Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Isolated Recurrence of Intracranial Granulocytic Sarcoma Mimicking a Falx Meningioma in Acute Myeloblastic Leukemia

  • Cho, Won-Ho (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Choi, Young-Jin (Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Choi, Byung-Kwan (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Cha, Seung-Heon (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine)
  • Received : 2009.09.10
  • Accepted : 2010.05.03
  • Published : 2010.05.28
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Abstract

Intracranial granulocytic sarcomas are rare tumors, which are composed of immature granulocytic cells. Although it has been well known that these tumors are associated with acute myeloblastic leukemia (AML), they have been almost always related to bone marrow relapse. However, isolated recurrence of granulocytic sarcoma following complete remission from prior AML is extremely rare, especially in the central nervous system. A 44-year-old male presented with isolated recurrence of granulocytic sarcoma mimicking a falx meningioma two years after complete remission by allogenic peripheral blood stem cell transfusion (PBSCT) in the acute myelomonoblastic leukemia (FAB, M4). Because of depressed mental state and mass effect, total surgical resection was performed. Pathological findings were compatible with the granulocytic sarcoma. There was no evidence of leukemic relapse in the peripheral blood. We suggest that this phenomenon can be explained by the hypothesis that a certain barrier effect such as blood brain barrier might lead to the proliferation of intracranial leukemic cells which metastasized before PBSCT.

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References

  1. Byrd JC, Edenfield WJ, Dow NS, Aylesworth C, Dawson N : Extramedullary myeloid cell tumors in myelodysplastic-syndromes : not a true indication of impending acute myeloid leukemia. Leuk Lymphoma 21 : 153-159, 1996 https://doi.org/10.3109/10428199609067593
  2. Byrd JC, Edenfield WJ, Shields DJ, Dawson NA : Extramedullary myeloid cell tumors in acute nonlymphocytic leukemia : a clinical review. J Clin Oncol 13 : 1800-1816, 1995 https://doi.org/10.1200/JCO.1995.13.7.1800
  3. Byrd JC, Weiss RB : Recurrent granulocytic sarcoma. An unusual variation of acute myelogenous leukemia associated with 8; 21 chromosomal translocation and blast expression of the neural cell adhesion molecule. Cancer 73 : 2107-2112, 1994 https://doi.org/10.1002/1097-0142(19940415)73:8<2107::AID-CNCR2820730815>3.0.CO;2-W
  4. Freedy RM, Miller KD Jr : Granulocytic sarcoma (chloroma) : sphenoidal sinus and paraspinal involvement as evaluated by CT and MR. AJNR Am J Neuroradiol 12 : 259-262, 1991
  5. Huter O, Brezinka C, Nachbaur D, Schwaighofer H, Lang A, Niederwieser D : Successful treatment of primary extramedullary leukemia (EML) of the uterus with radical therapy, chemotherapy, autologous bone marrow transplantation (bmt) and prophylactic local irradiation. Bone Marrow Transplant 18 : 663-664, 1996
  6. Imrie KR, Kovacs MJ, Selby D, Lipton J, Patterson BJ, Pantalony D, et al. : Isolated chloroma : the effect of early antileukemic therapy. Ann Int Med 123 : 351-353, 1995 https://doi.org/10.7326/0003-4819-123-5-199509010-00005
  7. Koehler M : Granulocytic sarcoma of the stomach. Gastrointest Endosc 48 : 190, 1998 https://doi.org/10.1016/S0016-5107(98)70162-2
  8. Mahendra P, Ager S, Bedlow AJ, Bloxham DM, Green AR, Marcus RE : Two unusual neurological presentations of granulocytic sarcoma in Philadelphia positive chronic myeloid leukemia. Leuk Lymphoma 15 : 351-355, 1994 https://doi.org/10.3109/10428199409049735
  9. Meis JM, Butler JJ, Osborne BM, Manning JT : Granulocytic sarcoma in nonleukemic patients. Cancer 58 : 2697-2709, 1986 https://doi.org/10.1002/1097-0142(19861215)58:12<2697::AID-CNCR2820581225>3.0.CO;2-R
  10. Neiman RS, Barcos M, Berard C, Bonner H, Mann R, Rydell RE, et al. : Granulocytic sarcoma : a clinicopathologic study of 61 biopsied cases. Cancer 48 : 1426-1437, 1981 https://doi.org/10.1002/1097-0142(19810915)48:6<1426::AID-CNCR2820480626>3.0.CO;2-G
  11. Nishimura S, Kyuma Y, Kamijo A, Maruta A : Isolated recurrence of granulocytic sarcoma manifesting as extra- and intracranial masses-- case report. Neurol Med Chir (Tokyo) 44 : 311-316, 2004 https://doi.org/10.2176/nmc.44.311
  12. Parker K, Hardjasudarma M, McClellan RL, Fowler MR, Milner JW : MR features of an intracerebellar chloroma. AJNR Am J Neuroradiol 17 : 1592-1594, 1996
  13. Pomerantz SJ, Hawkins HH, Towbin R, Lisberg WN, Clark RA : Granulocytic sarcoma (chloroma) : CT manifestations. Radiology 155 : 167-170, 1985 https://doi.org/10.1148/radiology.155.1.3856292
  14. Pui MH, Fletcher BD, Langston JW : Granulocytic sarcoma in childhood leukemia : imaging features. Radiology 190 : 698-702, 1994 https://doi.org/10.1148/radiology.190.3.8115614
  15. Sandhu GS, Ghufoor K, Gonzalez-Garcia J, Elexpuru-Camiruaga JA : Granulocytic sarcoma presenting as cauda equine syndrome. Clin Neurol Neurosurg 100 : 205-208, 1998 https://doi.org/10.1016/S0303-8467(98)00021-3
  16. Sao IS, Hull MT, Pak HY : Granulocytic sarcoma of the cervix as a primary manifestation : case without overt leukemia features for 26 months. Cancer 40 : 3030-3037, 1977 https://doi.org/10.1002/1097-0142(197712)40:6<3030::AID-CNCR2820400640>3.0.CO;2-#
  17. Sowers JJ, Moody DM, Naidich TP, Ball MR, Laster DW, Leeds NE : Radiographic features of granulocytic sarcoma (chloroma). J Comput Assist Tumogr 3 : 226-233, 1979 https://doi.org/10.1097/00004728-197904000-00015
  18. Stork JT, Cigtay OS, Schellinger D, Jacobson RJ : Recurrent chloromas in acute myelogenous leukemia. AJR Am J Roentgenol 142 : 777-778, 1984 https://doi.org/10.2214/ajr.142.4.777
  19. Yamamoto K, Hamaguchi H, Nagata H, Hara M, Tone O, Tomita H, et al. : Isolated recurrence of granulocytic sarcoma of the brain : successful treatment with surgical resection, intrathecal injection, irradiation and prophylactic systemic chemotherapy. Jpn J Clin Oncol 29 : 214-218, 1999 https://doi.org/10.1093/jjco/29.4.214

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