Ewha Med J.  2016 Jan;39(1):17-22. 10.12771/emj.2016.39.1.17.

Isolated Myeloid Sarcoma Presenting as Cord Compression by Paraspinal Mass

• Oh HH
• Kim HJ
• Han TH
• Kwon MK
• Bae SY
• Yuh YJ

• KMID: 2152753
• DOI: http://doi.org/10.12771/emj.2016.39.1.17

Abstract

Myeloid sarcoma is a rare tumor mass consisting of immature granulocytic cells occurring in an extramedullary site or in a bone. It has often been observed during the course of an acute leukemia, myelodysplastic syndrome or myeloproliferative neoplasms, and it can involve any site of the body. However, it rarely present in the absence of bone marrow infiltration, especially for the isolated spinal myeloid sarcoma. In this report, we describe a case of isolated myeloid sarcoma that showed spinal compression. A 66-year-old male, with no underlying disease or medication history, presented with a progressive back pain and numbness in bilateral lower extremities that had begun two weeks before. He was diagnosed with myeloid sarcoma with no evidence of bone marrow involvement. Tumor cells were positive for CD34, c-KIT, and Bcl-2 on the immunohistochemical stain. He was treated with systemic chemotherapy with daunorubicin plus cytosine arabinoside and achieved a partial response.

Keyword

Myeloid sarcoma; Spinal cord compression; Leukemia

MeSH Terms

Aged
Back Pain
Bone Marrow
Cytarabine
Daunorubicin
Drug Therapy
Humans
Hypesthesia
Leukemia
Lower Extremity
Male
Myelodysplastic Syndromes
Sarcoma, Myeloid*
Spinal Cord Compression
Cytarabine
Daunorubicin

Figure

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  Fig. 1 Computed tomography on admission. It shows extension of right paraspinal mass (arrows) into epidural space.

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  Fig. 2 Magnetic resonance (MR) image of the spine. (A) Axial T2-weighted MR image and (B) coronal T2-weighted fatsaturated MR image show epidural spinal cord compression (arrows).

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  Fig. 3 Histologic finding of psoas muscle core-needle biopsy. (A) The sections show 4 cores of needle biopsied specimen (H&E, ×10). (B) High power field reveals small round blue cells infiltrating into skeletal muscle fibers. Some cells with eosinophilic granules (arrows) are also found, suggestive of immature blasts of eosinophil (H&E, ×400). (C) The tumor cells infiltrates into venous wall with partial disruption (H&E, ×200).

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  Fig. 4 Immunohistochemical staining for tumor. (A) CD34 is positive for tumor cells (×200). (B) Bcl-2 is positive for tumor cells (×200). (C) C-KIT is focal positive (×200). (D) The percentage of Ki-67 positive cells is 70% (×200).

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  Fig. 5 Bone marrow aspirates and biopsy findings. (A) Hematopoietic cells of three lineages are within normal limit in number and distribution. No malignant cells are observed (Wright-Giemsa, ×400). (B) Bone marrow biopsy shows normocellular marrow. Hematopoietic cells of three lineages are within normal limit in number and distribution. No malignant cells are observed (H&E, ×100).

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  Fig. 6 A follow-up computed tomography. It shows a decreased extent of enhancing right paraspinal mass (arrows).

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