Ann Dermatol.  2011 Oct;23(Suppl 2):S270-S273. 10.5021/ad.2011.23.S2.S270.

Multiple Granulocytic Sarcomas in a Patient with Longstanding Complete Remission of Acute Myelogenous Leukemia

• Jung HD
• Kim HS
• Park YM
• Kim HO
• Lee JY

• KMID: 2156808
• DOI: http://doi.org/10.5021/ad.2011.23.S2.S270

Abstract

Granulocytic sarcoma is an extramedullary tumor composed of granulocytic precursor cells. It usually presents as a nodular mass in the course of acute myelogenous leukemia. Rarely, the tumor develops in non-hematological conditions or in a patient with complete remission from the acute myelogenous leukemia. In such cases, aleukemic granulocytic sarcoma can be a preceding sign of systemic leukemia or a first sign of hematologic relapse of leukemia. We present an unusual case of multiple granulocytic sarcomas developed in a patient with longstanding complete remission of acute myelogenous leukemia, who has not had bone marrow and peripheral blood involvement for a long time.

Keyword

Aleukemic leukemia cutis; AML M1; Granulocytic sarcoma

MeSH Terms

Bone Marrow
Granulocyte Precursor Cells
Humans
Leukemia
Leukemia, Myeloid, Acute
Recurrence
Sarcoma, Myeloid

Figure

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  Fig. 1 (A, B) Widespread well-demarcated variable-sized greenish firm cutaneous nodules over the face, trunk and extremities.

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  Fig. 2 (A) Dense cellular infiltrate among collagen bundles and in the perifollicular areas within the entire dermis (H&E, original magnification ×40). (B) Higher magnification reveals homogenous atypical cells with round to oval shaped hyperchromatic nuclei (H&E, original magnification ×400).

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  Fig. 3 (A) Tumor cells are positive for Leder stain and immunoperoxidase (original magnification ×400). (B) Tumor cells are negative for CD3, CD20, CD34, TdT and Pax-5 (original magnification ×40).

Reference

1. Neiman RS, Barcos M, Berard C, Bonner H, Mann R, Rydell RE, et al. Granulocytic sarcoma: a clinicopathologic study of 61 biopsied cases. Cancer. 1981. 48:1426–1437.

2. Wiernik PH, Serpick AA. Granulocytic sarcoma (chloroma). Blood. 1970. 35:361–369.

3. Duguid JK, Mackie MJ, McVerry BA. Skin infiltration associated with chronic myelomonocytic leukaemia. Br J Haematol. 1983. 53:257–264.

4. Murakami Y, Nagae S, Matsuishi E, Irie K, Furue M. A case of CD56+ cutaneous aleukaemic granulocytic sarcoma with myelodysplastic syndrome. Br J Dermatol. 2000. 143:587–590.

5. de Arruda Câmara VM, Morais JC, Portugal R, da Silva Carneiro SC, Ramos-e-Silva M. Cutaneous granulocytic sarcoma in myelodysplastic syndrome. J Cutan Pathol. 2008. 35:876–879.

6. Long JC, Mihm MC. Multiple granulocytic tumors of the skin: report of six cases of myelogenous leukemia with initial manifestations in the skin. Cancer. 1977. 39:2004–2016.

7. Firat F, Ozen G, Yildiz G, Sağlam A, Onder S, Tan E, et al. Late relapse of acute myeloblastic leukemia as myeloid sarcoma causing radiculopathy. Leuk Res. 2010. 34:e348–e350.

8. Byrd JC, Weiss RB. Recurrent granulocytic sarcoma. An unusual variation of acute myelogenous leukemia associated with 8;21 chromosomal translocation and blast expression of the neural cell adhesion molecule. Cancer. 1994. 73:2107–2112.

9. Harris DW, Ostlere LS, Rustin MH. Cutaneous granulocytic sarcoma (chloroma) presenting as the first sign of relapse following autologous bone marrow transplantation for acute myeloid leukaemia. Br J Dermatol. 1992. 127:182–184.

10. Orlandi E, Morra E, Lazzarino M, Castagnola C, Paulli M, Rosso R, et al. Multiple granulocytic sarcoma during complete hematologic remission of acute nonlymphoid leukemia. Acta Haematol. 1989. 81:41–43.

11. Mason TE, Demaree RS Jr, Margolis CI. Granulocytic sarcoma (chloroma), two years preceding myelogenous leukemia. Cancer. 1973. 31:423–432.

12. Takahashi T, Tsukuda H, Kimura H, Yoshimoto M, Tsujisaki M. Extramedullary relapse of AML with t(9;11)(p22;q23) associated with clonal evolution from trisomy 8 into tetrasomy 8. Intern Med. 2010. 49:447–451.

13. Cho-Vega JH, Medeiros LJ, Prieto VG, Vega F. Leukemia cutis. Am J Clin Pathol. 2008. 129:130–142.

14. Cronin DM, George TI, Sundram UN. An updated approach to the diagnosis of myeloid leukemia cutis. Am J Clin Pathol. 2009. 132:101–110.

15. Imrie KR, Kovacs MJ, Selby D, Lipton J, Patterson BJ, Pantalony D, et al. Isolated chloroma: the effect of early antileukemic therapy. Ann Intern Med. 1995. 123:351–353.

16. Yamauchi K, Yasuda M. Comparison in treatments of nonleukemic granulocytic sarcoma: report of two cases and a review of 72 cases in the literature. Cancer. 2002. 94:1739–1746.

17. Krause JR. Granulocytic sarcoma preceding acute leukemia: a report of six cases. Cancer. 1979. 44:1017–1021.