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8/11/2019 1case Report 11 New

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Case report

Primary Granulocytic sarcoma Lip in anonleukemic patient - A rare presentation

Srivastava kirti, Paul Sayan, Gupta Deepak,Tripathi A K*,Goel Ma hu Mati**PantMC,!erma "iten ra# Department o$ %a iotherapy ,*Department o$ Me icine ,**Department o$ Patholo&y# CSMM' ($ormerly KGM'),luckno

A+stract- A sixty year old male presented with a swelling in theupper lip. On cytological examination patient was diagnosed as acase of Granulocytic Sarcoma. His bone marrow examination wasnormal suggesting no systemic disease. Patient achieved completeresponse by radiotherapy alone. Eighteen months following

treatment patient is completely asymptomatic.

ey !ords" Granulocytic Sarcoma# $adiotherapy

ntro uction Granulocytic sarcoma %GS& also calledmyeloblastoma or myeloid sarcoma is a rare solid tumor composedof immature cells. 't was first described by A. (urns in )*)) % + &.GS is a rare occurrence with an estimated incidence of ., - million

in children and - million in adults this tumor occurs in about +/of adults and )0/ of children with myeloid 1eu2emia . 'n autopsyseries GS occurs in 3*/ of patients with acute and chronicmyelogenous leu2emia. Such tumors often display a greenish color due to the en4ymatic action of myeloperoxidase in the tumor cells #hence the term 56hloroma7 was given to this lesion in )*+0.8orefre9uently the term Extra :medullary myeloid tumor %E88; & has

been proposed to include all the forms of extramedullary myeloid

leu2emia infiltrates.. ;hey occur most commonly in bones# periostium # soft tissues# 1ymph


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report here a case of primary GS presenting as a solitary lump inthe lip with out bone marrow involvement.Case istory A sixty year old male patient presented to our OP> with a history of gradually progressive swelling in rightupper lip for one month which was not associated with bleeding or

pain and no difficulty in chewing. On examination a lumpyswelling was noted in right upper lip with redness. % fig") &;helump was non tender and there was no bleeding from the lump itwas soft to firm in consistency. ;he lump was mainly present onright side while it had crossed the midline to involve medial -0 rd

of left side of upper lip. ;here were some necrotic areas on theright side of buccal mucosa with surrounding odema with mildtenderness without any bleeding .6ytological examination of theswelling was done suggesting granulocytic sarcoma featuringscattered single large cells with high


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composed of immature myeloid cells. 't was first described in)*)). ) Such tumors often display a greenish color due to theen4ymatic action of myeloperoxidase in the tumor cellsD hence# theterm chloroma was given to this lesion in )*+0. #0 ;he !HOclassification separates these tumors into myeloid or monocyticsarcomas. 8ost tumors have been observed in patients with acutemyelogenous leu2emia and myeloproliferative disorders 0D however#they have been described in patients with myelodysplasia F andchronic lymphocytic leu2emia. +#C Granulocytic sarcomas may alsooccur in the absence of leu2emia# , as noted in our patient. ;he mostcommon sites of involvement are bone# periosteum# soft tissue#lymph node# and s2in. 0 $are occurrences in muscle# * meninges#

breast#)@

mediastinum# and ovary))

have also been reported. ;he present case demonstrates the unusual extramedullary presentationwith lip involvement. ;his often predates involvement of themarrow but in our case eighteen months following treatment

patient is absolutely normal. ;hough Granulocytic sarcoma istreated as acute myelogenous leu2emia with systemicchemotherapy with or without local radiotherapy # 1ocal radiationtherapy may be necessary in selected cases# li2e the case we have

reported .%e$erences.). 8enasce 1P# (aner ee SS# (ec2ett E#Harris 8. Extra3medullary myeloid tumour %

granulocytoma & is often misdiagonosed" A study of C cases.Histopathology) D0F"0 )3*.

. Iamauchi #Iasuda 8 comparison in treatments of nonleu2emic granulocyticsarcoma"report of two cases and a review of , cases in the literature.6ancer @@8ar )+D F%C&"),0 3FC.

0. (yrd J6# Edenfield J!#Shields >J#et al" Extramedullary myeloid tumors in acutenon lymphocytic myeloid leu2emia" A 6linical review.J 6lin Oncol )0" )*@@#) +.

F.

+.(urns A" Observations of Surgical Anatomy# Head and


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?ig . 8icrophotograph from cytological smear of ?ine needle aspirate from the lipswelling smear showing immature myeloid cells including blasts. % 8ay GrunwaldGiemsa F@@ &

+


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?igure" ) Pretreatment lesion involving right upper lip

C


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?igure" 0 Post treatment picture showing complete disappearance of the lesion

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