Multiple Granulocytic Sarcomas in a Patient with Longstanding Complete Remission of Acute Myelogenous Leukemia

Granulocytic sarcoma is an extramedullary tumor composed of granulocytic precursor cells. It usually presents as a nodular mass in the course of acute myelogenous leukemia. Rarely, the tumor develops in non-hematological conditions or in a patient with complete remission from the acute myelogenous leukemia. In such cases, aleukemic granulocytic sarcoma can be a preceding sign of systemic leukemia or a first sign of hematologic relapse of leukemia. We present an unusual case of multiple granulocytic sarcomas developed in a patient with longstanding complete remission of acute myelogenous leukemia, who has not had bone marrow and peripheral blood involvement for a long time.

Ultrasound and MR Findings of Aleukemic Leukemia Cutis in a Patient with Complete Remission of Acute Lymphoblastic Leukemia: A Case Report

Aleukemic leukemia cutis is an extremely rare condition characterized by the infiltration of leukemic cells in skin without blasts in the peripheral blood. Leukemia cutis is considered a grave prognostic sign, thus early diagnosis is important. Leukemia cutis usually occurs in patients with myeloid leukemia. To the best of our knowledge, there has been no report regarding the radiological findings of aleukemic leukemia cutis, which is probably due to the presence of the skin changes in most patients. We report the ultrasound and MR findings of aleukemic leukemia cutis, even without the skin manifestation in patients with a history of complete remission of the acute lymphoblastic leukemia following an allogeneic peripheral blood stem cell transplantation.

A Case of Aleukemic Leukemia Cutis

Aleukemic leukemia cutis is a rare condition characterized by invasion of leukemic cells in the skin before their appearance in the peripheral blood or bone marrow. We report a case of a 24-year-old man who presented with a 2-month history of nodules on his chin and left thigh. His medical history included acute myelocytic leukemia which had been in complete remission for 13 years and seminoma of the right testis which had been treated with orchiectomy 1 year before. Biopsy of the cutaneous lesions revealed infiltrating cells characterized by irregular shaped or kidney bean-shaped nuclei with abundant pale, slightly eosinophilic cytoplasm. These atypical cells stained positive for leukocyte common antigen, lysozyme and myeloperoxidase. His peripheral blood examination and bone marrow biopsy failed to demonstrate leukemic changes. With these results, a diagnosis of aleukemic leukemia cutis was made. We then performed another immunohistochemical stain for lysozyme and myeloperoxidase on the testicular specimen which had been diagnosed as seminoma 1 year previously. The tumor cells of seminoma were lysozyme- and myeloperoxidase-positive. We were also able to diagnose seminoma as isolated granulocytic sarcoma. A complete remission of the cutaneous lesion was achieved with chemotherapy, but recurrent leukemia cutis reappeared six months later. He underwent a bone marrow transplant but died 3 months later.

A Case of Aleukemic Leukemia Cutis Occurring During Spontaneous Remission of Acute Myelomonocytic Leukemia / 대한피부과학회지

Aleukemic leukemia cutis is a rare condition characterized by the invasion of the skin by leukemic cells before their appearance in the peripheral blood. We report here a case, who had presented spontaneous remission of acute leukemia and 3 weeks later, have been relapsed in only the skin lesion without hematologic abnormalities. Through histopathological studies of skin lesion, the diagnosis of aleukemic leukemia cutis was made.