From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
bloodwork
®
IMAGES
IN HEMATOLOGY
Rapid evolution of intracranial myeloid
sarcoma in 4 weeks: images in blood
D
E
F
c Philippe Prouet, The University of Tennessee Health Science Center; and Michael Martin, The West Clinic
A
65-year-old woman initially presented with chronic extreme headaches. Initial magnetic resonance
imaging (MRI) scans (panel A) revealed abnormal signaling possibly representing dural inflammation or
a meningioma. A complete blood count at that time was within normal limits. Four weeks later, her symptoms
included progressively worsening, right temporal throbbing headaches with associated right eye visual disturbance
and right facial paresthesias. Repeat MRI (panels B and C) revealed enlargement of the dural mass now extending
into the right cavernous sinus and right optic canal. Initial cerebrospinal fluid studies were negative for cytology
and infection. A biopsy revealed a myeloid sarcoma (panels D-F). A peripheral smear revealed 10% circulating
blasts, and a subsequent bone marrow biopsy revealed acute myeloid leukemia (AML) with 8:21 translocation.
In patients with AML, less than 1% present initially with prominent extramedullary disease, including myeloid
sarcoma. Myeloid sarcoma may present simultaneously with bone marrow disease, precede bone marrow disease,
or be seen in disease relapse. The presence of a myeloid sarcoma is diagnostic of AML independent of the
blast count. Myeloid sarcoma may be found in many isolated sites, including the dura, periosteum, and bone.
Myeloid sarcoma must be considered in the differential diagnosis in the presence of a rapidly progressing
dural mass.
For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is
continually updated with new atlas and case study images. For more information visit
http://imagebank.hematology.org.
DOI 10.1182/blood-2015-05-647388
1256
BLOOD, 3 SEPTEMBER 2015 x VOLUME 126, NUMBER 10
From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
2015 126: 1256
doi:10.1182/blood-2015-05-647388
Rapid evolution of intracranial myeloid sarcoma in 4 weeks: images in
blood
Philippe Prouet and Michael Martin
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