Granulocytic Sarcoma (Chloroma)
Imaging Findings in Adults and Children
A. Guermazi1,2,
C. Feger1,
P. Rousselot3,
M. Merad4,
N. Benchaib1,
P. Bourrier1,
X. Mariette4,
J. Frija1 and
E. de Kerviler1
1
Department of Radiology, Saint-Louis Hospital, AP-HP, 1 ave Claude Vellefaux,
75010 Paris, France.
2
Present address: Department of Radiology, University of California at San
Francisco, 350 Parnassus Ave., Ste. 150, San Francisco, CA 94117.
3
Department of Hematology, Saint-Louis Hospital, AP-HP, 75010 Paris,
France.
4
Department of Immuno-Hematology, Saint-Louis Hospital, AP-HP, 75010 Paris,
France.
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Fig. 1A. —28-year-old woman with acute myeloblastic leukemia,
readmitted to our hospital 8 months after first remission with 1-week history
of headache, vomiting, and dysphasia. Unenhanced CT scan of brain shows
irregular hyperdense mass with hypodense peritumoral edema in left parietal
lobe.
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Fig. 1B. —28-year-old woman with acute myeloblastic leukemia,
readmitted to our hospital 8 months after first remission with 1-week history
of headache, vomiting, and dysphasia. Unenhanced CT scan shows hyperdense mass
seen in A enhances homogeneously after contrast administration. Biopsy
subsequently revealed brain granulocytic sarcoma.
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Fig. 2A. —58-year-old woman with 2-month history of headache.
Unenhanced CT scan of brain shows right periventricular hyperdense mass
surrounded by edema (arrowheads).
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Fig. 2B. —58-year-old woman with 2-month history of headache.
Unenhanced T1-weighted MR image in axial plane shows poorly defined right
periventricular lesion that is isointense with gray matter, with
periventricular mass effect.
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Fig. 2C. —58-year-old woman with 2-month history of headache.
T2-weighted MR image in axial plane shows surrounding edema much better than
B and shows relatively hypointense rim of lesion
(arrowheads).
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Fig. 2D. —58-year-old woman with 2-month history of headache.
Contrast-enhanced T1-weighted MR image in axial plane reveals marked
homogeneous enhancement of lesion. Examination of cerebrospinal fluid revealed
blasts, and histologic examination revealed brain granulocytic sarcoma. No
evidence of medullary or systemic disease was found. Seven months later,
patient was diagnosed with systemic acute myeloblastic leukemia with
eosinophils.
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Fig. 3. —44-year-old woman with history of acute myeloblastic leukemia
who had medullary and systemic relapse 6 months after autologous bone marrow
transplantation. Contrast-enhanced CT scan of chest shows left paraventebral
soft-tissue mass without bone destruction or epidural extension, which
corresponded to granulocytic sarcoma at biopsy. Complete resolution was
obtained in next 2 months after chemotherapy.
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Fig. 4A. —65-year-old woman with acute myeloblastic transformation of
1-year history of aplastic anemia who presented with ptosis of right eye of
2-week duration. Contrast-enhanced CT scan in coronal plane through mid orbit
reveals soft-tissue mass involving right medial rectus muscle and right
maxillary sinus. Ethmoid mass with bony destruction of left ethmoid cells also
can be seen.
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Fig. 4B. —65-year-old woman with acute myeloblastic transformation of
1-year history of aplastic anemia who presented with ptosis of right eye of
2-week duration. Contrast-enhanced T1-weighted MR image in coronal plane shows
dense and heterogeneous enhancement of lesions. Biopsy subsequently showed
right orbital and paranasal sinus granulocytic sarcoma. Despite therapy,
patient died 6 months later.
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Fig. 5. —40-year-old woman with relapse of acute myeloblastic leukemia
who presented with left thoracic pain. Contrast-enhanced CT scan of chest in
axial plane shows soft-tissue mass of chest wall with rib lysis
(arrowheads), which corresponded to granulocytic sarcoma at biopsy.
Complete remission was obtained after chemotherapy and radiation therapy.
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Fig. 6A. —24-year-old man with acute myeloblastic leukemia who
presented with thoracic pain and hemoptysis. Posteroanterior radiography of
chest shows left hilar lymph node enlargement (arrowheads) associated
with left upper air-space consolidation.
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Fig. 6B. —24-year-old man with acute myeloblastic leukemia who
presented with thoracic pain and hemoptysis. Unenhanced CT scan of chest
reveals large irregular nodular opacities. Subsequent biopsy showed
granulocytic sarcoma infiltrating hilar lymph nodes and involving lung
parenchyma. Complete resolution was obtained after chemotherapy and radiation
therapy.
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Fig. 7A. —36-year-old woman with acute myeloblastic leukemia associated
with myelofibrosis who presented with dyspnea. Unenhanced CT of chest shows
large right hilar mass associated with small pleural effusion
(arrowheads).
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Fig. 7B. —36-year-old woman with acute myeloblastic leukemia associated
with myelofibrosis who presented with dyspnea. CT slice 20-mm caudate to
A shows right nodular peribronchial consolidations and some
interstitial septal lines. Biopsy subsequently showed granulocytic sarcoma
involving peribronchial spaces. Patient died 8 days later.
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Fig. 8A. —40-year-old man with unremarkable medical history, admitted
for small-bowel obstruction. Sonogram shows 5-cm mass involving jejunum.
