[Granulocytic sarcoma of the tonsils associated with myelodysplastic syndrome].
METHODS
A 60-year-old man with anaemia was found to have a myelodysplastic syndrome (MDS) which was classified as refractory anemia with ringsideroblasts (RAEB). Because of severe fever the patient was hospitalized. Waldeyer's throat ring revealed signs of acute inflammation.


RESULTS
Indicated severe anemia and thrombocytopenia. Leucocytes were 8000/ml with a pathological shift to the left (1920/ml blasts). CRP (4.7 g/dl) and BSG (59/91mm) were abnormal. An axial CT of the neck showed a left sided paratonsillar abscess.


METHODS
The tonsillitis was treated with antibiotics. Persistent fever up to 39.8 degrees C suggested resistance to therapy. After three weeks the patient developed septicemia and died. Autopsy revealed MDS with excess of blasts in transformation (RAEBT-t). Granulocytic sarcoma was found in the throating where there was no paratonsillar abscess. Generalized miliary tuberculosis was proved at autopsy, explaining the continuous fever resistant to antibiotic treatment.


CONCLUSIONS
Granulocytic sarcoma is rarely associated with myelodysplastic syndrome. Deficiency in the immune system may facilitate the occurrence of miliary tuberculosis.
Geisse
M
M
Pathologisches Institut, des Klinikums Darmstadt, Germany.
Mall
G
G
Fritze
D
D
Gartenschläger
M
M
D000754:Anemia, Refractory, with Excess of Blasts / Q000473:pathology*; D000756:Anemia, Sideroblastic / Q000473:pathology*; D001853:Bone Marrow / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D014066:Palatine Tonsil / Q000473:pathology; D000039:Peritonsillar Abscess / Q000473:pathology; D009195:Peroxidase / Q000032:analysis; D023981:Sarcoma, Myeloid / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014067:Tonsillar Neoplasms / Q000473:pathology*; D014069:Tonsillitis / Q000473:pathology; D014391:Tuberculosis, Miliary / Q000473:pathology
D009195:Peroxidase