Megakaryoblastic leukemia presenting as a temporal bone granulocytic sarcoma

Case report

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✓ The unusual presentation of acute megakaryoblastic leukemia as a temporal bone granulocytic sarcoma in an infant without systemic manifestations of leukemia is reviewed. Leukemia should be considered in the differential diagnosis of skull and skull-based lesions since the appearance on neuroradiological imaging is not unique in this diagnosis. Surgical treatment, as in this case, is limited to obtaining tissue for diagnosis and draining the infection.

Article Information

Address reprint requests to: Bruce A. Kaufman, M.D., Department of Neurosurgery, St. Louis Children's Hospital, 400 South Kingshighway, St. Louis, Missouri 63110.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left: Computerized tomography (CT) scan after intravenous administration of contrast material. The tumor extends from the middle to the posterior fossa, with minimal contrast enhancement. A hyperdense mass on the uncontrasted study is not shown. The mastoid air cells have been obliterated. Right: High-resolution CT scan via bone windows defining the extensive destruction of the lateral temporal bone, mastoid air cells, and erosion through both tables of the skull with subcutaneous extension. The denser bone of the inner-ear structures is preserved.

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    T1-weighted magnetic resonance (MR) images (TR 800 msec, TE 22 msec, 5 mm thick). Left: Uncontrasted MR image, axial projection. The tumor gives a homogeneous signal and is slightly hypointense. The dural margin (black arrows) and erosion through the skull (open arrow) are easily appreciated. (The spotty increased signal in both temporal lobes is artifact.) Center: Gadolinium-enhanced MR image, coronal view. The tumor is diffusely enhanced, with its superior and inferior extent seen clearly. The extra-axial location and extension through the skull (arrow) is again easily appreciated. Cervical lymphadenopathy is also identified (asterisk). Right: Gadolinium-enhanced MR image, coronal view, after irradiation and chemotherapy. The tumor has involuted significantly, with only a small amount of tissue signal visible within the mastoid region (arrow).

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    Left: Photomicrograph of a section through the lymph node, showing metastatic tumor (asterisk) nearly obliterating the lymph tissue. H & E, × 150. Right: Photomicrograph of the bone marrow aspirate demonstrating atypical blasts with large nuclei and cytoplasmic projections. H & E, × 750.

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