Bilateral parotid gland enlargement as a presenting manifestation of relapsed pediatric acute myeloid leukemia

Parotid gland involvement is a rare presentation of Acute Myeloid Leukemia (AML). We report a 10-year-old girl of acute myelomonocytic leukemia with normal cytogenetics and positivity for inversion 16, who after completion of first consolidation of the BFM 2004 AML protocol, presented with bilateral parotid gland enlargement. Bone marrow examination was suggestive of a relapse. Fine needle aspiration of the parotid gland showed presence of myeloblasts. Patient was given FLAG-IDA chemotherapy, with which the parotid swellings rapidly regressed and she achieved a remission and was planned for allogenic bone marrow transplantation. Acute myelomonocytic and monoblastic leukemias are known to be associated with tissue infiltration. However, exocrine gland involvement such as parotid enlargement is rare and is associated with a poor prognosis as was seen in our patient who despite having inversion 16 positivity had poor disease outcome. Keywords: acute myeloid leukemia; parotid gland enlargement; granulocytic sarcoma.

Diagnostic dilemma and challenges of granulocytic sarcoma: a review

The maleficent tumour granulocytic sarcoma is an unusual cancer indite of progressive myeloid precursor cells. It is a Chloroma basically present at an extramedullary location spread through immature granulocytic cells. It can affect any part of the body but the primary site is soft tissues, outside bone marrow, lymph nodes. The root cause may be many factors i.e. genetic, environmental, carcinogens etc. This proliferative type of cancer is sometimes misdiagnosis in contradictory to other acute/chronic tumours. For a histopathologist, it is a challenge for an accurate diagnosis. The tissue biopsy is the known diagnostic technique used since days in cancer diagnosis. To address this review, our main focus is to investigate, analyse the diagnostic limitations or research gaps in granulocytic sarcoma recognition at the clinical level and what can be the possibilities that have developed recently in tumour detection at an early stage. Next, we will try to develop a hypothesis from pinpoint methods used in it as molecular diagnosis, immune-histochemical biomarkers, flow cytometry (FACS) for confirmation of sarcoma so that specificity and sensitivity can be well examined. The prognosis/diagnosis in myeloid tumour detection depends on key factor innovation and medical devices and that should be filled in research and so a gold standard diagnostic kit should be developed.