Chandra Piyush, Dhake Sanket, Purandare Nilendu, Agrawal Archi, Shah Sneha, Rangarajan Venkatesh
Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Indian J Nucl Med. 2017 Jul-Sep;32(3):198-202. doi: 10.4103/ijnm.IJNM_10_17.
Granulocytic sarcoma (GS) is a rare extramedullary manifestation in patients with acute myeloid leukemia (AML), which can precede the diagnosis or occur in the posttreatment setting. Unlike its established role in other hematological malignancies like Hodgkin's on non-Hodgkin's disease, the exact role of positron emission tomography/computed tomography (PET/CT) in AML with or without GS remains to be defined.
We retrospectively reviewed PET/CT scans of 12 patients with histologically proven GS. Marrow examination of these patients identified nine patients with isolated GS (without existent leukemia) and three patients with coexistent leukemia.
PET/CT accurately identified all clinically evident GS in all 12 patients at initial staging and at follow-up with tumors, showing moderate to high 2-deoxy-2-fluoro-D-glucose uptake. Coexistent marrow disease was seen on PET/CT in three patients, which was confirmed on histopathology. In the same patients, PET/CT also detected additional sites of extramedullary disease in 66.6% (n = 8), which was either clinically occult or not evident on routine CT.
PET/CT appears to be a highly sensitive imaging modality in diagnostic evaluation of GS. The most important indication of using PET/CT in these cases is to identify additional sites of clinically occult extramedullary disease, which can potentially impact treatment decisions and outcomes.
粒细胞肉瘤（GS）是急性髓系白血病（AML）患者罕见的髓外表现，可在诊断前出现或发生于治疗后。与它在其他血液系统恶性肿瘤（如霍奇金病或非霍奇金病）中已明确的作用不同，正电子发射断层扫描/计算机断层扫描（PET/CT）在伴有或不伴有GS的AML中的确切作用仍有待确定。
我们回顾性分析了12例经组织学证实为GS患者的PET/CT扫描结果。对这些患者的骨髓检查发现9例为孤立性GS（无白血病），3例伴有白血病。
PET/CT在初始分期及随访时准确识别了所有12例患者临床上明显的GS，肿瘤表现为中到高度的2-脱氧-2-氟-D-葡萄糖摄取。3例患者在PET/CT上可见并存的骨髓疾病，经组织病理学证实。在同一批患者中，PET/CT还在66.6%（n = 8）的患者中检测到了髓外疾病的其他部位，这些部位在临床上隐匿或在常规CT上不明显。
PET/CT在GS的诊断评估中似乎是一种高度敏感的成像方式。在这些病例中使用PET/CT的最重要指征是识别临床上隐匿的髓外疾病的其他部位，这可能会影响治疗决策和结果。
