Sun Xiaona, Rong Xin, Nie Hongping, Yan Xiaoming
Department of Ophthalmology, Peking University First Hospital, Peking University, Beijing, China.
Eur J Ophthalmol. 2020 Dec 6:1120672120976551. doi: 10.1177/1120672120976551.
Granulocytic sarcoma (GS) is rare as an isolated presentation of relapse after allogeneic hematopoietic stem-cell transplantation (allo-HSCT), particularly in adult patients with acute myelogenous leukemia (AML). We report here the case of a 37-year-old man who developed a GS of the retro-orbital as an isolated manifestation of AML relapse 27 months after allo-HSCT.
A 37-year-old man was diagnosed with AML and subsequently received allo-HSCT after clinical chemical remission. The patient suddenly presented with painless exophthalmos of the left eye twenty-seven months after allo-HSCT. Orbital magnetic resonance imaging (MRI) revealed left retro-orbital masses. Histopathology revealed diffused infiltration of leukemic blasts. Further systemic investigation showed no leukemic involvement of his other organs. Isolated retro-orbital relapse of AML was diagnosed. Despite treatment using retro-orbital irradiation, the patient died 6 months after presentation.
Our patient had a poor survival prognosis, even with timely diagnosis and proper treatment. Although the ophthalmologist has a secondary role in the diagnosis and treatment of leukemia, a prompt recognition of the ocular manifestations and their significance as a sign of possible extramedullary lesion is crucial.
粒细胞肉瘤（GS）作为异基因造血干细胞移植（allo-HSCT）后复发的孤立表现较为罕见，尤其是在成年急性髓系白血病（AML）患者中。我们在此报告一例37岁男性患者，在allo-HSCT后27个月出现眼眶后粒细胞肉瘤，作为AML复发的孤立表现。
一名37岁男性被诊断为AML，在临床化学缓解后接受了allo-HSCT。allo-HSCT后27个月，患者突然出现左眼无痛性眼球突出。眼眶磁共振成像（MRI）显示左侧眼眶后肿块。组织病理学显示白血病原始细胞弥漫浸润。进一步的全身检查显示他的其他器官无白血病累及。诊断为AML孤立性眼眶后复发。尽管采用了眼眶后照射治疗，但患者在出现症状后6个月死亡。
即使及时诊断并给予适当治疗，我们的患者生存预后仍较差。尽管眼科医生在白血病的诊断和治疗中起次要作用，但迅速识别眼部表现及其作为可能髓外病变迹象的意义至关重要。
