Intracranial Chloroma(Granulocytic Sarcoma) by Lymphocytic Leukemia

  • Jeong, Ho-Seok (Department of Neurosurgery, Inje University Busan Paik Hospital) ;
  • Kim, Moo-Seong (Department of Neurosurgery, Inje University Busan Paik Hospital) ;
  • Jung, Yong-Tae (Department of Neurosurgery, Inje University Busan Paik Hospital) ;
  • Sim, Jae-Hong (Department of Neurosurgery, Inje University Busan Paik Hospital)
  • Published : 2005.07.28

Abstract

Intracranial chloroma may occur in leukemia, although they are rare. A 23-year-old female complained diplopia. Brain magnetic resonance MR imaging showed tumors in the both cavernous sinus, both tentorial and anterior falx. Gamma-Knife radiosurgery was performed with maximal dose; 20Gy, marginal dose; 10Gy. Peripheral blood smear revealed leukemia, and bone marrow aspiration biopsy showed acute lymphocytic leukemia. Two weeks later, MR image for the stereotactic biopsy noticed markedly decreased tumor size. Biopsy result was lymphocytic leukemia. She received conventional radiation therapy, chemotherapy, and bone marrow transplantation. Brain involvement by acute lymphocytic leukemia is very rare. Even though chloroma are sensitive to radiation therapy, prognosis is poor because of the gravity of the underlying disease and association with impending blast transformation. The authors reports a intracranial chloroma by acute lymphocytic leukemia.

Keywords

References

  1. Barnett MJ, Zussman WV : Granulocytic sarcoma of the brain : a case report and review of the literature. Radiology 160 : 223-225, 1986 https://doi.org/10.1148/radiology.160.1.3459211
  2. Bekassy AN, Hermans J, Gorin NC, Gratwohl A : Granulocytic sarcoma after allogeneic bone marrow transplantation : a retrospective European multicenter survey. Bone Marrow Transplant 17 : 801-808, 1996
  3. Benvenisti DS, Ultmann JE : Eosinophilic leukemia ; report of five cases and review of literature. Ann Intern Med 71 : 731-745, 1969 https://doi.org/10.7326/0003-4819-71-4-731
  4. Cavdar AO, Arcasoy A, Babacan E, Gozdasoglu S, Topuz U, Fraumeni JF : Ocular granulocytic sarcoma (chloroma) with acute myelomonocytic leukemia in Turkish children. Cancer 41 : 1606-1609, 1978 https://doi.org/10.1002/1097-0142(197804)41:4<1606::AID-CNCR2820410451>3.0.CO;2-Y
  5. Huter O, Brezinka C, Nachbaur D, Schwaighofer H, Lang A, Niederwieser D : Successful treatment of primary extramedullary leukemia of the uterus with radical therapy, chemotherapy, autologous bone marrow transplantation and prophylactic local irradiation. Bone Marrow Transplant 18 : 663-664, 1996
  6. Imrie KR, Kovacs MJ, Selby D, Lipton J, Patterson BJ, Pantalony D, et al : Isolated chloroma : the effect of early antileukemic therapy. Ann Int Med 123 : 351-353, 1995 https://doi.org/10.7326/0003-4819-123-5-199509010-00005
  7. Jeong YG, Lee SI, Jung YT, Kim SC, Sim JH : Extradural granulocytic sarcoma of the thoracic spine. J Korean Neurosurg Soc 22 : 853-858, 1993
  8. Kao SCS, Yuh TC, Sato Y, Barloon TJ : Intracranial granulocytic sarcoma (chloroma) : MNR findings. J Comput Assist Tomogr 11 : 938-941, 1987 https://doi.org/10.1097/00004728-198711000-00003
  9. Liu PI, Ishimaru T, McGregor DH, Okada H, Steer A : Autopsy study of granulocytic sarcoma (chloroma) in patients with myelogenous leukemia, Hiroshima-Nagasaki 1949-1969. Cancer 31 : 948-955, 1973 https://doi.org/10.1002/1097-0142(197304)31:4<948::AID-CNCR2820310428>3.0.CO;2-N
  10. Muss HB, Moloney WC : Chloroma and other myeloblastic tumors. Blood 42 : 721-728, 1973
  11. Neiman RS, Barcos M, Berard C, Bonner H, Man R, Rydell RE, et al : Granulocytic sarcoma : a clinicopathologic study of 61 biopsied cases. Cancer 48 : 1426-1437, 1981 https://doi.org/10.1002/1097-0142(19810915)48:6<1426::AID-CNCR2820480626>3.0.CO;2-G
  12. Pomerantz SJ, Hawkins HH, Towbin R, Lisberg WN, Clark RA : Granulocytic sarcoma (chloroma) : CT manifestations. Radiology 155 : 167-170, 1985 https://doi.org/10.1148/radiology.155.1.3856292
  13. Quitt M, Kelner J, Sova J, Froom P, Aghai E : Accelerated phase of CML presenting with hypercalcemia and a mediastinal mass. Acta Haematol 99 : 231-233, 1998 https://doi.org/10.1159/000040845
  14. Rappaport H : Tumors of the hematopoietic system, atlas of tumor pathology, section III, Fascicle 8. Armed Forces Institute of Pathology, Washington, D.C., 1966, pp241-243
  15. Sandhu GS, Gonzalez-Garcia J, Elexpuru-Camiruaga JA : Granulocytic sarcoma presenting as cauda equina syndrome. Clin Neurol Neurosurg 100 : 205-208, 1998 https://doi.org/10.1016/S0303-8467(98)00021-3
  16. Sowers JJ, Moody DM, Naidich TP, Ball MR, Laster DW, Leeds NE : Radiographic features of granulocytic sarcome (chloroma). J Comput Assist Tumogr 3 : 226-233, 1979 https://doi.org/10.1097/00004728-197904000-00015