate treatment are recommended to prevent leukemic transformation.

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Spinal chloroma presenting with triplegia in an aleukaemic patient

Cited by 25 publications

References 14 publications

Paraplegia as the presenting manifestation of extramedullary megakaryoblastic transformation of previously undiagnosed chronic myelogenous leukemia

Paraplegia as the presenting manifestation of extramedullary megakaryoblastic transformation of previously undiagnosed chronic myelogenous leukemia

Spinal Granulocytic Sarcoma Manifesting as Radiculopathy in a Nonleukemic Patient -Case Report-

Spinal Epidural Granulocytic Sarcoma in a Child Precedent to Clinical Manifestation of Acute Myeloid Lymphoma -Case Report-

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