Presentation
A 12 year-old boy presents to A & E at midnight, with a 24 hour history of paralysis. No anal tone. Anuria. 2am MRI performed.
Patient Data
Well defined long segment of homogenously enhancing tissue in the upper/mid thoracic epidural space, which is partially effacing the cord, but without signal change within.
Bilateral paravertebral soft tissue.
Extensive ill-defined infiltrative appearing soft tissue in the epidural and indural space from L5-coccyx. This is infiltrating all the sacral foraminae bilaterally encasing the exiting nerve roots.
Diffusely enhancing bone marrow throughout the spine.
Enlarged tonsils and adenoids.
Case Discussion
Rare case of first presentation AML, with granulocytic sarcoma (chloromas).
Chloromas are solid extramedullary tumors, most often found in conjunction with bone or nervous tissue. The term chloroma arising from the frequent, but not exclusive, green color of the tissue on gross pathology.
Granulocytic sarcoma lesions are composed of immature myeloid elements and therefore represents focal accumulation of leukemic cells. Various sites have been documented, with the extra-dural space being one of the commonest. The diffuse form often involves the spinal nerve roots.
The patient's WCC turned out to be > 200 mm 3.
A bone marrow biopsy confirmed acute myeloid leukemia.
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