Gupta Saurabh, Chawla Inderjit, Singh Vishwajeet, Singh Karnail
Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India.
Department of Surgery, Government Medical College, Patiala, Punjab, India.
BMJ Case Rep. 2014 Aug 22;2014:bcr2014206138. doi: 10.1136/bcr-2014-206138.
A 16-year-old boy presented with intestinal obstruction with left lumbar mass. On evaluation with ultrasonography and contrast-enhanced CT of abdomen he was found to have left colo-colic intussusception. On exploratory laparotomy he was found to have invagination of necrosed distal transverse colon and splenic flexure with omentum into descending colon with enlarged mesenteric lymph nodes for which left hemicolectomy was performed. Histopathology and immunohistochemistry was suggestive of submucosal infiltration by immature myeloid precursors with few metamyelocytes and occasional eosinophils and the cells showed cytoplasmic granular positivity with myeloperoxidase stain suggestive of granulocytic sarcoma (chloroma-extra-medullary manifestation of acute myeloid leukaemia). Our patient received three cycles of cytarabine+daunorubicin chemotherapy in the postoperative period and is doing well at 12 months of follow-up. Granulocytic sarcoma (chloroma) presenting as colo-colic intussusception is very rare and has not been reported in literature so far.
一名16岁男孩因肠梗阻伴左腰部肿块就诊。经腹部超声和增强CT检查，发现他患有左半结肠套叠。在剖腹探查术中，发现坏死的远端横结肠和脾曲连同网膜套入降结肠，伴有肠系膜淋巴结肿大，为此进行了左半结肠切除术。组织病理学和免疫组化提示有未成熟髓系前体细胞的黏膜下浸润，有少量晚幼粒细胞和偶见嗜酸性粒细胞，这些细胞髓过氧化物酶染色显示胞质颗粒阳性，提示为粒细胞肉瘤（绿色瘤——急性髓系白血病的髓外表现）。我们的患者在术后接受了三个周期的阿糖胞苷+柔红霉素化疗，随访12个月时情况良好。以结肠结肠套叠形式出现的粒细胞肉瘤（绿色瘤）非常罕见，迄今为止文献中尚未有报道。
