대한흉부영상의학회 Weekly Chest Cases

Case No : 1243 Date 2021-08-16

Courtesy of Kum Ju Chae, Gong Yong Jin / Jeonbuk National University Hospital
Age/Sex 34 / M
Chief ComplaintFever up to 38.5, myalgia, weight loss, thrombocytopenia

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Diagnosis With Brief Discussion

Diagnosis: Myeloid sarcoma
Radiologic Findings: Fig 1. Chest PA shows the bulging contour of the right paraspinal stripe.
Fig 2-5. CT scans reveal mass-like lesions in the both paravertebral area and multiple mediastinal, and intraabdominal lymph nodes enlargement.
He was diagnosed with acute myeloid leukemia on the bone marrow biopsy. He underwent mediastinal lymph nodes excision biopsy, and it was proven as myeloid sarcoma.
Brief Review: Myeloid sarcoma, also known as granulocytic sarcoma or chloroma, is a solid tumor of extramedullary localization composed of malignant primitive myeloid cells. Its occurrence is linked with acute myeloid leukemia and less commonly in those with chronic myeloid leukemia, myelodysplastic syndrome, or other myeloproliferative disorders. The prevalence of myeloid sarcoma varied from 2.5% to 9% in AML patients. Mediastinal myeloid sarcoma can be in the form of discrete masses or more commonly as diffusely infiltrating soft tissue which may have trans-compartmental involvement and is frequently mistaken for lymphoma on imaging. Lung manifestations consist of alveolar opacities, nodules, or interstitial septal lines. In general, myeloid sarcoma masses were isodense to muscle on CT scans, and isointense and hyperintense (mild to moderate) on T1- and T2-weighted MR images, respectively. Diffusion-weighted images might be a useful diagnostic tool for myeloid sarcoma evaluation, because of the high cellularity in these lesions.
Please refer to: KSTR Imaging Conference 2005 Spring Case 7,
References: 1. Meyer HJ, Beimler M, Borte G, Pönisch W, Surov A. Radiological and clinical patterns of myeloid sarcoma. Radiol Oncol. 2019 Mar 14;53(2):213-218.
2. Singh A, Kumar P, Chandrashekhara SH, Kumar A. Unravelling chloroma: review of imaging findings. Br J Radiol. 2017 Jul;90(1075):20160710.
3. Guermazi A, Feger C, Rousselot P, Merad M, Benchaib N, Bourrier P, Mariette X, Frija J, de Kerviler E. Granulocytic sarcoma (chloroma): imaging findings in adults and children. AJR Am J Roentgenol. 2002 Feb;178(2):319-25
Keywords

No. of Applicants : 96

▶ Correct Answer : 3/96, 3.1%

- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- The University of Tokyo Hospital , Japan RYO KUROKAWA

▶ Correct Answer as Differential Diagnosis : 6/96, 6.3%

- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- Mayo Clinic , United States AKITOSHI INOUE
- Other , Korea (South) HYEJIN YANG
- Chonbuk National University Hospital , Korea (South) MINGI SHIN
- Other , Korea (South) SEONGSU KANG
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi

▶ Semi-Correct Answer : 13/96, 13.5%

- , United Kingdom SAMSON KADE
- Osaka Red Cross Hospital , Japan YUSUKE UTSUNOMIYA
- , Italy PAOLO BALDASSARI
- Tiger Gate Hospital , Japan SHIN-ICHI CHO
- Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
- Osaka University , Japan AKINORI HATA
- Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
- Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
- Nishida Hospital , Japan SHOJI OKUDA
- Toranomon Hospital , Japan KAORU SUMIDA
- Private sector , Greece VASILIOS TZILAS
- iran university , Iran MOHAMAD REZA AYOUBPOUR
- the first affiliatited hospital of nanjing medical univercity , China HAI XU

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1243 Date 2021-08-16

Discussion

No. of Applicants : 96