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• W2118928713 abstract "Acute Myeloid Leukemia (AML) in adults is an often heterogeneous disease entity in its etiology and presentation, but recent advances have certainly shown that effective treatments may result in complete remission at substantial rates (1). According to American Cancer Society statistics (2), 12,330 people were diagnosed with AML in 2010, with 8,950 deaths from the disease, and an estimated 12,950 new cases and 9,050 deaths in 2011 (3). As indicated by these approximations, the incidence of AML appears to be rising, likely due to the increasing age of the population, with etiologies in the elderly more likely to include AML arising in a background of myelodysplasia, related to chemical exposures, or related to treatment for other previous cancers (1).A “typical” presentation of AML may present with sequelae of cytopenias, including bleeding and petechial rashes, infection, fatigue and weakness, weight loss and systemic symptoms. However, there are interesting unusual presentations of AML that may manifest with alarming clinical findings. These can include pericardial and pleural effusions (4a-Rege K et al), as well as rare cases of atrial involvement (5b- Tirado et al). CNS infiltration (6c-Schumann et al) has also been reported and is more likely in monocytic-lineage leukemias that may favor sanctuary sites (1), and these leukemias may also present with gum and soft tissue infiltration (7a). Neurologic complications have indeed been seen and reported in the literature as far back as the 1960’s and 1970’s with descriptions of meningitis, encephalitis, hemi- or paraplegias, involvement of cranial or peripheral nerves, and spinal cord compression (7d- Anjaria et al). Even more specifically, however, leukemias giving rise to spinal cord involvement due to vertebral destruction or epidural masses have been reported in the literature by Wildydes in 1963, and summarized by Anjaria. Myeloid sarcoma arises as a subacute form of AML, with a male:female ratio of 2:1, increased incidence in children or young adults, and presentation as a single or multiple tumor masses made up of immature leukemic cells with or without green pigments, and located in the subperiosteum or bone marrow. It can appear in the orbit, anywhere in the skull, sinuses, spine, sacrum, or ribs, with radiologic features of local erosion, cortical thinning, compression at extradural or peripheral nerves sites, but not necessarily causing invasion of the dura (7d-Anjaria et al, referencing 8e-Aita 1964, 9f- Rao 1962).We report here the presentation of AML as a “surprise” finding in an elderly female with virtually no obvious peripheral pancytopenias or abnormalities of her complete blood count, but who presented with an acute spinal cord compression and bony destruction in the spine.In particular, this patient’s leukemia cells also exhibited a t(9;22) translocation in addition to an unusual FAB classification of AML with megakaryocytic differentiation as the phenotype.We ask the following questions: (a) What treatment options would you offer this patient? Is she a candidate for aggressive induction chemotherapy? Biological therapy? (b) How would you monitor her for response to treatment? (c) How would you recommend and tailor maintenance therapy for this individual?" @default.
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• W2118928713 date "2012-12-01" @default.
• W2118928713 modified "2023-09-26" @default.
• W2118928713 title "A 75-Year-Old Woman With Thoracic Spinal Cord Compression and Chloroma (granulocytic sarcoma)" @default.
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• W2118928713 doi "https://doi.org/10.1053/j.seminoncol.2012.10.002" @default.
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