Limits...
Spinal Myeloid Sarcoma "Chloroma" Presenting as Cervical Radiculopathy: Case Report.

Hu X, Shahab I, Lieberman IH - Global Spine J (2015)

Bottom Line: X-rays showed that the overall cervical alignment was intact and there was no evidence of a recurrent lesion.MRI showed no evidence of compressive or remnant lesion.Knowledge of its clinical presentation, imaging, and histologic characterization can lead to early diagnosis and appropriate treatment.

View Article: PubMed Central - PubMed

Affiliation: Scoliosis and Spine Tumor Center, Texas Back Institute, Texas Health Presbyterian Hospital Plano, Plano, Texas, United States.

ABSTRACT
Study Design Case report. Objective Myeloid sarcoma (also known as chloroma) is a rare, extramedullary tumor composed of immature granulocytic cells. It may occur early in the course of acute or chronic leukemia or myeloproliferative disorders. Spinal cord invasion by myeloid sarcoma is rare. The authors report a rare case of spinal myeloid sarcoma presenting as cervical radiculopathy. Methods A previously healthy 43-year-old man presented with progressive neck, right shoulder, and arm pain. Cervical magnetic resonance imaging (MRI) revealed a very large enhancing extradural soft tissue mass extending from C7 through T1, with severe narrowing of the thecal sac at the T1 level. The patient underwent posterior cervical open biopsy, laminectomy, and decompression. Histologic examination of the surgical specimen confirmed the diagnosis of myeloid sarcoma. Postoperatively, a bone marrow biopsy was done, which showed myeloproliferative neoplasm with eosinophilia. The patient then received systemic chemotherapy and radiotherapy. Results At the 10-month follow-up, the patient reported complete relief of arm pain and neck pain. X-rays showed that the overall cervical alignment was intact and there was no evidence of a recurrent lesion. MRI showed no evidence of compressive or remnant lesion. Conclusions Spinal myeloid sarcoma presenting as cervical radiculopathy is rare, and it may be easily misdiagnosed. Knowledge of its clinical presentation, imaging, and histologic characterization can lead to early diagnosis and appropriate treatment.

No MeSH data available.


Related in: MedlinePlus

Cervical magnetic resonance imaging showing the enhancing extradural soft tissue mass extending from C7 through T1 with severe narrowing of the thecal sac at T1 level. (A, B) T2-weighted images; (C, D) T1-weighted images.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4472287&req=5

FI1400023cr-2: Cervical magnetic resonance imaging showing the enhancing extradural soft tissue mass extending from C7 through T1 with severe narrowing of the thecal sac at T1 level. (A, B) T2-weighted images; (C, D) T1-weighted images.

Mentions: A 43-year-old man presented with progressive neck, right shoulder, and arm pain of about 2 weeks' duration. The patient described that the pain radiated down his right upper extremity through the triceps region, into the forearm, and onto the fourth and fifth digits. There was no precipitating factor such as injury or trauma. The patient initially sought care with a chiropractor and a nurse practitioner and received various treatments including massage, cervical adjustment, intramuscular steroid injection, and steroid pack. He was also prescribed muscle relaxants and narcotic analgesics. Despite these interventions, his pain continued to increase. On physical examination, the patient was noted to be splinting his neck and actively resisting any neck motion. There was tenderness palpable over the right scapular border. There was decreased sensation on the ulnar aspect of his right hand as well as decreased pinch strength and sensation in the right fourth and fifth digits. There was also decreased sensation to pinprick over the entire right scapula. X-ray examination showed mild, multilevel cervical degenerative changes with spurring noted at the C5, C6, and C7 levels, but the disk height was relatively well maintained (Fig. 1). Cervical magnetic resonance imaging (MRI) revealed a very large, enhancing extradural soft tissue mass extending from C7 through T1 with severe narrowing of the thecal sac at the T1 level. There was also a large soft tissue mass to the right of midline from C7 to T2 with some areas of decreased or absent enhancement suggesting necrosis or developing phlegmon or abscess (Fig. 2).


