Myeloid sarcoma with multiple lesions of the central nervous system in a patient without leukemia

Case report

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✓ The authors report the unusual case of a 35-year-old woman suffering from left leg numbness and radiculopathy due to multiple lesions in the central nervous system: one right parietal extracranial–intracranial lesion with invasion of the sensory cortex, and two intraspinal, intradural lesions compressing the spinal cord at T3–5 and S1–4. Biopsy sampling of the extracranial part of the parietal lesion led to a diagnosis of myeloid sarcoma. Further examination revealed no evidence of leukemic disease or myeloproliferative disorder. An aggressive multimodal approach to treatment in this patient with a combination of chemotherapy, whole-body radiotherapy, and allogeneic bone marrow transplantation was started immediately. The patient experienced full neurological recovery and complete disappearance of all lesions. At the 7-year follow-up examination, there was no evidence of disease. To the authors’ knowledge, this is the first report of a myeloid sarcoma with both intracranial and intraspinal manifestations in a patient without leukemia.

Abbreviations used in this paper:AML = acute myelogenous leukemia; CNS = central nervous system; EC–IC = extracranial–intracranial; MR = magnetic resonance.

Article Information

Address reprint requests to: Georg Widhalm, M.D., Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. email: georg.widhalm@meduniwien.ac.at.

© AANS, except where prohibited by US copyright law.

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Figures

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    Coronal (left) and sagittal (right) Gd-enhanced T1-weighted MR images showing a homogeneously enhancing EC–IC right parietal mass with invasion of the sensory cortex and a small subgaleal lesion in the occipital region.

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    Left: Sagittal T1-weighted MR image revealing an intraspinal, intradural, isodense mass between S-1 and S-4 (arrow). Right: Axial fat-saturation Gd-enhanced T1-weighted MR image demonstrating a homogeneously enhancing intraspinal, intradural, extramedullary lesion at T3–5 with significant compression of the spinal cord from the left dorsal aspect of the lesion.

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    Photomicrographs showing portions of tumor stained with H & E (A), myeloperoxidase (B), CD43 (C), and CD34 (D). Original magnification × 600.

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