Diagnosis and surgical treatment of primary isolated aggressive lumbar myeloid sarcoma: a rare case report and review of the literatures

Abstract

Background: Myeloid sarcoma is a rare, extramedullary, solid tumor derived from immature myeloid cell precursors. It is most frequently accompanied by acute myelogenous leukemia, though infrequently found in non-acute myelogenous leukemia patients. The tumor may involve any part of the body, but the lumbar spine is seldom involved. The present case study aims to understand the diagnosis and surgical treatment of a rare primary isolated myeloid sarcoma of the lumbar spine causing aggressive spinal cord compression in a non-acute myelogenous leukemia patient.

Case presentation: A 29-year-old man complained of an aggressive radiating pain to the lower extremities and moderate dysuria with a Visual Analogue Scale score that gradually increased from 3 to 8. Lumbar enhanced magnetic resonance imaging and computed tomography revealed a lumbar canal lesion at lumbar spine L2 to L4 with spinal cord compression. A whole body bone scan with fused single photon emission computed tomography/computed tomography demonstrated abnormal ^99mTc-methylene diphosphonate accumulation in the L3 lamina and spinous process. No evidence of infection or hematology disease was observed in laboratory tests. Due to rapid progression of the symptoms and lack of a clear diagnosis, decompression surgery was performed immediately. During the operation, an approximately 6.0 × 2.5 × 1.2 cm monolithic, fusiform, soft mass in the epidural space and associated lesion tissues were completely resected. The radiating pain was relieved immediately and the dysuria disappeared within 1 week. Intraoperative pathological frozen section analysis revealed a hematopoietic malignant tumor and postoperative immunohistochemistry examination confirmed the diagnosis of myeloid sarcoma.

Conclusions: The primary isolated aggressive lumbar myeloid sarcoma is rarely seen, the specific symptoms and related medical history are unclear. Surgery and hematological treatment are effective for understanding and recognizing this rare tumor.

Keywords: Acute myelogenous leukemia; Case report; Decompression surgery; Lumbar spine; Myeloid sarcoma.

Fig. 1

Preoperative enhanced T1-weighted magnetic resonance images (MRI) of the lumbar spine. a Sagittal and (b) (c) transverse views show an iso-intense, fusiform, high-signal lesion in the L2 to L4 vertebral canal, with complete compression of the local spinal cord and a mixed signal around the L3 lamina, spinous process, and soft tissue. Preoperative computed tomography (CT) of the lumbar spine. d Sagittal and (e) (f) transverse views show an iso-dense fusiform soft lesion at the L2 to L4 lumbar canal with local spinal cord compression and slight bone destruction.The black arrows show the scope of the lesion

Fig. 2

Preoperative whole body bone scan with single photon emission computed tomography (SPECT). SPECT/CT did not show bone destruction (a). Abnormal ^99mTc-methylene diphosphonate (MDP) accumulation was demonstrated in the L3 lamina and spinous process on the fused SPECT/CT (b) and whole body bone scan (c). No signs of other bone destruction and metastasis were observed in the examination

Fig. 3

a The epidural soft mass in the vertebral canal during surgery. The white arrows show the scope of the mass. b The approximately 6.0 × 2.5 × 1.2 cm monolithic irregular fusiform soft mass was completely resected. (c) The restored dura sac became engorged and pulsatile after the mass resection. The white arrows show the scope of the dura sac. The postoperative 3rd month magnetic resonance images (MRI) and X-ray images. d T2-weighted MRI sagittal and (e) (f) transverse views show the dura sac was engorged without any compression. The white arrows show the scope of the engorged dura sac. The black arrows show the postoperative soft tissue changes. No obvious mass relapse was observed. The anteroposterior X-ray image (g) and lateral image (h) show the screw-rod fixation was normal

Fig. 4

Hematoxylin and eosin-stained section. a Low power field view (4 × 10 magnification): diffuse, uniform, heterocytic infiltration and (b) high power field view (20 × 10 magnification): irregular nuclei and eosinophilic and mitotic figures are easily seen. Immunohistochemistry examination demonstrating (c) the positive expression of cluster of differentiation (CD)33 and (d) positive expression of myeloperoxidase (MPO). The diagnosis of myeloid sarcoma was confirmed. The black arrow shows the positive regions