Acute Myeloid Leukemia Disguised as a Solid Tumor

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Granulocytic sarcomas, or extramedullary collections of immature leukemic cells, are observed in a small precentage of myeloid leukemias. The t(8;21) seems to have a higher association with granulocytic sarcoma. Although patients with t(8;21) generally have a more favorable prognosis, the presence of these sarcomas makes their course less favorable. We report a case of a woman with acute myeloid leukemia M2 who presented with 5 sites of extramedullary involvement including pleural fluid involvement which is exceedingly rare. She presented with weakness and shortness of breath. She was initially evaluated and treated for an upper respiratory tract infection. Later work-up revealed the presence of circulating blasts on peripheral blood smear. Bone marow biopsy showed 100% cellularity with blast forms comprising > 80% of those. A computed tomography scan was done, which showed a paratracheal mass, an anterior mediastinal mass, a perinephric soft tissue density and a pleural effusion which was positive for malignant cells by cytology. A superior extraconal mass was found in the left orbit on magnetic resonance imaging. The patient received induction chemotherapy after which repeat scans have shown a resolution of the pleural effusion and improvement in the size of the other granulocytic sarcoma. A review of granulocytic sarcomas shows that they can occur in numerous anatomic sites. There appears to be an association with the neural cell adhesion molecule CD56. The prognosis is worse in those with granulocytic sarcoma. Stem cell transplantation is considered an early option thought not clearly defined at this point.

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