- Email: [email protected]
Isolated spinal myeloid sarcoma with rapid progression
Accepted Manuscript Title: Isolated spinal myeloid sarcoma with rapid progression Author: Chenlong Yang, Jingyi Fang, Yulun Xu PII: DOI: Reference:
S1529-9430(16)00307-7 http://dx.doi.org/doi: 10.1016/j.spinee.2016.01.193 SPINEE 56858
To appear in:
The Spine Journal
Please cite this article as: Chenlong Yang, Jingyi Fang, Yulun Xu, Isolated spinal myeloid sarcoma with rapid progression, The Spine Journal (2016), http://dx.doi.org/doi: 10.1016/j.spinee.2016.01.193. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
Title Page
2
Isolated spinal myeloid sarcoma with rapid progression
3
Chenlong Yanga, M.D.
4
Jingyi Fangb, Ph.D.
5
Yulun Xua,*, M.D., Ph.D.
6
a
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical
7
University, No. 6, Tiantan Xili, Dongcheng District, Beijing 100050, China; China
8
National Clinical Research Center for Neurological Diseases, Beijing 100050,
9
China.
10
b
11
Medical University, No.6, Tiantan Xili, Dongcheng District, Beijing 100050, China.
Department of Neuro-pathology, Beijing Neurosurgical Institute, Capital
12 13
*Correspondence to: Prof. Yulun Xu, M.D., Ph.D.
14
Address: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical
15
University, No. 6, Tiantan Xili, Dongcheng District, Beijing 100050, China.
16
Tel: +86-13501285331, Fax: +86-10-6709-6523;
17
Email: [email protected]
18 19
E-mail of all other authors:
20
Chenlong Yang: [email protected]
21
Jingyi Fang: [email protected]
22 23
STUDY FUNDING:
24
No targeted funding reported.
25
DISCLOSURE:
26
The authors report no disclosures relevant to the manuscript.
27
Keywords: myeloid sarcoma; spinal tumor; leukemia 1 Page 1 of 4
1
A 33-year-old woman presented with a one-week history of left back pain and
2
paraplegia of lower extremities. Laboratory data were all within normal limits.
3
Neurological examination revealed a complete loss of sensation below the T10
4
dermatome, and muscle strength of grade 0/5 in lower extremities. Her spinal
5
magnetic resonance imaging (MRI) demonstrated a mass in the spinal canal at
6
T8–T10 (Fig. 1). The spinal computed tomography (CT) revealed the lesion was
7
isodense, and no bone destruction was noted (Fig. 2A–C). The tumor was sub-totally
8
resected. Immunohistological examination showed myeloid sarcoma (Fig. 2D–E), with
9
positive staining for myeloperoxidase (MPO), leukocyte common antigen (LCA),
10
CD10, CD34, CD56, CD68, CD99, CD117 and lysozyme; the Ki–67 labeling index
11
was approximately 60%. Postoperatively, the neurological defects remained, and the
12
repeated laboratory examinations were normal. While just four days after discharge,
13
she was readmitted to the local institution with multi-system mucocutaneous
14
hemorrhages,
15
ecchymosis. The laboratory tests revealed severe thrombocytopenia, anemia and
16
leukopenia, and thus a crisis of acute myelogenous leukemia was considered.
17
Unfortunately, she succumbed to the disease two days later.
manifesting
as
hematemesis,
hematochezia,
hematuria,
and
18
Myeloid sarcoma (MS) can rarely occur in patients without any evidence of
19
leukemia and may precede the development of systemic disease [1]. Isolated spinal
20
MS is exceedingly rare, which has been described only in a few case reports with
21
variable prognosis [2,3]. The aggressive clinical course and rapid progression with a
2 Page 2 of 4
1
fatal outcome in this case should be highlighted. It is crucial for the clinicians to be
2
aware of the potential leukemic risks in patients with MS. Once MS was identified
3
histologically, a systematical hematological evaluation is necessary, and an early
4
chemotherapy may be helpful for reversing the poor prognosis.
5 6
REFERENCES:
7
[1] Piñán MA, Ardanaz MT, Guinea JM, García-Ruiz JC. Myeloid sarcoma preceding
8
an acute promyelocytic leukaemia with neuromeningeal infiltration. Ann Hematol.
9
2014;93:339-40.
10 11
[2] Chamberlain MC, Tredway TL, Born D, Fink J. Teaching NeuroImages: sacral spine chloroma. Neurology. 2013;81:e87
12
[3] Baikaidi M, Chung SS, Tallman MS, Damon LE, Walker AR, Marcucci G, Sholi AM,
13
Morris GJ. A 75-year-old woman with thoracic spinal cord compression and
14
chloroma (granulocytic sarcoma). Semin Oncol. 2012;39:e37-46.
3 Page 3 of 4
1
FIGURE LEGENDS:
2
Figure 1: The spinal magnetic resonance images revealed an epidural mass at
3
T8–T10 level with isointensity on both T1-weighted (A) and T2-weighed (B&C) images.
4
The tumor extended through the left intervertebral foramens (C). The sagittal (D),
5
coronal (E), and axial (F) enhanced T1-weighted images demonstrated a
6
homogeneous contrast enhancement.
7 8
Figure 2: The spinal computed tomography (CT) revealed an isodense lesion (A; B
9
for locating). The three-dimensional bony reconstruction showed no bone destruction
10
(C). Pathological H&E stain of the resected tissue revealed myeloid sarcoma (D x200;
11
E x400).
