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Weekly Chest CasesArchive of Old Cases

Case No : 1405 Date 2024-09-24

  • Courtesy of Woo Hyeon Lim,Ji Young Lee, Jiyoung Song / Seoul National University Hospital
  • Age/Sex 22 / M
  • Chief ComplaintPalpable lesion at the left chest wall (1WA). __ Brief history: AML from MDS, s/p alloBMT
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Granulocytic sarcoma (myeloid sarcoma, chloroma)
Radiologic Findings
Fig 1. A chest PA shows a lentiform opacity in the left middle lung field, suggestive of a pleural or extrapleural lesion.
Fig 2, 3. CT scans reveals a soft tissue mass involving the chest wall, with bony erosion of the adjacent rib.
Fig 4. MRI shows T2-hyper and T1-hypointensities with contrast enhancement.
Fig 5. PET/CT reveals intense hypermetabolism in the lesion (SUVmax, 17), and also identifies another hypermetabolic lesion in the thoracic spine (SUVmax, 18), which was initially overlooked.
Brief Review
Granulocytic sarcoma, also known as myeloid sarcoma or chloroma, is an extramedullary tumor originating from malignant primitive myeloid cells. This disease is associated with leukemic conditions, most commonly acute myeloid leukemia, and can affect any part of the body. It is more commonly a manifestation of a recurrence of the primary disease rather than a concurrent or primary manifestation. Allogenic bone marrow transplantation is a recognized risk factor for granulocytic sarcoma.
The imaging features of granulocytic sarcoma can be nonspecific, making clinical context important. CT scans often reveal homogeneous contrast enhancement. On MRI, T2-hyperintensity and T1-iso/hypointensity are more frequently observed compared to skeletal muscles. Similar to CT scans, homogeneous contrast enhancement of the lesion is commonly seen. Diffusion-weighted imaging generally shows more severe diffusion restriction than skeletal muscles. These lesions typically demonstrate intense FDG uptake on PET/CT, and FDG-PET can detect additional lesions.
The overall survival of patients with granulocytic sarcoma is poor, with a median survival of 12.8 months.
References
1. Meyer et al. Clinical and imaging features of myeloid sarcoma: a German multicenter study. BMC Cancer. 2019 Nov 27;19(1):1150.
Keywords

No. of Applicants : 61

▶ Correct Answer : 26/61,  42.6%
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Other , Korea (South) BYUK GYUNG CHOI
  • - Other , Korea (South) SEONGSU KANG
  • - , Korea (South) JIN YOUNG LEE
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - , Japan KENTARO KOTANI
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - GHICL , France MANUEL TOLEDANO
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Kyoto University , Japan SHO KOYASU
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Juntendo University , Japan YUTAKA IKENOUCHI
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 9/61,  14.8%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Oita university , Japan AYUMI KAMEI
  • - , Korea (South) DONG-HO BANG
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Japan YOSHIKI ISHII
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
  • - , Sweden MOHAMAD TLASS
▶ Semi-Correct Answer : 6/61,  9.8%
  • - Other , Korea (South) DOWOO KIM
  • - University of Yamanashi , Japan HIROAKI WATANABE
  • - Other , Korea (South) CHAEHUN LIM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Fukuoka university , Japan KEISUKE SATO
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
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