Nair Vishnu Vikraman, Kundnani Vishal, Shetty Abhijith, Jain Mukul, Chodavadiya Sunil Shamjibhai, Patel Jenil
Department of Orthopaedics, Bombay Hospital and Medical Research Institute, Mumbai, Maharashtra, India.
J Orthop Case Rep. 2023 Feb;13(2):30-33. doi: 10.13107/jocr.2023.v13.i02.3544.
Chloromas are defined as metastatic granulocytic solid tumors of myeloid origin occurring at an extramedullary site. In this case report, we present an uncommon case of chronic myeloid leukemia (CML) presenting with metastatic sarcoma to the dorsal spine causing acute paraparesis.
A 36-year-old male presented in the OPD with complaints of progressive upper back pain and acute paraparesis since a 1 week. The patient is a previously diagnosed case of CML on treatment for the same. MRI of the dorsal spine indicated extradural soft-tissue lesions in D5-D9 extending to the right side of the spinal canal displacing the cord to the left. Considering the acute paraparesis that the patient developed, he was taken for an emergency decompression of the tumor. Microscopy showed infiltration of fibrocartilaginous tissue of polymorphous origin mixed with atypical myeloid precursor cells. Immunohistochemistry reports show atypical cells diffusely expressing myeloperoxidase, focally expressing CD34 and Cd117.
Rare case reports like this are the only literature available on remission in CML cases with sarcomas. The acute paraparesis in our patient was prevented from increasing to a paraplegia by surgical means. Immediate decompression of the spinal cord in patients with paraparesis and associated radiotherapy and chemotherapy should be considered in all patients with myeloid sarcomas of CML origin. While examining patients of CML, the possibility of a granulocytic sarcoma should always be kept in mind.
绿色瘤被定义为起源于髓系的转移性粒细胞实体瘤，发生于髓外部位。在本病例报告中，我们呈现了一例罕见的慢性髓性白血病（CML）病例，该病例表现为转移性肉瘤侵犯胸椎导致急性下肢轻瘫。
一名36岁男性因自1周前出现进行性上背部疼痛和急性下肢轻瘫而就诊于门诊。该患者既往已确诊为CML并正在接受治疗。胸椎MRI显示D5 - D9节段硬膜外软组织病变，延伸至椎管右侧，将脊髓向左移位。考虑到患者出现的急性下肢轻瘫，对其进行了肿瘤紧急减压手术。显微镜检查显示多形性来源的纤维软骨组织浸润，伴有非典型髓系前体细胞。免疫组织化学报告显示非典型细胞弥漫性表达髓过氧化物酶，局灶性表达CD34和Cd117。
像这样的罕见病例报告是CML合并肉瘤缓解情况的唯一可用文献。通过手术手段，我们患者的急性下肢轻瘫得以避免发展为截瘫。对于所有CML起源的髓系肉瘤患者，出现下肢轻瘫时应考虑立即进行脊髓减压，并联合放疗和化疗。在检查CML患者时，应始终牢记粒细胞肉瘤的可能性。
