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Myeloid Sarcoma: An Unusual Presentation of Acute Promyelocytic Leukemia Causing Spinal Cord Compression
Acute promyelocytic leukemia with concurrent myeloid sarcoma is a rare clinical event. Herein we describe a patient that presented with back pain and bilateral leg weakness caused by spinal cord compression due to extramedullary deposition of leukemic cells. Acute promyelocytic leukemia was suspected based on immunophenotypic findings of malignant cells in bone marrow aspirate. The diagnosis was confirmed by the presence of PML-RAR? fusion copies. MRI showed multiple hyperintense changes on the vertebral bodies, together with intraspinal masses causing spinal cord compression. The patient immediately underwent radiotherapy, and was treated with all-trans retinoic acid and idarubicin. Reassessment MRI showed complete resolution of all intraspinal masses and the disappearance of most of the bony lesions. Post-treatment bone marrow aspirate showed complete hematological and molecular remission. The motor power of his legs fully recovered from 0/5 to 5/5; however, sensory loss below the T4 level persisted.

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Authors: Tay Za Kyaw, Jayaranee A.s. Maniam, Ping Chong Bee, Edmund Fui Min Chin, Veera Sekaran Nadarajan, Hemalatha Shanmugam, Khairul Azmi Abd Kadir

Keywords: Miyeloid sarkom, Promiyelositik lösemi, Kord kompresyonu, Kloroma

  • Year: 2012
  • Number: 3
  • Referance No: 94809

  • Figure 1: T2 weighted MRI of the patient’s spine. (A+B): Images taken at presentation showing an intraspinal mass (white arrows) located extradurally between T2 and T4 vertebral bodies with multiple hyperintense bony lesions (black arrows) on T12, L1, L2, L4 and L5 vertebral bodies. (C+D): Images taken 1 month after treatment showing no evidence of intraspinal mass but the bony lesions on thoracic and lumbar vertebral bodies were persistent (black arrows). (E): Image taken after the third consolidation therapy showing a few residual bony lesions on L1 and L2 vertebral bodies (black arrows).
  • Figure 2: Flow cytometric immunophenotyping of the bone marrow aspirate showing leukemic cells which are CD45 (+), CD13 (+), CD117 (+), cytoplasmic MPO (+), CD34 (-), HLA-DR (-), CD22 (-) and cytoplasmic CD3 (-).
  • Figure 3: Diffuse infiltration of neoplastic cells in the bone marrow biopsy (H&E, x40). Immunohistochemical analysis of the infiltrating neoplastic cells showed positive reaction with CD117 (CD117 x40) and negative reaction with CD34 (CD34 x40) and HLA-DR (HLA-DR x40).

Copyright © 2013 TJH Atlas of Hematology. All rights reserved.