Liquid Presenting as Solid: A Rare Presentation of Acute Myeloid Leukaemia as a Solid Epidural Mass

  • Varsha Gupta Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
  • Firas Ajam Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
  • Gabriella Conte Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
  • Alsadiq Al Hillan Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
  • Kadhim Al-Banaa Department of Medicine, Beaumont Hospital, Dearborn, MI, USA
  • Vinit Singh Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, CT, USA
  • Michael Levitt Division of Hematology and Oncology, Jersey Shore University Medical Center, Neptune, NJ, USA
DOI: https://doi.org/10.12890/2020_001802

Keywords

Central nervous system-myeloid sarcoma, chloroma, granulocytic sarcoma, acute myeloid leukaemia

Abstract

Myeloid sarcoma (MS) is a very rare malignant tumour composed of myeloblasts. It most commonly involves soft tissue, bone, periosteum and lymph nodes, but unusual presentation sites have also been reported. Typically, MS evolves concurrently with active leukaemia or following remission, when it is known as secondary MS. But rarely MS can occur de novo without evidence of concomitant haematological disease. Herein, we report an unusual case of central nervous system-MS in a patient without evidence of concomitant haematological disease. In this case, progressive thoracic and lumbar pain with paraplegia ultimately led to the diagnosis of acute myeloid leukaemia. We also conducted a PubMed search for case reports, case series and reviews of past literature regarding central nervous system-MS and report our findings.

VIEW THE ENTIRE ARTICLE

References

  • Dores GM, Devesa SS, Curtis RE, MS Linet, Morton LM. Acute leukemia incidence and patient survival among children and adults in the United States, 2001-2007. Blood 2012;119(1):34–43.
  • Goyal G, Bartley AC, Patnaik MM, Litzow MR, Al-Kali A, Go RS. Clinical features and outcomes of extramedullary myeloid sarcoma in the United States: analysis using a national data set. Blood Cancer J 2017;7(8):e592.
  • Burns A (ed.). Observations of surgical anatomy. In: Head and neck. London, UK:Royce; 1811, p. 364.
  • King A. A case of chloroma. Monthly J Med 1853;17:97.
  • Rappaport H. Tumors of the hematopoietic system. In: Atlas of tumor pathology. Washington, DC: Armed Forces Institute of Pathology; 1967, Section III, Fascicle 8.
  • Bakst RL, Tallman MS, Douer D, Yahalom J. How I treat extramedullary acute myeloid leukemia. Blood 2011;118:3785–3793.
  • Breccia M, D'Andrea M, Mengarelli A, Morano SG, D'Elia GM, Alimena G. Granulocytic sarcoma of the pancreas successfully treated with intensive chemotherapy and stem cell transplantation. Eur J Haematol 2003;70:190–192.
  • Fitoz S, Atasoy C, Yavuz K, Gozdasoglu S, Erden I, Akyar S. Granulocytic sarcoma. Cranial and breast involvement. Clin Imaging 2002;26:166–169.
  • Aki H, Baslar Z, Uygun N, Ozguroglu M, Tuzuner N. Primary granulocytic sarcoma of the urinary bladder: case report and review of the literature. Urology 2002;60:345.
  • Pileri SA, Ascani S, Cox MC, Campidelli C, Bacci F, Piccioli M, et al. Myeloid sarcoma: clinico-pathologic, phenotypic and cytogenetic analysis of 92 adult patients. Leukemia 2007;21(2):340–350.
  • Almond LM, Charalampakis M, Ford SJ, Gourevitch D, Desai A. Myeloid sarcoma: presentation, diagnosis, and treatment. Clin Lymphoma Myeloma Leuk 2017;17(5):263–267.
  • Yang C, Liu Y, Li G, Bai J. Multifocal myeloid sarcoma in the central nervous system without leukemia. Clin Neurol Neurosurg 2014;120:99–102.
  • Cervantes GM, Cayci Z. Intracranial CNS manifestations of myeloid sarcoma in patients with acute myeloid leukemia: review of the literature and three case reports from the author’s institution. J Clin Med 2015;4(5):1102–1112.
  • Piñán MA, Ardanaz MT, Guinea JM, García-Ruiz JC. Myeloid sarcoma preceding an acute promyelocytic leukaemia with neuromeningeal infiltration. Ann Hematol 2014;93(2):339–340.
  • Widhalm G, Dietrich W, Müllauer L, Streubel B, Rabitsch W, Kotter MR, et al. Myeloid sarcoma with multiple lesions of the central nervous system in a patient without leukemia. Case report. J Neurosurg 2006;105(6):916–919.
  • Yang B, Yang C, Fang J, Yang J, Xu Y. Clinicoradiological characteristics, management and prognosis of primary myeloid sarcoma of the central nervous system: a report of four cases. Oncol Lett 2017;14(3):3825–3831.
  • Cuglievan B, Menegaz BA, Garces S, Rytting ME. Acute myeloid leukaemia masquerading as a primary CNS tumour. BMJ Case Rep 2017;2017:bcr-2017-220891.
  • Imrie KR, Kovacs MJ, Selby D, Lipton J, Patterson BJ, Pantalony D, et al. Isolated chloroma: the effect of early antileukemic therapy. Ann Intern Med1995;123(5):351–353.
  • Olar A, Lapadat R, Davidson CJ. Central nervous system involvement by myeloid sarcoma: a report of 12 cases and review of the literature. Clin Neuropathol 2016;35(5):314–325.
  • Gill AS, Gill R, Kaloostian P. Intracranial myeloid sarcoma metastasis mimicking acute subdural hematoma. Case Rep Surg 2017;2017:3056285.
  • Novello M, Coli A, Della Pepa GM. Myeloid sarcoma with megakaryoblastic differentiation mimicking a sellar tumor. Neuropathology 2014;34(2):179–184.
  • Palejwala AH, O'Connor KP, Shi H. Chronic myeloid leukemia manifested as myeloid sarcoma: review of literature and case report. J Clin Neurosci 2019;64:269–276.
  • Takhenchangbam DS, Laishram RS, Thoudem TS. Proptosis and facial palsy as an unusual clinical presentation of acute myeloid leukemia. Iran J Cancer Prev 2013;6(1):52–54.
  • Heath JL, Aumann WK, Maxfield CM, Wechsler DS. Isolated central nervous system chloroma as a presenting sign of relapsed pediatric acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2018;40(7):e442–e445.
  • Algharras AA, Mamourian A, Coyne T. Leukostasis in an adult with AML presenting as multiple high attenuation brain masses on CT. J Clin Diagn Res 2013;7(12):3020–3022.

    • Published: 2020-09-08

    Issue: Vol 7 No 11 (view)

    Section: Articles

    How to cite:
    1.
    Gupta V, Ajam F, Conte G, Al Hillan A, Al-Banaa K, Singh V, Levitt M. Liquid Presenting as Solid: A Rare Presentation of Acute Myeloid Leukaemia as a Solid Epidural Mass. EJCRIM 2020;7 doi:10.12890/2020_001802.