A Patigaroo, S BANDAY, W RASHID, R MALIK, F Patigaroo, S Patigaroo
chloroma, granulocytic sarcoma gs, ihc, leukemia
A Patigaroo, S BANDAY, W RASHID, R MALIK, F Patigaroo, S Patigaroo. Isolated Granulocytic Sarcoma Of Head And Neck Region Without Any Marrow Involvement. The Internet Journal of Otorhinolaryngology. 2010 Volume 13 Number 2.
Granulocytic sarcoma is usually seen concomitantly with or subsequently to the appearance of leukemia but may rarely precede appearance of AML. Granulocytic sarcoma presenting as an isolated mass without any peripheral evidence of leukemia is very rare presentation and poses diagnostic and therapeutic challenges to the doctor .We report a case of fifty year old male presenting as isolated GS involving head and neck region without any marrow or peripheral evidence of leukemia.
Granulocytic sarcoma (GS) is a localized tumour composed of immature cells of granulocytic series that infiltrate the extra medullary tissues.The most common sites of involvement are bone, lymph node and skin. Most cases of GS occur with acute or chronic leukemia but it can occur with other myeloproliferative or myelodysplastic syndromes. Rarely the tumour may be diagnosed before diagnosis of any hematological disorder; most of them are harbingers of existing or impending acute myeloid leukemia.
A 50 year old male, hypertensive, diabetic presented to SKIMS with complains of headache, vomiting, neck pain, and weakness of left lower limb. His examination revealed power of grade 1 in the left lower limb with left plantar extensor. The rest of the examination was normal . The baseline investigations of the patient including CBC, PBF,LFT, KFT, ECG andCXR were normal. MRI (fig 1), PET Scan (Fig 2) was done preoperatively.
Subsequently the patient was operated and underwent left posterior far lateral occipital craniotomy with removal of foramen magnum condyl and left posterior arch of C1 and left C2 hemilaminectomy and decompression of SOL was done. Histopathology(fig 3) was done
IHC revealed stain for CD43 strongly positive in most of the immature cells while smaller number of cells are positive for CD68and . Tumour cells are negative for CD1a and CD3.Tumour cells were positive for myeloperoxidase
Thus a final diagnosis of isolated GS of head and neck region with no evidence of any leukemia was made. The patient received radiotherapy after surgery. He is doing well. Chemotherapy options are being discussed with the patient. MRI (Fig 5) after surgery and radiotherapy showed no definite evidence of residual or recurrent disease.
Granulocytic sarcoma was first described by the British physician A. Burns in 1811(1) .This name is derived from the Greek word
Isolated GS is a rare tumour. Response to chemo therapy and prognosis is better in isolated GS than when associated with AML. Systemic chemotherapy should be given to all patients with isolated GS .Radiotherapy and surgery should be reserved for only palliative intent.