4 Page 4 of 4
S1529-9430(16)00307-7 http://dx.doi.org/doi: 10.1016/j.spinee.2016.01.193 SPINEE 56858
To appear in:
The Spine Journal
Please cite this article as: Chenlong Yang, Jingyi Fang, Yulun Xu, Isolated spinal myeloid sarcoma with rapid progression, The Spine Journal (2016), http://dx.doi.org/doi: 10.1016/j.spinee.2016.01.193. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
Title Page
2
Isolated spinal myeloid sarcoma with rapid progression
3
Chenlong Yanga, M.D.
4
Jingyi Fangb, Ph.D.
5
Yulun Xua,*, M.D., Ph.D.
6
a
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical
7
University, No. 6, Tiantan Xili, Dongcheng District, Beijing 100050, China; China
8
National Clinical Research Center for Neurological Diseases, Beijing 100050,
9
China.
10
b
11
Medical University, No.6, Tiantan Xili, Dongcheng District, Beijing 100050, China.
Department of Neuro-pathology, Beijing Neurosurgical Institute, Capital
12 13
*Correspondence to: Prof. Yulun Xu, M.D., Ph.D.
14
Address: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical
15
University, No. 6, Tiantan Xili, Dongcheng District, Beijing 100050, China.
16
Tel: +86-13501285331, Fax: +86-10-6709-6523;
17
Email: [email protected]
18 19
E-mail of all other authors:
20
Chenlong Yang: [email protected]
21
Jingyi Fang: [email protected]
22 23
STUDY FUNDING:
24
No targeted funding reported.
25
DISCLOSURE:
26
The authors report no disclosures relevant to the manuscript.
27
Keywords: myeloid sarcoma; spinal tumor; leukemia 1 Page 1 of 4
1
A 33-year-old woman presented with a one-week history of left back pain and
2
paraplegia of lower extremities. Laboratory data were all within normal limits.
3
Neurological examination revealed a complete loss of sensation below the T10
4
dermatome, and muscle strength of grade 0/5 in lower extremities. Her spinal
5
magnetic resonance imaging (MRI) demonstrated a mass in the spinal canal at
6
T8–T10 (Fig. 1). The spinal computed tomography (CT) revealed the lesion was
7
isodense, and no bone destruction was noted (Fig. 2A–C). The tumor was sub-totally
8
resected. Immunohistological examination showed myeloid sarcoma (Fig. 2D–E), with
9
positive staining for myeloperoxidase (MPO), leukocyte common antigen (LCA),
10
CD10, CD34, CD56, CD68, CD99, CD117 and lysozyme; the Ki–67 labeling index
11
was approximately 60%. Postoperatively, the neurological defects remained, and the
12
repeated laboratory examinations were normal. While just four days after discharge,
13
she was readmitted to the local institution with multi-system mucocutaneous
14
hemorrhages,
15
ecchymosis. The laboratory tests revealed severe thrombocytopenia, anemia and
16
leukopenia, and thus a crisis of acute myelogenous leukemia was considered.
17
Unfortunately, she succumbed to the disease two days later.
manifesting
as
hematemesis,
hematochezia,
hematuria,
and
18
Myeloid sarcoma (MS) can rarely occur in patients without any evidence of
19
leukemia and may precede the development of systemic disease [1]. Isolated spinal
20
MS is exceedingly rare, which has been described only in a few case reports with
21
variable prognosis [2,3]. The aggressive clinical course and rapid progression with a
2 Page 2 of 4
1
fatal outcome in this case should be highlighted. It is crucial for the clinicians to be
2
aware of the potential leukemic risks in patients with MS. Once MS was identified
3
histologically, a systematical hematological evaluation is necessary, and an early
4
chemotherapy may be helpful for reversing the poor prognosis.
5 6
REFERENCES:
7
[1] Piñán MA, Ardanaz MT, Guinea JM, García-Ruiz JC. Myeloid sarcoma preceding
8
an acute promyelocytic leukaemia with neuromeningeal infiltration. Ann Hematol.
9
2014;93:339-40.
10 11
[2] Chamberlain MC, Tredway TL, Born D, Fink J. Teaching NeuroImages: sacral spine chloroma. Neurology. 2013;81:e87
12
[3] Baikaidi M, Chung SS, Tallman MS, Damon LE, Walker AR, Marcucci G, Sholi AM,
13
Morris GJ. A 75-year-old woman with thoracic spinal cord compression and
14
chloroma (granulocytic sarcoma). Semin Oncol. 2012;39:e37-46.
3 Page 3 of 4
1
FIGURE LEGENDS:
2
Figure 1: The spinal magnetic resonance images revealed an epidural mass at
3
T8–T10 level with isointensity on both T1-weighted (A) and T2-weighed (B&C) images.
4
The tumor extended through the left intervertebral foramens (C). The sagittal (D),
5
coronal (E), and axial (F) enhanced T1-weighted images demonstrated a
6
homogeneous contrast enhancement.
7 8
Figure 2: The spinal computed tomography (CT) revealed an isodense lesion (A; B
9
for locating). The three-dimensional bony reconstruction showed no bone destruction
10
(C). Pathological H&E stain of the resected tissue revealed myeloid sarcoma (D x200;
11
E x400).
4 Page 4 of 4