Associates' Presentations
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Granulocytic sarcoma: Local presentation of a systemic disease.
Rupika Uberoi, M.D. (Associate), Vikram Nangia, M.D. (Associate). Sinai Samaritan Medical Center, University of Wisconsin Medical School, Milwaukee Clinical Campus, Milwaukee, Wisconsin.
Granulocytic sarcoma or chloroma is a localized tumor mass composed of immature cells of the granulocytic series. They are a rare, but well documented, manifestation of myelogenous leukemia. The reported incidence of chloroma in acute myeloid leukemia is 3.1-9.1%. Less commonly, it has been reported in chronic myeloid leukemia (CML) and very rarely in other myeloproliferative disorders. We report an unusual case of CML in which the initial presentation of the disease was spinal cord compression secondary to granulocytic sarcoma.
A 36-year-old woman presented with complaints of backache for three weeks and a three-day history of progressive weakness, numbness and tingling in her lower extremities. Her past medical history was unremarkable. Physical examination was significant for findings suggestive of spastic paraplegia and numbness extending to the level of the tenth dorsal segment, and the absence of splenomegaly. Initial laboratory data revealed a total white blood cell count of 193,000/mm3. Peripheral smear was typical of CML. Magnetic resonance imaging of the thoracic spine showed extensive infiltration of the spinal canal by a tumorous growth from the level of the fourth to the eleventh thoracic vertebra. An emergent decompressive laminectomy was performed and tissue samples were obtained which confirmed this tumor to be granulocytic sarcoma. The patient received post-operative radiotherapy with no improvement in symptoms.
Granulocytic sarcoma usually occurs concurrently with clinical evidence of leukemia, although it may rarely arise while the patient is in clinical remission and may antedate the diagnosis of leukemia by as many as two years. Bone is the most common site of involvement and kidney the most commonly involved organ. Presentations include local pain (78%), tumor nodules (65%), and motor or sensory disturbances (52%). Treatment involves initiation of chemotherapy at the earliest. Evidence of cord compression warrants emergent laminectomy while stable neurological signs are treated with radiotherapy. The mean survival in CML after diagnosis of chloroma has been reported to be 3.8 months.
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