Department of Diagnostic and Interventional Radiology, University of Leipzig, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
Department of Hematology and Oncology, University Hospital Leipzig, Leipzig, Germany.
BMC Cancer. 2019 Nov 27;19(1):1150. doi: 10.1186/s12885-019-6357-y.
Myeloid sarcoma (MS), also known as chloroma, is an extramedullary manifestation of malignant primitive myeloid cells. Previously, only small studies investigated clinical and imaging features of MS. The purpose of this study was to elucidate clinical and imaging features of MS based upon a multicenter patient sample.
Patient records of radiological databases of 4 German university hospitals were retrospectively screened for MS in the time period 01/2001 and 06/2019. Overall, 151 cases/76 females (50.3%) with a mean age of 55.5 ± 15.1 years and 183 histopathological confirmation or clinically suspicious lesions of MS were included into this study. The underlying hematological disease, localizations, and clinical symptoms as well as imaging features on CT and MRI were investigated.
In 15 patients (9.9% of all 151 cases) the manifestation of MS preceded the systemic hematological disease. In 43 cases (28.4%), first presentation of MS occurred simultaneously with the initial diagnosis of leukemia, and 92 (60.9%) patients presented MS after the initial diagnosis. In 37 patients (24.5%), the diagnosis was made incidentally by imaging. Clinically, cutaneous lesions were detected in 35 of 151 cases (23.2%). Other leading symptoms were pain (n = 28/151, 18.5%), neurological deficit (n = 27/151, 17.9%), swelling (n = 14/151, 9.3%) and dysfunction of the affected organ (n = 10/151, 6.0%). Most commonly, skin was affected (n = 30/151, 16.6%), followed by bone (n = 29/151, 16.0%) and lymphatic tissue (n = 21/151, 11.4%). Other localizations were rare. On CT, most lesions were homogenous. On T2-weighted imaging, most of the lesions were hyperintense. On T1-weighted images, MS was hypointense in n = 22/54 (40.7%) and isointense in n = 30/54 (55.6%). A diffusion restriction was identified in most cases with a mean ADC value of 0.76 ± 0.19 × 10 mm/s.
The present study shows clinical and imaging features of MS based upon a large patient sample in a multicenter design. MS occurs in most cases meta-chronous to the hematological disease and most commonly affects the cutis. One fourth of cases were identified incidentally on imaging, which needs awareness of the radiologists for possible diagnosis of MS.
髓外肉瘤（MS），又称绿色瘤，是恶性原始髓细胞的髓外表现。此前，只有少数研究调查了 MS 的临床和影像学特征。本研究的目的是基于多中心患者样本阐明 MS 的临床和影像学特征。
回顾性筛选 2001 年 1 月至 2019 年 6 月期间 4 家德国大学医院的放射学数据库中的患者记录，以确定 MS。总共纳入了 151 例/76 例女性（50.3%），平均年龄为 55.5±15.1 岁，包括 183 例组织病理学证实或临床可疑的 MS 病变。研究了潜在的血液系统疾病、定位和临床症状以及 CT 和 MRI 的影像学特征。
在 15 例患者（所有 151 例患者的 9.9%）中，MS 的表现先于全身血液系统疾病。43 例（28.4%）患者首次出现 MS 与白血病的初始诊断同时发生，92 例（60.9%）患者在初始诊断后出现 MS。37 例（24.5%）患者通过影像学偶然诊断。临床上，151 例患者中有 35 例（23.2%）出现皮肤病变。其他主要症状包括疼痛（28/151，18.5%）、神经功能缺损（27/151，17.9%）、肿胀（14/151，9.3%）和受影响器官功能障碍（10/151，6.0%）。最常见的是皮肤受累（30/151，16.6%），其次是骨骼（29/151，16.0%）和淋巴组织（21/151，11.4%）。其他定位很少见。在 CT 上，大多数病变是均匀的。在 T2 加权成像上，大多数病变呈高信号。在 T1 加权图像上，22/54（40.7%）例为低信号，30/54（55.6%）例为等信号。大多数病例在扩散受限，平均 ADC 值为 0.76±0.19×10mm/s。
本研究基于多中心设计的大型患者样本，展示了 MS 的临床和影像学特征。MS 大多数情况下发生在血液系统疾病之后，最常见的是皮肤。四分之一的病例是偶然在影像学上发现的，这需要放射科医生注意可能的 MS 诊断。
