Shao Yuan-Dong, Wang Xue-Hua, Sun Lei, Cui Xin-Gang
Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, Jinan 250000, Shandong Province, China.
Department of Spine Surgery, Binzhou People's Hospital, Binzhou 256600, Shandong Province, China.
World J Clin Cases. 2022 Nov 6;10(31):11536-11541. doi: 10.12998/wjcc.v10.i31.11536.
As an extramedullary form of proliferating myeloblasts, granulocytic sarcoma (GS) is common in patients with acute myeloid leukemia. GS in the central nervous system is rare, and an intraspinal space-occupying lesion caused by GS is even rarer. Surgical decompression is often necessary to remove the intraspinal space-occupying lesion. To the best of our knowledge, we report, for the first time a case of GS that caused extensive compression in the spinal canal without surgical decompression treatment.
A 15-year-old male suddenly developed numbness and weakness in his lower limbs for 10 d, which affected his walking ability. Acute myeloid leukemia was later diagnosed in the Department of Hematology. Magnetic resonance imaging revealed that multiple segmental space-occupying lesions were causing severe spinal cord compression in the thoracic spinal canal. As a result, the patient received routine chemotherapy before surgery. Interestingly, the intraspinal space-occupying lesions completely diminished on magnetic resonance imaging after a course of chemotherapy, and the sensation and strength in his lower limbs markedly recovered.
An intraspinal space-occupying lesion could be the first symptom of acute myeloid leukemia, causing spinal nerve compression without any other symptoms. Following standard chemotherapy, spinal canal compression can be quickly relieved, and the spinal cord and nerve function restored, avoiding emergency surgery.
作为增殖性成髓细胞的一种髓外形式,粒细胞肉瘤(GS)在急性髓系白血病患者中较为常见。中枢神经系统的GS较为罕见,由GS引起的椎管内占位性病变则更为罕见。通常需要进行手术减压以切除椎管内占位性病变。据我们所知,我们首次报告了一例未经手术减压治疗而导致椎管广泛受压的GS病例。
一名15岁男性突然出现下肢麻木和无力10天,影响了其行走能力。随后在血液科被诊断为急性髓系白血病。磁共振成像显示多个节段性占位性病变导致胸段椎管严重脊髓受压。因此,患者在手术前接受了常规化疗。有趣的是,经过一个疗程的化疗后,磁共振成像显示椎管内占位性病变完全消失,患者下肢的感觉和力量明显恢复。
椎管内占位性病变可能是急性髓系白血病的首发症状,可导致脊神经受压而无任何其他症状。经过标准化疗后,椎管压迫可迅速缓解,脊髓和神经功能得以恢复,避免了急诊手术。