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.

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Epidural Spinal Cord Compression in Acute Myelogenous Leukemia

Archives of Neurology ◽

10.1001/archneur.1980.00500540097021 ◽

1980 ◽

Vol 37 (5) ◽

pp. 319-319 ◽

Cited By ~ 9

Author(s):

J. Hildebrand ◽

L. Leenaerts ◽

Y. Nubourgh ◽

A. Verhest ◽

J. Flament-Durand

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Acute Myelogenous Leukemia ◽

Cord Compression ◽

Myelogenous Leukemia ◽

Acute Myelogenous

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Intradural Extramedullary Tumor Causing Compression of the Thoracic and Lumbar Vertebrae in a 22-year-old Male with Acute Myeloid Leukemia

Acta Medica Philippina ◽

10.47895/amp.v54i2.1528 ◽

2020 ◽

Vol 54 (2) ◽

Author(s):

Ronna Cheska V. De Leon ◽

Camille Ariadne C. Tanchanco ◽

Ma. Angelina L. Mirasol ◽

Joven Jeremius Q. Tanchuco

Keyword(s):

Spinal Cord ◽

Lumbar Vertebrae ◽

Cord Compression ◽

Myeloid Sarcoma ◽

Myelogenous Leukemia ◽

Monocytic Differentiation ◽

Extramedullary Tumor ◽

Acute Myelogenous ◽

Immature Myeloid Cells ◽

Intradural Extramedullary

Myeloid sarcoma, characterized by the presence of immature myeloid cells occurring at an extramedullary site, is a rare manifestation of acute myelogenous leukemia (AML). Spinal cord compression as an initial presentation of AML is very rare with only a few reported cases. We discuss a case of a 22-year-old male who presented with bicytopenia and paraplegia. Workups were consistent with AML with monocytic differentiation. Chromosomal analysis revealed loss of Y and t (8;21). Spinal cord MRI showed intradural extramedullary-enhancing soft tissue lesions at levels T2 to T7 and L5 to S1, suspected to be myeloid sarcoma. Patient, however, succumbed to severe nosocomial infection prior to initiation of chemotherapy and radiotherapy.

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Spinal Cord Compression in Patients with Acute Myeloid and Lymphoid Leukemia

Blood ◽

10.1182/blood-2020-137446 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 26-27

Author(s):

Shehab Fareed Mohamed ◽

Elabbass Abdelmahmuod ◽

Elrazi Awadelkarim A Ali ◽

Abdulqadir Jeprel Nashwan ◽

Dina Sameh Soliman ◽

...

Keyword(s):

Spinal Cord ◽

Acute Myeloid Leukemia ◽

Acute Lymphoblastic Leukemia ◽

Acute Leukemia ◽

Spinal Cord Compression ◽

Myeloid Leukemia ◽

Lymphoblastic Leukemia ◽

Cord Compression ◽

Myeloid Sarcoma ◽

Acute Myeloid

Introduction Acute leukemias can be divided into acute myeloid leukemia and acute lymphoblastic leukemia. Common presentations of acute leukemia include fever, symptoms of anemia, bleeding, bone pain palpable Lymph nodes or spleen and symptoms due inflation or leukocystasis. Extramedullary mass is rare and can be of myeloid tissue and known as Chloroma or myeloid (granulocytic) sarcoma which one of the WHO classifications for acute myeloid leukemia. Common sites of occurrence are skin, sinuses, bone and other. It's rarely involve central nervous system. Spinal cord involvement usually manifest as epidural mass causing cord compression. Spinal epidural tumor with acute leukemia and myeloid sarcoma is rare and can be found in 3-9% in patients with leukemia. In this review we decide to review the cases of spinal cord compression caused by acute myeloid leukemia (including Chloroma) and acute lymphoblastic leukemia due to the significance of such presentation in addition to reports that Myeloid sarcoma of the spine has very poor prognosis Methodology: We have reviewed the literature using: PubMed, google scholar, Scopus for patient with spinal cord compression and acute leukemia. We used the search term and synonyms : : acute myeloid leukemia , acute myelocytic leukemia , acute monocytic leukemia , acute lymphoblastic leukemia , acute lymphoid leukemia, chloroma , myeloid sarcoma ,granulocytic sarcoma, spinal cord compression .We included adult patients above 18 years old only cases we exclude pediatrics cases and cases of chronic leukemia's and other myeloproliferative disorders as well as cases of central nervous system involvement other than spinal cord Results We gathered the information from 98 cases with general demographics, presentation, image modality, cytogenetics and molecular in addition to management and outcome. We have found mean age for the patients is 38 years old with male predominance with 70% of the cases. The most presenting symptom was back pain in around 75% of the cases. Neurological findings showed sensory loss and parapreresis in most of the documented cases. MRI was most performed modality of imaging 63% followed by Computed tomography(CT) 15 % and then myelogram 13 %, which is least used due to invasive nature and before the era of MRI. The most common affected site on spinal cord were thoracic followed by lumbar. Cytogenetics and molecular data was not reported in most of the cases. Patients were treated with either steroids or surgery or radiotherapy and or chemotherapy while few underwent bone marrow transplant, but the most common approach was surgery+ radiotherapy + chemotherapy combination. Steroids used in most of the cases especially in the cases of acute lymphoblastic leukemia and dexamethasone was the steroids of the choice mainly. The outcome of the patients were variable, 30 % were alive at the time of the reports 30 % died and 30 % between relapse and complete remission. Conclusions Acute leukemia can be presented as mass causing spinal cord compression which is very serious. There are is no standardized management of patients with acute leukemia who presented with spinal cord compression nether guidelines or steps to follow. Some reports speculated also specific morphology and cytogenetics association with predisposition to have Extramedullary mass, however there lack of reporting of such a valuable information. Large studies including all adjusted variables required to determine if spinal cord compression presentation can be an independent risk facto or not Effective diagnosis and prompt action should take place. Figure Disclosures No relevant conflicts of interest to declare.