Spinal Myeloid Sarcoma "Chloroma" Presenting as Cervical Radiculopathy: Case Report.

Hu X, Shahab I, Lieberman IH - Global Spine J (2015)

Cervical magnetic resonance imaging showing the enhancing extradural soft tissue mass extending from C7 through T1 with severe narrowing of the thecal sac at T1 level. (A, B) T2-weighted images; (C, D) T1-weighted images.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4472287&req=5

FI1400023cr-2: Cervical magnetic resonance imaging showing the enhancing extradural soft tissue mass extending from C7 through T1 with severe narrowing of the thecal sac at T1 level. (A, B) T2-weighted images; (C, D) T1-weighted images.
Mentions: A 43-year-old man presented with progressive neck, right shoulder, and arm pain of about 2 weeks' duration. The patient described that the pain radiated down his right upper extremity through the triceps region, into the forearm, and onto the fourth and fifth digits. There was no precipitating factor such as injury or trauma. The patient initially sought care with a chiropractor and a nurse practitioner and received various treatments including massage, cervical adjustment, intramuscular steroid injection, and steroid pack. He was also prescribed muscle relaxants and narcotic analgesics. Despite these interventions, his pain continued to increase. On physical examination, the patient was noted to be splinting his neck and actively resisting any neck motion. There was tenderness palpable over the right scapular border. There was decreased sensation on the ulnar aspect of his right hand as well as decreased pinch strength and sensation in the right fourth and fifth digits. There was also decreased sensation to pinprick over the entire right scapula. X-ray examination showed mild, multilevel cervical degenerative changes with spurring noted at the C5, C6, and C7 levels, but the disk height was relatively well maintained (Fig. 1). Cervical magnetic resonance imaging (MRI) revealed a very large, enhancing extradural soft tissue mass extending from C7 through T1 with severe narrowing of the thecal sac at the T1 level. There was also a large soft tissue mass to the right of midline from C7 to T2 with some areas of decreased or absent enhancement suggesting necrosis or developing phlegmon or abscess (Fig. 2).

Bottom Line: X-rays showed that the overall cervical alignment was intact and there was no evidence of a recurrent lesion.MRI showed no evidence of compressive or remnant lesion.Knowledge of its clinical presentation, imaging, and histologic characterization can lead to early diagnosis and appropriate treatment.

View Article: PubMed Central - PubMed

Affiliation: Scoliosis and Spine Tumor Center, Texas Back Institute, Texas Health Presbyterian Hospital Plano, Plano, Texas, United States.

ABSTRACT
Study Design Case report. Objective Myeloid sarcoma (also known as chloroma) is a rare, extramedullary tumor composed of immature granulocytic cells. It may occur early in the course of acute or chronic leukemia or myeloproliferative disorders. Spinal cord invasion by myeloid sarcoma is rare. The authors report a rare case of spinal myeloid sarcoma presenting as cervical radiculopathy. Methods A previously healthy 43-year-old man presented with progressive neck, right shoulder, and arm pain. Cervical magnetic resonance imaging (MRI) revealed a very large enhancing extradural soft tissue mass extending from C7 through T1, with severe narrowing of the thecal sac at the T1 level. The patient underwent posterior cervical open biopsy, laminectomy, and decompression. Histologic examination of the surgical specimen confirmed the diagnosis of myeloid sarcoma. Postoperatively, a bone marrow biopsy was done, which showed myeloproliferative neoplasm with eosinophilia. The patient then received systemic chemotherapy and radiotherapy. Results At the 10-month follow-up, the patient reported complete relief of arm pain and neck pain. X-rays showed that the overall cervical alignment was intact and there was no evidence of a recurrent lesion. MRI showed no evidence of compressive or remnant lesion. Conclusions Spinal myeloid sarcoma presenting as cervical radiculopathy is rare, and it may be easily misdiagnosed. Knowledge of its clinical presentation, imaging, and histologic characterization can lead to early diagnosis and appropriate treatment.

No MeSH data available.


Related in: MedlinePlus