[Aleukemic chloroma. review of literature and diagnostic problems: 1 case]

The authors report the case of a 30-year-old man with granulocytic sarcoma of the chest wall presenting as a swelling with axillary lymphadenopathy followed by pleuropericardial effusions. The myeloblastic nature of the tumor cells was confirmed on the adenogram by the detection of granulations, rare Auer bodies and myeloperoxydase activity. It was confirmed by the presence of numerous granulations by electron microscopy and by that of a chloracetate esterase activity detected using Leder's protocol (9) on sections of material mounted in paraffin wax after formol fixation. Four marrow biopsies form different sites were normal. The course was fatal in six months, despite multiple chemotherapy, with massive invasion of the thorax by the tumor without the presence of myeloblasts in the circulating blood. The autopsy confirmed the preponderance of thoracic involvement (greenish in colour) and the presence of diffuse marrow myeloblastosis. In the light of this case, the rare instances (of the order of 10) of aleukaemic chloroma recorded in the literature are reviewed, emphasising the difficulties of diagnosis of these tumours and the ways in which they may be overcome.