Granulocytic sarcoma presenting as cauda equina syndrome

Granulocytic sarcoma (GS) is a tumour formed by myeloid precursors in an extramedullary site and is associated with myeloid leukaemias and other myeloproliferative disorders. We present a patient with symptoms of cauda equina compression where MRI of the spine showed extradural lesions at S1 and L3 levels. This patient had normal bone marrow and peripheral blood for a further 6 weeks from onset of symptoms. Such aleukaemic presentations of GS are rare and have potential for misdiagnosis and delay in treatment. Therefore we recommended early open biopsy of such tumours.