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Case 286 - Discussion

Uploaded: 2009-04-13, Updated: 2009-04-13



CK AE1/3  
CD3 CD20
CD117 CD117
CD34 CD34
Lysozyme Lysozyme

The peripheral blood and bone marrow biopsy show no evidence of tumor infiltrate.

Myeloid Sarcoma (Chloroma) of the Pancreas

Granulocytic sarcomas, also known as chloroma, myeloblastoma and extramedullary myeloid cell tumor, are extramedullary tumor masses of immature myeloid cells. Granulocytic sarcomas usually occur during either leukemia relapse or remission. Very rarely, chloroma can occur without a known pre-existing or concomitant diagnosis of acute leukemia, acute promyelocytic leukemia or MDS/MPS; this is known as primary chloroma. In the absence of systemic chemotherapy, almost all primary chloromas will develop acute leukemia with a median time of 7 months. Therefore, primary chloroma could be considered an initial manifestation of acute leukemia, rather than a localized process, and could be treated as such. Chloromas may occur in virtually any organ or tissue. The most common areas of involvement are the skin (also known as leukemia cutis) and the gums. Skin involvement typically appears as violaceous, raised, non-tender plaques or nodules, which on biopsy are found to be infiltrated with myeloblasts. Primary chloroma of the pancreas is rare, with less than ten cases reported in the literatures. Successful management of primary pancreatic chloroma with complete remission has been reported using high-dose chemotherapy.


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