Korean J Hematol.  2008 Dec;43(4):268-271. 10.5045/kjh.2008.43.4.268.

Primary Granulocytic Sarcoma with Multiple Organ Involvement

• Lim SN
• Lee JH
• Lee WJ
• Park HJ
• Kim KM
• Choi YS
• Lee JH
• Lee KH

• KMID: 1485087
• DOI: http://doi.org/10.5045/kjh.2008.43.4.268

Abstract

We report here a case of primary granulocytic sarcoma that involved multiple organs simultaneously and simulated clinical features of lymphoma at initial presentation. A 55 year-old man was referred to our center for the treatment and evaluation of lymphoma, which was diagnosed for nasal and colonic polyps in a local hospital. In our center, brain MR imaging showed multiple soft tissue lesions in brain and the whole body PET demonstrated multiple hypermetabolic lesions. Immunohistochemical staining of biopsy specimen on nasal and colonic polyp showed negativity of all lymphoma markers and positivity of myeloid markers, and final pathologic diagnosis was granulocytic sarcoma. Cytogenetic analysis of malignant cells in CSF showed chromosomal abnormalities of t(16;16)(p13.1;q22). Bilateral bone marrow examination was done with no evidence of abnormal cell infiltration and with normal cytogenetics. Complete remission was induced with 5 cycles of anti-leukemic chemotherapy, intrathecal chemotherapy and whole brain irradiation. However, leukemia relapsed in blood and bone marrow three months after the completion of treatment and the patient died 11.5 months after initial diagnosis of primary granulocytic sarcoma. In conclusion, immune-histochemical staining is necessary to obtain accurate pathologic diagnosis of granulocytic sarcoma. Pathogenetic role of t(16;16) in granulocytic sarcoma should be evaluated and appropriate treatment of primary granulocytic sarcoma should be defined in the future studies.

Keyword

Primary granulocytic sarcoma; Immunohistochemical stain; Cytogenetic analysis

MeSH Terms

Biopsy
Bone Marrow
Bone Marrow Examination
Brain
Chromosome Aberrations
Colonic Polyps
Cytogenetic Analysis
Cytogenetics
Humans
Leukemia
Lymphoma
Sarcoma, Myeloid
Sarcoma, Myeloid

Figure

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  Fig. 1 (A) Brain MR imaging shows soft tissue lesions involving left nasopharynx, left cavernous sinus, Meckel's cave, left infratemporal area, bilateral paranasal sinus, bilateral intraconal and extraconal spaces, and left orbital apex. (B) The whole body PET (F-18 FDG) shows multiple hypermetabolic lesions in left nasopharynx, left skull base, right maxillary sinus, anterior mediastinum, peritoneum, liver, right kidney and multiple lymph node sites (left cervical level Ib, both cervical level II, left cardiophrenic, right paraaortic and left external inguinal).

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  Fig. 2 Cytogenetic analysis was performed using leukemic blasts in the CSF analysis and chromosomal abnormalities of t(16;16)(p13.1;q22), +21, +2mar were noted.

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