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Granulocytic sarcoma as a cause of cord compression
Clinical Radiology (1997) 52, 803-805
Correspondence Letters are published at the discretion of the Editor. Opinions expressed by correspondents are not necessarily those ~?fthe Editor. Unduly long letters may be returned to the authors for shortening. Letters in response to a paper may be sent to the author of the paper so that the reply can be published in the same issue. Letters should be typed double spaced and should be signed by all authors personally. References should be given in the style specified in the Instructions to Authors at the front of the Journal.
GRANULOCYTIC S A R C O M A AS A CAUSE OF C O R D COMPRESSION SIR - We read with interest the case report of Sajjad et al. [1] describing granulocyfic sarcoma presenting as acute cord compression in a previously undiagnosed patient. We recently saw a patient with disseminated granulocytic sarcoma deposits who also developed cord compression. A 32-year-old man was diagnosed as having chronic myeloid leukaemia in 1994, having presented with fatigue, weight loss and splenomegaly. He received an allogenic bone marrow transplant in 1995 which unfortunately failed. More recently he had received two donor leucocyte transfusions from a sibling, in addition to hydroxyurea. This was successful in producing some reduction in the neutrophil count but shortly afterwards he presented with right shoulder pain. Plain films demonstrated a right apical pleural based mass associated with some erosion of the fourth rib (Fig. 1). Computed tomography showed this to be a lobulated pleural mass and a paravertebral mass. Prior to biopsy of this pleural lesion the patient developed sudden proptosis of the left eye associated with some headache. MRI was performed and showed a lesion centred on the greater wing of the sphenoid, extending forwards into the orbit, medially into the superior orbital fissure and posteriorly into the middle cranial fossa (Fig. 2). Biopsy of the pleural mass confirmed solid deposits of granulocytic sarcoma. A week following the onset of orbital signs the patient developed sudden urinary symptoms and leg weakness. MRI demonstrated multiple tumour deposits within the spinal canal and vertebral column (Fig. 3). Palliative radiotherapy was given with no improvement. The patient died shortly afterwards from bronchopneumonia. As discussed by Sajjad et al. [1], granulocytic sarcoma (chloroma) is a very uncommon manifestation of neoplastic disease of myeloid cells. It is more frequent in children or young adults and most commonly involves the skull, facial bones and axial skeleton. Unlike the patient described by Sajjad et al., our patient had a proven diagnosis of chronic myeloid leukaemia, although we can find no previous report of a pleural granulocytic sarcoma mass associated with rib destruction. This case demonstrates that extensive dissemination can occur and should be considered in patients when known disorders of myeloid stem cells develop focal lesions. J. M. WIDE J. CURTIS
Fig. 2 - Axial Tl-weighted images of the left orbit with gadolinium enhancement demonstrating an extraconal and intracranial tumour deposit.
Department of Radiology Royal Liverpool University Hospital Liverpool, UK
Fig. 3 - Sagittal T2-weighted images of the thoracic spine showing multiple spinal deposits and cord compression.
References
Fig. 1 - Apical pleural mass with associated rib erosion and paravertebral shadowing.
© 1997 The Royal College of Radiologists.
1 Sajjad Z, Haq N, Kandula V. Case report: granulocytic sarcoma (GS) presenting as acute cord compression in a previously undiagnosed patient. Clinical Radiology 1997;52:69-71.
Correspondence Letters are published at the discretion of the Editor. Opinions expressed by correspondents are not necessarily those ~?fthe Editor. Unduly long letters may be returned to the authors for shortening. Letters in response to a paper may be sent to the author of the paper so that the reply can be published in the same issue. Letters should be typed double spaced and should be signed by all authors personally. References should be given in the style specified in the Instructions to Authors at the front of the Journal.
GRANULOCYTIC S A R C O M A AS A CAUSE OF C O R D COMPRESSION SIR - We read with interest the case report of Sajjad et al. [1] describing granulocyfic sarcoma presenting as acute cord compression in a previously undiagnosed patient. We recently saw a patient with disseminated granulocytic sarcoma deposits who also developed cord compression. A 32-year-old man was diagnosed as having chronic myeloid leukaemia in 1994, having presented with fatigue, weight loss and splenomegaly. He received an allogenic bone marrow transplant in 1995 which unfortunately failed. More recently he had received two donor leucocyte transfusions from a sibling, in addition to hydroxyurea. This was successful in producing some reduction in the neutrophil count but shortly afterwards he presented with right shoulder pain. Plain films demonstrated a right apical pleural based mass associated with some erosion of the fourth rib (Fig. 1). Computed tomography showed this to be a lobulated pleural mass and a paravertebral mass. Prior to biopsy of this pleural lesion the patient developed sudden proptosis of the left eye associated with some headache. MRI was performed and showed a lesion centred on the greater wing of the sphenoid, extending forwards into the orbit, medially into the superior orbital fissure and posteriorly into the middle cranial fossa (Fig. 2). Biopsy of the pleural mass confirmed solid deposits of granulocytic sarcoma. A week following the onset of orbital signs the patient developed sudden urinary symptoms and leg weakness. MRI demonstrated multiple tumour deposits within the spinal canal and vertebral column (Fig. 3). Palliative radiotherapy was given with no improvement. The patient died shortly afterwards from bronchopneumonia. As discussed by Sajjad et al. [1], granulocytic sarcoma (chloroma) is a very uncommon manifestation of neoplastic disease of myeloid cells. It is more frequent in children or young adults and most commonly involves the skull, facial bones and axial skeleton. Unlike the patient described by Sajjad et al., our patient had a proven diagnosis of chronic myeloid leukaemia, although we can find no previous report of a pleural granulocytic sarcoma mass associated with rib destruction. This case demonstrates that extensive dissemination can occur and should be considered in patients when known disorders of myeloid stem cells develop focal lesions. J. M. WIDE J. CURTIS
Fig. 2 - Axial Tl-weighted images of the left orbit with gadolinium enhancement demonstrating an extraconal and intracranial tumour deposit.
Department of Radiology Royal Liverpool University Hospital Liverpool, UK
Fig. 3 - Sagittal T2-weighted images of the thoracic spine showing multiple spinal deposits and cord compression.
References
Fig. 1 - Apical pleural mass with associated rib erosion and paravertebral shadowing.
© 1997 The Royal College of Radiologists.
1 Sajjad Z, Haq N, Kandula V. Case report: granulocytic sarcoma (GS) presenting as acute cord compression in a previously undiagnosed patient. Clinical Radiology 1997;52:69-71.