title: Myeloid sarcoma: an unusual presentation of acute promyelocytic leukemia causing spinal cord compression.
abstract: Acute promyelocytic leukemia with concurrent myeloid sarcoma is a rare clinical event. Herein we describe a patient that presented with back pain and bilateral leg weakness caused by spinal cord compression due to extramedullary deposition of leukemic cells. Acute promyelocytic leukemia was suspected based on immunophenotypic findings of malignant cells in bone marrow aspirate. The diagnosis was confirmed by the presence of PML-RARα fusion copies. MRI showed multiple hyperintense changes on the vertebral bodies, together with intraspinal masses causing spinal cord compression. The patient immediately underwent radiotherapy, and was treated with all-trans retinoic acid and idarubicin. Reassessment MRI showed complete resolution of all intraspinal masses and the disappearance of most of the bony lesions. Post-treatment bone marrow aspirate showed complete hematological and molecular remission. The motor power of his legs fully recovered from 0/5 to 5/5; however, sensory loss below the T4 level persisted.
authors.affiliation: University of Malaya, Faculty of Medicine, Department of Pathology, Kuala Lumpur, Malaysia.
authors.forename: Tay Za
authors.initials: TZ
authors.lastname: Kyaw
authors.affiliation: University of Malaya, Faculty of Medicine, Department of Pathology, Kuala Lumpur, Malaysia.
authors.forename: Jayaranee A S
authors.initials: JA
authors.lastname: Maniam
authors.affiliation: University of Malaya, Faculty of Medicine, Department of Medicine, Kuala Lumpur, Malaysia.
authors.forename: Ping Chong
authors.initials: PC
authors.lastname: Bee
authors.affiliation: University of Malaya, Faculty of Medicine, Department of Medicine, Kuala Lumpur, Malaysia.
authors.forename: Edmund Fui
authors.initials: EF
authors.lastname: Chin
authors.affiliation: University of Malaya, Faculty of Medicine, Department of Pathology, Kuala Lumpur, Malaysia.
authors.forename: Veera Sekaran
authors.initials: VS
authors.lastname: Nadarajan
authors.affiliation: University of Malaya, Faculty of Medicine, Department of Pathology, Kuala Lumpur, Malaysia.
authors.forename: Hemalatha
authors.initials: H
authors.lastname: Shanmugam
authors.affiliation: University of Malaya, Faculty of Medicine, Department of Radiology, Kuala Lumpur, Malaysia.
authors.forename: Khairul Azmi Abd
authors.initials: KA
authors.lastname: Kadir
keywords: Chloroma; Cord compression; Myeloid sarcoma; Promyelocytic leukemia
references.citation: Leuk Lymphoma. 1999 Apr;33(3-4):219-29
references.pmid: 10221502
references.citation: Med Pediatr Oncol. 1998 Sep;31(3):144-9
references.pmid: 9722895
references.citation: Leukemia. 1999 Sep;13(9):1406-8
references.pmid: 10482992
references.citation: Leukemia. 2007 Feb;21(2):340-50
references.pmid: 17170724
references.citation: J Clin Oncol. 2001 Oct 15;19(20):4023-8
references.pmid: 11600603
references.citation: Adv Hematol. 2010;2010:137608
references.pmid: 20339529
references.citation: Cancer. 1981 Sep 15;48(6):1426-37
references.pmid: 7023656
references.citation: Gastroenterol Clin Biol. 1999 Jun-Jul;23(6-7):779-82
references.pmid: 10470535
references.citation: Neurol India. 2005 Jun;53(2):221-3
references.pmid: 16010065
references.citation: Int J Hematol. 2009 Jan;89(1):95-97
references.pmid: 19109732
references.citation: Leukemia. 2006 Jan;20(1):35-41
references.pmid: 16307026
references.citation: Am J Clin Pathol. 2009 Sep;132(3):426-37
references.pmid: 19687319