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Clinical images

Granulocytic sarcoma of the skin

Mario Pirisi, Marco Krengli and Guido Valente
CMAJ September 23, 2008 179 (7) 727; DOI: https://doi.org/10.1503/cmaj.080674
Mario Pirisi MD
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Marco Krengli MD
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Guido Valente MD
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  • © 2008 Canadian Medical Association

An 89-year-old woman with refractory anemia presented with a painful neck mass that measured 5 cm × 3 cm (Figure 1A). Her peripheral leukocyte count was (118 × 109/L), with 98% immature blood cells. A biopsy of the mass showed massive infiltration of the subcutaneous connective tissue by eosinophilic cells (Figure 1B). Clusters of these cells stained intensely positive for myeloperoxidase (Figure 1B insert), which confirmed the diagnosis of granulocytic sarcoma.

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Figure 1: A: An 89-year-old woman with a painful neck mass (5 cm × 3 cm). B: A biopsy of the mass showed massive infiltration of the subcutaneous connective tissue by eosinophilic cells (original magnification × 220), with intensely positive staining for myeloperoxidase (insert: original magnification × 440). C: The tumour regressed 4 months after treatment.

Granulocytic sarcomas are extramedullary tumours associated with acute myeloid leukemia. They are also known as chloromas because they express myeloperoxidase and therefore appear green or turn green in the presence of dilute acid.

For our patient, cytoreduction was achieved with a low-dose oral etoposide, and the neck mass was controlled by electron beam radiotherapy. Four months later, the patient remained in fair condition. Figure 1C shows complete regression of the neck lesion, which was replaced by a pigmented scar.

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  • Clinical images are chosen because they are particularly intriguing, classic or dramatic. Submissions of clear, appropriately labelled high-resolution images must be accompanied by a figure caption and the patient's written consent for publication. A brief explanation (300 words maximum) of the educational significance of the images with minimal references is required.

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Canadian Medical Association Journal: 179 (7)
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23 Sep 2008
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Granulocytic sarcoma of the skin
Mario Pirisi, Marco Krengli, Guido Valente
CMAJ Sep 2008, 179 (7) 727; DOI: 10.1503/cmaj.080674

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Granulocytic sarcoma of the skin
Mario Pirisi, Marco Krengli, Guido Valente
CMAJ Sep 2008, 179 (7) 727; DOI: 10.1503/cmaj.080674
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