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Metastasizing Meningioma

Neurosurgery ◽

10.1227/00006123-198612000-00022 ◽

1986 ◽

Vol 19 (6) ◽

pp. 1028-1030 ◽

Cited By ~ 27

Author(s):

Tom Russell ◽

T. Moss

Keyword(s):

Computed Tomography ◽

Spinal Cord ◽

Spinal Cord Compression ◽

Primary Tumor ◽

Unusual Case ◽

Clinical Presentation ◽

Spinal Tumor ◽

Cord Compression ◽

Metastatic Spread ◽

Intracranial Meningioma

Abstract A very unusual case of metastatic spread of a meningioma is described. The clinical presentation was of extradural spinal cord compression, without evidence of a primary tumor. Computed tomography did not reveal any intracranial meningioma; the histopathology of the extradural spinal tumor was identical with that of two intracranial meningiomas previously excised.

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Myeloid Sarcoma: An Unusual Presentation of Acute Promyelocytic Leukemia Causing Spinal Cord Compression

Turkish Journal of Hematology ◽

10.5505/tjh.2012.94809 ◽

2012 ◽

Vol 29 (3) ◽

pp. 278-282 ◽

Cited By ~ 10

Author(s):

Tay Za Kyaw ◽

Jayaranee A.s. Maniam ◽

Ping Chong Bee ◽

Edmund Fui Min Chin ◽

Veera Sekaran Nadarajan ◽

...

Keyword(s):

Spinal Cord ◽

Acute Promyelocytic Leukemia ◽

Spinal Cord Compression ◽

Cord Compression ◽

Promyelocytic Leukemia ◽

Myeloid Sarcoma ◽

Unusual Presentation

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Do Routine Computed Tomography Scans Detect Early Spinal Cord Compression in Patients with Castrate Resistant Prostate Cancer? Implications for the PROMPTS Trial

Clinical Oncology ◽

10.1016/j.clon.2016.11.019 ◽

2017 ◽

Vol 29 (3) ◽

pp. e87

Author(s):

A. Khan ◽

A. Gao ◽

E. Hall ◽

S. Hassan ◽

C. Cruikshank ◽

...

Keyword(s):

Prostate Cancer ◽

Computed Tomography ◽

Spinal Cord ◽

Spinal Cord Compression ◽

Cord Compression ◽

Computed Tomography Scans ◽

Castrate Resistant Prostate Cancer ◽

Castrate Resistant

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Thoracic Vertebral Hemangioma with Spinal Cord Compression: Multidisciplinary Surgical Treatment and Follow-up of Six Patients

Orthopaedic Surgery ◽

10.1111/os.12293 ◽

2016 ◽

Vol 8 (4) ◽

pp. 462-467 ◽

Cited By ~ 4

Author(s):

Hui-lin Zhang ◽

Yong-cheng Hu ◽

Rajendra Aryal ◽

Xin He ◽

Deng-xing Lun ◽

...

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Spinal Cord Compression ◽

Cord Compression ◽

Vertebral Hemangioma

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Spinal Cord Compression in Paget's Disease of Bone Treated Medically

Journal of the Royal Society of Medicine ◽

10.1177/014107688708000523 ◽

1987 ◽

Vol 80 (5) ◽

pp. 319-321 ◽

Cited By ~ 3

Author(s):

A S M Jawad ◽

H Berry

Keyword(s):

Spinal Cord ◽

Lumbar Spine ◽

Spinal Cord Compression ◽

Vertebral Column ◽

Paget’S Disease ◽

Cauda Equina ◽

Cord Compression ◽

Paget's Disease ◽

Paget’S Disease Of Bone ◽

Paget's Disease Of Bone

The most common sites for Paget's disease of the spine are the sacrum followed by the lumbar spine1, but paraparesis is more common with dorsal involvement. Over 100 cases of dysfunction of the spinal cord or cauda equina secondary to Paget's disease of the vertebral column have been described since it was first reported by Wyllie2. We report a patient with paraparesis secondary to Paget's disease of the dorsal vertebrae with complete myelographic obstruction, who was treated medically with disodium etidronate.

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