Compressive myelopathy caused by granulocytic sarcomas of spine: report of two cases and review of literature

Abstract

Objective To strengthen the understanding of granulocytic sarcomas (GS) by investigating the clinical characteristics of GS of spine. Methods The clinical data of 2 GS patients were retrospectively analyzed, and the related literature was reviewed. Results Because of the double lower limbs numbness, the 2 GS patients came to orthopedics department of the 306th Hospital of PLA. Magnetic resonance imaging (MRI) of the 2 patients showed an epidural mass located at the 9th-11th and 2nd-4th thoracic levels. Their histopathological examination and immunohistochemistry revealed GS. For example 1, she was diagnosed with acute promyelocytic leukemia (APL) and has been morphologic complete commission (CR) from 1995 to 2015. Chemotherapy and all-trans retinoic acid (ATRA) were performed after extramedullary relapse in thoracic spine, breast, ovary, sternum bone and lymph nodes. So far, the patient is still in follow-up. For example 2, he was diagnosed as isolated GS by morphology, immune phenotype, chromosome and gene examinations. Because he refused chemotherapy, radiotherapy was performed after surgical intervention. So far, he is loss of follow-up. Conclusions Spinal epidural of GS is rare. Surgery can reduce or remove nerve compression symptoms, and help clear diagnosis. The current recommended treatment regimen in patients presenting with isolated GS or GS presenting concomitantly with AML is conventional AML-type chemotherapeutic protocols. The differences in prognosis of GS patients may be partially attributed to different characteristics of patient. Key words: Sarcoma, myeloid; Leukemia, promyelocytic, acute; Spinal cord compression; Spinal canal; Thoracic vertebrae