Extramedullary acute myeloid leukemia (granulocytic sarcoma) with arm paresis, maculopapular exanthema and organ involvement.
Granulocytic sarcoma (extramedullary myelosarcoma, chloroma) is a rare extramedullary myeloid tumor which can occur at any anatomical site as isolated finding or associated with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS). In this case, we describe a 71-year-old man who presented with incomplete paresis of the left arm, periorbital swelling, a maculopapular exanthema and organ involvement including testis and stomach. The tumors responded to combination chemotherapy and the patient fully recovered. However, after five months the patient relapsed and died quickly. This case confirms the importance of including granulocytic sarcoma in the differential diagnoses of a variety of diseases. In AML, the presence of granulocytic sarcoma is associated with worse overall survival. When diagnosed, it should be treated with intensive chemotherapy as soon as possible.
Glossmann
Jan-Peter
JP
First Department of Internal Medicine, University Hospital Cologne, Joseph-Stelzmann-Str. 9, 50931 Köln, Germany. jan-peter.glossmann@uni-koeln.de
Staak
Jan Oliver
JO
Wickenhauser
Claudia
C
Diehl
Volker
V
Josting
Andreas
A
D000368:Aged; D015703:Antigens, CD; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001132:Arm; D014408:Biomarkers, Tumor / Q000032:analysis; D002265:Carboxylic Ester Hydrolases / Q000032:analysis; D002543:Cerebral Hemorrhage / Q000209:etiology; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D005076:Exanthema / Q000209:etiology*; D017809:Fatal Outcome; D006801:Humans; D051917:Leukosialin; D008297:Male; D008942:Mitoxantrone / Q000008:administration & dosage; D009363:Neoplasm Proteins / Q000032:analysis; D010291:Paresis / Q000209:etiology*; D023981:Sarcoma, Myeloid / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D012795:Sialoglycoproteins / Q000032:analysis; D012867:Skin / Q000737:chemistry / Q000473:pathology*; D013270:Stomach / Q000737:chemistry / Q000473:pathology*; D013737:Testis / Q000737:chemistry / Q000473:pathology*; D013866:Thioguanine / Q000008:administration & dosage; D014746:Vimentin / Q000032:analysis
D015703:Antigens, CD; D014408:Biomarkers, Tumor; D051917:Leukosialin; D009363:Neoplasm Proteins; C465014:SPN protein, human; D012795:Sialoglycoproteins; D014746:Vimentin; D003561:Cytarabine; D008942:Mitoxantrone; D002265:Carboxylic Ester Hydrolases; C019873:chloroacetate esterase; D013866:Thioguanine; D003630:Daunorubicin