Ann Rehabil Med.  2013 Apr;37(2):280-285. 10.5535/arm.2013.37.2.280.

Brachial Plexopathy due to Myeloid Sarcoma in a Patient With Acute Myeloid Leukemia After Allogenic Peripheral Blood Stem Cell Transplantation

• Ha Y
• Sung DH
• Park Y
• Kim DH

• KMID: 2165783
• DOI: http://doi.org/10.5535/arm.2013.37.2.280

Abstract

Myeloid sarcoma is a solid, extramedullary tumor comprising of immature myeloid cells. It may occur in any organ; however, the invasion of peripheral nervous system is rare. Herein, we report the case of myeloid sarcoma on the brachial plexus. A 37-year-old woman with acute myelogenous leukemia achieved complete remission after chemotherapy. One year later, she presented right shoulder pain, progressive weakness in the right upper extremity and hypesthesia. Based on magnetic resonance images (MRI) and electrophysiologic study, a provisional diagnosis of brachial plexus neuritis was done and hence steroid pulse therapy was carried out. Three months later the patient presented epigastric pain. After upper gastrointestinal endoscopy, myeloid sarcoma of gastrointestinal tract was confirmed pathologically. Moreover, 18-fluoride fluorodeoxyglucose positron emission tomography showed a fusiform shaped mass lesion at the brachial plexus overlapping with previous high signal lesion on the MRI. Therefore, we concluded the final diagnosis as brachial plexopathy due to myeloid sarcoma.

Keyword

Myeloid sarcoma; Brachial plexus; Acute myelogenous leukemia

MeSH Terms

Brachial Plexus
Brachial Plexus Neuritis
Brachial Plexus Neuropathies
Endoscopy, Gastrointestinal
Female
Gastrointestinal Tract
Humans
Hypesthesia
Leukemia, Myeloid, Acute
Magnetic Resonance Spectroscopy
Myeloid Cells
Peripheral Blood Stem Cell Transplantation
Peripheral Nervous System
Positron-Emission Tomography
Sarcoma, Myeloid
Shoulder Pain
Upper Extremity

Figure

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  Fig. 1 Magnetic resonance images (coronal, short tau inversion recovery image) from ventral (A) towards dorsal (D) surfaces of the brachial plexus shows diffuse high signal intensity and mild swelling of the right brachial plexus (arrow) from trunk level to cord level. No definite mass lesion was noted within or outside the brachial plexus.

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  Fig. 2 18-Fluoride fluorodeoxyglucose positron emission tomography (PET) findings. Three-dimensional projection image (A, B) PET/computed tomography fusion axial image (C) reveal hot uptake in stomach, transverse colon, right perihepatic space, right cardiophrenic angle, anterior mediastinum and right brachial plexus. Fusiform shaped mass lesions can be seen at the cord level of right brachial plexus (black and white arrow).

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