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Granulocytic sarcoma of pediatric head and neck: an institutional experience
Brianne Barnett Roby1, Dennis Drehner, James D Sidman
1Children's Hospitals and Clinics of Minnesota, Children's Specialty Center, Minneapolis, MN 55404, USA. barne284@umn.edu
Insights
Granulocytic sarcoma in children
Area of Science:
- Pediatric Oncology
- Hematology
- Pathology
Background:
- Granulocytic sarcoma is a rare extramedullary tumor.
- It is often associated with acute myeloid leukemia (AML).
- Head and neck involvement in pediatric patients is uncommon.
Purpose of the Study:
- To present a case series of pediatric head and neck granulocytic sarcoma.
- To review the long-term outcomes of these patients.
- To emphasize the importance of considering granulocytic sarcoma in pediatric head and neck masses.
Main Methods:
- Retrospective search of a tertiary hospital pathology database.
- Inclusion criteria: biopsy-proven granulocytic sarcoma of the head and neck in pediatric patients.
- Data collected on diagnosis, treatment, and outcomes.
Main Results:
- Six cases identified between 1992 and 2004.
- Patient ages ranged from 22 months to 14 years.
- All patients had underlying acute myeloid leukemia (AML); diagnosis varied (de novo, pre-existing, or relapse).
- Treatment included induction chemotherapy and bone marrow transplantation.
- High mortality rate: 2 deaths during induction, 1 post-transplant relapse and death.
- Only 1 of 6 patients was disease-free at 2 years post-transplant.
Conclusions:
- Granulocytic sarcoma should be included in the differential diagnosis for pediatric head and neck tumors.
- All pediatric cases in this series were associated with acute myeloid leukemia (AML).
- The long-term prognosis for pediatric patients with granulocytic sarcoma and AML is poor.
Objective:
To demonstrate a case series of granulocytic sarcoma of the head and neck found in the pediatric population and review long-term outcomes.
Methods:
A pathology database at a tertiary hospital was searched for patients with biopsy specimens from the head and neck diagnosed as granulocytic sarcoma.
Results:
There were 6 cases between 1992 and 2004 that met inclusion criteria. Subjects' age ranged from 22 months to 14 years old. In three cases, the patients were diagnosed with acute myeloid leukemia (AML) based on biopsy results; 2 patients were already diagnosed with AML when diagnosed with granulocytic sarcoma, and in 1 case, a relapse of AML was diagnosed. In all cases, patients began induction chemotherapy. Two patients died during induction chemotherapy from infection. The remaining 4 patients underwent bone marrow transplants. One patient had a relapse post-transplant and died. Only one patient was healthy two years post-transplant.
Conclusion:
The results of this series suggest granulocytic sarcoma must be on the differential when tumors present in the head and neck region in pediatric patients. In our series, 100% of the patients with granulocytic sarcoma had underlying AML. The long-term prognosis of patients with AML who developed granulocytic sarcoma is quite poor.
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