J Korean Med Sci.  2006 Aug;21(4):745-748. 10.3346/jkms.2006.21.4.745.

Nonleukemic Granulocytic Sarcoma in the Bile Duct: A Case Report

• Kim HW
• Choi SJ
• Lee JH
• Lee JH
• Kim TS
• Kim YG
• Kang JM
• Huh J
• Park KM
• Lee KH

• KMID: 2157832
• DOI: http://doi.org/10.3346/jkms.2006.21.4.745

Abstract

Granulocytic sarcoma (GS) is an extramedullary tumor composed of immature myeloid cells, typically occurring during the course of acute myelogenous leukemia. Non-leukemic GS, that is, GS with no evidence of overt leukemia and no previous history of leukemia, is very rare, and even more unusual is nonleukemic GS of the bile duct. We report a case of nonleukemic GS of the bile duct. The patient was initially misdiagnosed as a bile duct carcinoma arising in the hilum of the liver (so-called Klatskin tumor), and received a right lobectomy of the liver. Histological examination of the tumor yielded the diagnosis of GS, and the bone marrow biopsy did not show any evidence of leukemia. Considering the risk of subsequent development of overt leukemia, the patient was treated with two cycles of combination chemotherapy as used in the cases of acute myelogenous leukemia. To date, he has remained free of disease 15 months after treatment.

Keyword

Sarcoma, Granulocytic; Bile Ducts; Leukemia, Myelocytic, Acute

MeSH Terms

Tomography, X-Ray Computed/methods
Sarcoma, Granulocytic/*diagnosis/metabolism/radiography
Radiography, Abdominal
Peroxidase/analysis
Male
Immunohistochemistry
Humans
Diagnosis, Differential
Bile Ducts/chemistry/pathology
Bile Duct Neoplasms/*chemically induced/metabolism/radiography
Antigens, CD45/analysis
Adult

Figure

• 

  Fig. 1 Abdominal computed tomography demonstrating thickening of common bile duct wall, luminal narrowing at common hepatic duct level (A), and mild, diffuse dilatation of intrahepatic duct (B).

• 

  Fig. 2 Magnetic resonance cholangiography showing dilatation of both intrahepatic duct and right posterior duct.

• 

  Fig. 3 The great majority of the cells in the infiltrate consists of myeloid precursors with large round to oval cells with slightly eosinophilic cytoplasm and round to oval vesicular nuclei, admixed with a minor population of more mature myeloid forms including eosinophils (hematoxilin-eosin, ×400).

• 

  Fig. 4 Immunohistochemical stain for myeloperoxidase (MPO) reveals positive granular cytoplasmic staining of most of the myeloid cells except for the most immature precursors, and the epithelial cells of the bile ducts (×400).

Reference

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

2. Eshghabadi M, Shojania AM, Carr I. Isolated granulcytic sarcoma: Report of a case and review of the literature. J Clin Oncol. 1986. 4:912–917.

3. Meis JM, Butler JJ, Osborne BM, Manning JT. Granulocytic sarcoma in nonleukemic patients. Cancer. 1986. 58:2697–2709.

4. Menasce LP, Banerjee SS, Beckett E, Harris M. Extra-medullary myeloid tumour (granulocytic sarcoma) is often misdiagnosed: a study of 26 cases. Histopathology. 1999. 34:391–398.

5. 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.

6. Matsueda K, Yamamoto H, Doi I. An autopsy case of granulocytic sarcoma of the porta hepatis causing obstructive jaundice. J Gastroenterol. 1998. 33:428–433.

7. Bayle C, Romdhane NB, Bastard C, Vannier JP, Hayat M, Lemerle J, Bernard A. Acute leukemia with extramedullary presentation and mixed myeloid and lymphoid expression. Pediatr Hematol Oncol. 1986. 3:293–296.

8. Spahr J, Behm FG, Schneider V. Preleukemic granulocytic sarcoma of cervix and vagina: initial manifestation by cytology. Acta Cytol. 1982. 26:55–60.

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

10. Imrie KR, Kovacs MJ, Selby D, Lipton J, Patterson BJ, Pantalony D, Poldre P, Ngan BY, Keating A. Isolated chloroma: the effect of early antileukemic therapy. Ann Intern Med. 1995. 123:351–353.