Granulocytic sarcoma (chloroma): CT manifestations

Area of Science:

• Oncology
• Radiology
• Hematology

Background:

• Chloroma, also known as granulocytic sarcoma, represents extramedullary tumorous infiltrations of myelogenous leukemia cells.
• It can be the initial or isolated manifestation of leukemia, even during bone marrow remission.

Purpose of the Study:

• To review the computed tomography (CT) findings of chloroma in eight patients.
• To describe the characteristic appearances of chloroma on CT across different anatomical locations.
• To emphasize the importance of accurate diagnosis for guiding treatment decisions.

Main Methods:

• Retrospective review of eight cases of histologically confirmed chloroma.
• Analysis of CT scans to characterize the size, enhancement patterns, and location of chloroma lesions.
• Correlation of imaging findings with clinical presentation and bone marrow status.

Main Results:

• Chloroma involvement was observed in lymph nodes, subcutaneous tissues, peritoneum, pleural space, pelvis, and portal hepatis.
• Two patients presented with chloroma as the only sign of disease during bone marrow remission.
• Extracranial chloroma typically appeared as small, non-enhancing nodular densities mimicking lymphoma on CT.
• Cranial involvement predominantly affected the orbit.
• Central nervous system presentations were variable, including high-attenuation masses resembling lymphoma, hematoma, or metastatic neuroblastoma.

Conclusions:

• Chloroma has a diverse CT appearance, often mimicking other malignancies or conditions.
• Early recognition of chloroma on CT is vital for appropriate management.
• Radiation therapy is frequently the preferred treatment for localized chloroma, distinguishing it from systemic chemotherapy for leukemia.