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Case Reports
. 2017 Jun;30(3):269-273.
doi: 10.1177/1971400916689343. Epub 2017 Jan 30.

Diagnosis in subdural myeloid sarcoma

Alan Lackey  1   2 , Barbara Laing  2 , Andrew Perkins  2   3 , Michael Bryant  1   2
Affiliations
Case Reports

Diagnosis in subdural myeloid sarcoma

Alan Lackey et al. Neuroradiol J. 2017 Jun.

Abstract

Introduction A 74-year-old man presented to hospital with a headache, thrombocytopaenia and an acute deterioration in cognition on a background of acute monocytic leukaemia in remission. Method This is a case report with computed tomography (CT), magnetic resonance (MR) and histopathology imaging. Results Preoperative CT and limited MR demonstrated a subdural lesion with marked midline shift. Craniotomy performed for evacuation of the presumed subdural haematoma revealed a solid tumour-like lesion. Histopathology identified the presence of a myeloid sarcoma (chloroma). Postoperative MRI with contrast revealed the solid nature of the mass. Conclusion The use of contrast is critical in the assessment of intracranial lesions to distinguish myeloid sarcoma from subdural haematoma in the context of leukaemia and a neurologically deteriorating patient.

Keywords: Hematoma; acute; leukaemia; magnetic resonance imaging; myeloid; neuroimaging; sarcoma; subdural.

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Figures

Figure 1.
Figure 1.
Preoperative imaging: (a) Axial non-contrast computed tomography of the brain. (b) Axial magnetic resonance diffusion-weighted imaging sequence of the brain. (c) Axial magnetic resonance imaging – apparent diffusion coefficient sequence of the brain. (d) Axial magnetic resonance T2-weighted imaging of the brain.
Figure 2.
Figure 2.
Postoperative imaging: (a) Axial T1-weighted magnetic resonance imaging fluid-attenuated inversion recovery sequence of the brain. (b) Axial T2-weighted magnetic resonance of the brain.
Figure 3.
Figure 3.
Postoperative imaging: (a) Coronal T1-weighted magnetic resonance imaging with gadolinium of the brain – through the frontal lobe. (b) Coronal T1-weighted magnetic resonance imaging with gadolinium of the brain – through the temporal lobe. (c) Sagittal T1-weighted magnetic resonance imaging with gadolinium of the brain.
Figure 4.
Figure 4.
Postoperative imaging: (a) Axial T1-weighted magnetic resonance imaging with gadolinium of the brain. (b) Axial magnetic resonance susceptibility-weighted imaging of the brain.
Figure 5.
Figure 5.
Subdural lesion histopathology (a) Hematoxylin and eosin stain. (b) CD68 immunohistochemistry.
See this image and copyright information in PMC

References

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