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Fig. 8B. —40-year-old man with unremarkable medical history, admitted
for small-bowel obstruction. Barium examination of small bowel shows stricture
of mid jejunum with upstream dilatation.
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Fig. 8C. —40-year-old man with unremarkable medical history, admitted
for small-bowel obstruction. Enhanced CT scan of abdomen shows intestinal
involvement with stenosis and parietal thickening associated with ascites and
peritoneal carcinosis. Diagnosis at biopsy was granulocytic sarcoma of small
intestine without evidence of blood or bone marrow involvement. Twenty-one
months later, patient was diagnosed with acute myeloblastic leukemia with
central nervous system and bone marrow involvement.
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Fig. 9. —53-year-old man with acute myeloblastic leukemia who
presented with acute abdominal pain. Enhanced CT scan of abdomen obtained
concurrently with diagnosis shows hypodense mass of head of pancreas
(arrowheads). Biopsy subsequently confirmed diagnosis of pancreatic
granulocytic sarcoma. Six weeks later, after chemotherapy and radiation
therapy, repeated CT showed resolution of pancreatic mass.
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Fig. 10. —16-year-old boy with relapse of acute myeloblastic leukemia
admitted for intermittent left flank pain. Enhanced CT scan of abdomen shows
left retroperitoneal mass invading psoas and kidney hilum associated with
pyelocaliectasis. Subsequent biopsy confirmed retroperitoneal granulocytic
sarcoma. Remission was obtained after chemotherapy.
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Fig. 11A. —58-year-old man with unremarkable medical history who
presented with swelling of left testicle. Sonogram shows heterogeneous mass of
testis and epididymis. Orchiectomy specimens revealed granulocytic sarcoma,
without blood or bone marrow involvement.
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Fig. 11B. —58-year-old man with unremarkable medical history who
presented with swelling of left testicle. At 3 months, CT scan revealed
abdominal relapse with large partially necrotic lateroaortic mass. At same
time, acute myeloblastic leukemia was diagnosed. CT-guided biopsy (not shown)
revealed retroperitoneal granulocytic sarcoma. Patient died 1 month later of
liver failure resulting from chemotherapy.
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Fig. 12A. —41-year-old woman with history of acute myeloblastic leukemia
associated with abnormal eosinophils who presented with palpable mass in left
breast. (Reprinted with permission from
[10]) Left lateral mammogram
discloses dense, rounded, and spiculated mass of 3-cm diameter with irregular
margins and skin retraction.
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Fig. 12B. —41-year-old woman with history of acute myeloblastic leukemia
associated with abnormal eosinophils who presented with palpable mass in left
breast. (Reprinted with permission from
[10]) Sonogram shows
irregularly shaped nonhomogeneous hypoechoic mass with ill-defined margins and
posterior acoustic shadow.
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Fig. 12C. —41-year-old woman with history of acute myeloblastic leukemia
associated with abnormal eosinophils who presented with palpable mass in left
breast. (Reprinted with permission from
[10]) CT scan of thorax
obtained 3 days after B shows spiculated mass that contains small foci
of necrosis. Skin wall is thickened (arrowhead).
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Fig. 12D. —41-year-old woman with history of acute myeloblastic leukemia
associated with abnormal eosinophils who presented with palpable mass in left
breast. (Reprinted with permission from
[10]) On sagittal MR imaging,
mass is inhomogeneous and hyperintense on STIR image (D), hypointense
on T1-weighted image (E). Mass enhances markedly but inhomogeneously
after gadolinium administration and fat saturation (F). Mass
spiculations and skin thickening also can be seen. Fine-needle breast biopsy
revealed granulocytic sarcoma. Patient received two courses of chemotherapy.
Five weeks later, mass was no longer palpable.
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Fig. 12E. —41-year-old woman with history of acute myeloblastic leukemia
associated with abnormal eosinophils who presented with palpable mass in left
breast. (Reprinted with permission from
[10]) On sagittal MR imaging,
mass is inhomogeneous and hyperintense on STIR image (D), hypointense
on T1-weighted image (E). Mass enhances markedly but inhomogeneously
after gadolinium administration and fat saturation (F). Mass
spiculations and skin thickening also can be seen. Fine-needle breast biopsy
revealed granulocytic sarcoma. Patient received two courses of chemotherapy.
Five weeks later, mass was no longer palpable.
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Fig. 12F. —41-year-old woman with history of acute myeloblastic leukemia
associated with abnormal eosinophils who presented with palpable mass in left
breast. (Reprinted with permission from
[10]) On sagittal MR imaging,
mass is inhomogeneous and hyperintense on STIR image (D), hypointense
on T1-weighted image (E). Mass enhances markedly but inhomogeneously
after gadolinium administration and fat saturation (F). Mass
spiculations and skin thickening also can be seen. Fine-needle breast biopsy
revealed granulocytic sarcoma. Patient received two courses of chemotherapy.
Five weeks later, mass was no longer palpable.
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Fig. 12G. —41-year-old woman with history of acute myeloblastic leukemia
associated with abnormal eosinophils who presented with palpable mass in left
breast. (Reprinted with permission from
[10]) Unenhanced T1-weighted
MR image in sagittal plane shows marked reduction of tumor size.
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Copyright © 2002 by the American Roentgen Ray Society.
