Acute promyelocytic leukemia presenting as recurrent spinal myeloid sarcomas 3 years before developing leukemia: A case report with review of literature

Abstract

The de novo myeloid sarcoma (MS) type of acute promyelocytic leukemia (APL) is rare, and clinical features may differ from extramedullary diseases in advanced APL. Many cases occur as a spinal tumor, and some occur in the absence of bone-marrow diseases or coagulation abnormalities. Fluorescence in situ hybridization analysis of MS tissue is useful for accurate diagnosis, even in preserved tissue.

Keywords: acute promyelocytic leukemia; fluorescence in situ hybridization; myeloid sarcoma; spinal tumor.

Figure 1

A, Sagittal T2‐weighted magnetic resonance imaging of the spine. A tumor emerging from the vertebral bodies of L2 through L4 is present. In addition, high signal intensity in the vertebral bodies of Th12, L3‐L5 is evident. B, 18F‐fluoro‐deoxy‐glucose positron‐emission tomography image showing nodular uptakes in the vertebras, ribs, pelvis, and femur. Standardized uptake value given as the maximum pixel value in the tumor was 3.54 at the right pelvis, where it was increased the most

Figure 2

Hematoxylin‐eosin–stained section of the vertebral mass. Tumor cells with eosinophilic cytoplasm are diffusely infiltrating the bone tissue (original magnification ×100)

Figure 3

Bone‐marrow smear of second relapse phase (May‐Grunwald Giemsa stain, original magnification ×400). A, Proliferation of aberrant promyelocytes. B, The faggot cell (arrow, ×1000).