Intradural granulocytic sarcoma presenting as a lumbar radiculopathy

Case report

Fred S. C. Kim Department of Pathology, Toronto Western Hospital, Toronto, Ontario, Canada

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 M.D.
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James T. Rutka Department of Pathology, Toronto Western Hospital, Toronto, Ontario, Canada

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 M.D., Ph.D.
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Mark Bernstein Department of Pathology, Toronto Western Hospital, Toronto, Ontario, Canada

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 M.D., F.R.C.S.(C)
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Lothar Resch Department of Pathology, Toronto Western Hospital, Toronto, Ontario, Canada

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Ellen Warner Department of Pathology, Toronto Western Hospital, Toronto, Ontario, Canada

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Dominic Pantalony Department of Pathology, Toronto Western Hospital, Toronto, Ontario, Canada

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✓ Granulocytic sarcoma usually occurs in the setting of leukemia and myeloproliferative disorders. Rarely, it can occur in isolation at various anatomical sites without hematological evidence of leukemia. The unique case of an elderly man presenting with right L2–3 radiculopathy is described. Intradural granulocytic sarcoma of the L-2 and L-3 nerve roots with extradural extension was found at surgery and he was treated with incomplete resection and antileukemic chemotherapy. Local recurrence at 3 months was treated with irradiation. Granulocytic sarcoma is frequently misdiagnosed and invariably progresses to acute leukemia. The chloroacetic acid esterase, granulocytic immunohistochemical markers, and electron microscopy appearance can aid in diagnosis. The prognosis is improved with initial aggressive antileukemic chemotherapy and local irradiation.

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