Abstract
BackgroundMyeloid sarcoma is a rare, extramedullary, solid tumor derived from immature myeloid cell precursors. It is most frequently accompanied by acute myelogenous leukemia, though infrequently found in non-acute myelogenous leukemia patients. The tumor may involve any part of the body, but the lumbar spine is seldom involved. The present case study aims to understand the diagnosis and surgical treatment of a rare primary isolated myeloid sarcoma of the lumbar spine causing aggressive spinal cord compression in a non-acute myelogenous leukemia patient.Case presentationA 29-year-old man complained of an aggressive radiating pain to the lower extremities and moderate dysuria with a Visual Analogue Scale score that gradually increased from 3 to 8. Lumbar enhanced magnetic resonance imaging and computed tomography revealed a lumbar canal lesion at lumbar spine L2 to L4 with spinal cord compression. A whole body bone scan with fused single photon emission computed tomography/computed tomography demonstrated abnormal 99mTc-methylene diphosphonate accumulation in the L3 lamina and spinous process. No evidence of infection or hematology disease was observed in laboratory tests.Due to rapid progression of the symptoms and lack of a clear diagnosis, decompression surgery was performed immediately. During the operation, an approximately 6.0 × 2.5 × 1.2 cm monolithic, fusiform, soft mass in the epidural space and associated lesion tissues were completely resected. The radiating pain was relieved immediately and the dysuria disappeared within 1 week. Intraoperative pathological frozen section analysis revealed a hematopoietic malignant tumor and postoperative immunohistochemistry examination confirmed the diagnosis of myeloid sarcoma.ConclusionsThe primary isolated aggressive lumbar myeloid sarcoma is rarely seen, the specific symptoms and related medical history are unclear. Surgery and hematological treatment are effective for understanding and recognizing this rare tumor.
Highlights
Myeloid sarcoma is a rare, extramedullary, solid tumor derived from immature myeloid cell precursors
Myeloid sarcoma (MS) is most frequently accompanied by acute myelogenous leukemia (AML) [2], though infrequently found in non-AML patients, and may further precede the diagnosis of hematology disease [3]
MS, previously described as granulocytic sarcoma, myelosarcoma, or chloroma, is a rare, extramedullary solid mass composed of immature myeloid cell precursors [1, 8]
Summary
As primary isolated aggressive lumbar MS is rarely seen, the specific symptoms and related medical history are unclear. In the present case study, immediate surgery played an important role in specimen collection and the patient’s symptoms were quickly alleviated. The prognosis of primary isolated lumbar spine MS is generally poor. Rapid and accurate diagnosis provides the basis for further treatment and appropriate hematologic treatment should receive the utmost priority to improve the long-term outcomes. As our case study is rare and specific, this report will improve the understanding and recognition of the rare tumor in the future
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