Isolated recurrence of intracerebral granulocytic sarcoma in acute lymphoblastic leukemia: a case report
Sun-Ho Lee1, Jaechan Park, Sung-Kyoo Hwang
1Department of Neurosurgery, School of Medicine, Kyungpook National University, 50 samduk-2-ga, 700-721, Jung-gu, Daegu, Republic of Korea.
Insights
This study reports a rare case of granulocytic sarcoma (chloroma) in the brain of a patient with acute lymphoblastic leukemia. This intracranial tumor presented as an isolated recurrence, highlighting a rare manifestation of central nervous system relapse.
Area of Science:
- Neuro-oncology
- Hematology
- Leukemia Research
Background:
- Intracranial granulocytic sarcoma (chloroma) is a rare extramedullary manifestation of leukemia, typically associated with acute myelogenous leukemia.
- Central nervous system (CNS) relapse in leukemia can present with diverse clinical and radiological features.
Observation:
- A 27-year-old male, in complete remission from acute lymphoblastic leukemia (ALL), presented with symptoms of increased intracranial pressure, including severe headache and blurred vision.
- Brain magnetic resonance imaging revealed an enhanced intraaxial mass in the right temporal region, initially misdiagnosed as an extraaxial tumor.
Findings:
- Open biopsy and surgical resection confirmed the mass as an intraaxial lymphoblastic leukemia infiltration, indicating a CNS relapse.
- This case represents a rare instance of intraparenchymal granulocytic sarcoma occurring in the context of acute lymphoblastic leukemia, challenging typical associations.
Implications:
- This case underscores the importance of considering rare presentations of leukemia relapse, even in patients with ALL.
- Accurate diagnosis of intracranial masses in leukemia patients is crucial for appropriate treatment and management of CNS involvement.
- Further research into the mechanisms and management of granulocytic sarcoma in ALL may improve patient outcomes.
Abstract:
Intracranial granulocytic sarcoma (chloroma) may occur rarely in leukemia. A 27-year-old male presented with an isolated recurrence of granulocytic sarcoma manifesting as an intraaxial mass 27 months after complete remission of acute lymphoblastic leukemia. He was admitted due to a severe headache and blurred vision. Brain magnetic resonance imaging demonstrated an enhanced mass which was initially interpreted as an extraaxial tumor in the right temporal region. Because of increased intracranial pressure and the mass effect, open biopsy with surgical resection was performed. The biopsy result indicated that intraaxial lymphoblastic leukemia infiltration had caused CNS relapse. Although granulocytic sarcoma occurs primarily in patients with acute myelogenous leukemia, the authors report a rare case of intraparenchymal granulocytic sarcoma in acute lymphoblastic leukemia.
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