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Radiologic Manifestations of Granulocytic Sarcoma in Adult Leukemia

¹ Department of Diagnostic Radiology, The University of Hong Kong, Queen Mary Hospital, Rm. 405, Block K, Pokfulam Rd., Pokfulam, Hong Kong.
² Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.

View larger version (101K): [in a new window]   Fig. 1A. —68-year-old man with 2-year history of acute myeloid leukemia complained of painful, reddened right eye. Conjunctival biopsy confirmed granulocytic sarcoma. Six months later, patient presented with bilateral swoilen and painful testes. Fat-suppressed T2-weighted fast spin-echo MR image (TR/TE, 3560/30) of orbit shows conjunctiva (arrow) of right globe that is thickened and mildly hyperintense to muscle.

View larger version (95K): [in a new window]   Fig. 1B. —68-year-old man with 2-year history of acute myeloid leukemia complained of painful, reddened right eye. Conjunctival biopsy confirmed granulocytic sarcoma. Six months later, patient presented with bilateral swoilen and painful testes. T1-weighted spin-echo MR image (820/9) show testes to be mildly hyperintense to muscle. Bilateral hydroceles and thickened tunica vaginalis (arrowheads) are visible. There is abnormal marrow signal (arrow) in right femur.

View larger version (72K): [in a new window]   Fig. 1C. —68-year-old man with 2-year history of acute myeloid leukemia complained of painful, reddened right eye. Conjunctival biopsy confirmed granulocytic sarcoma. Six months later, patient presented with bilateral swoilen and painful testes. T2-weighted fast spin-echo MR image (4920/80) shows loss of normal hyperintensity of testes. Abnormal bone marrow (arrow) in right upper femoral shaft shares similar signal changes with testes.

View larger version (143K): [in a new window]   Fig. 2A. —32-year-old man with acute myeloid leukemia who had leukemic relapse in nasopharynx and was treated with local radiotherapy and chemotherapy. Patient presented 18 months later with headache and confusion. Contrast-enhanced CT scan of nasopharynx shows soft-tissue mass (1) that is obliterating right fossa of Rosenmuller.

View larger version (142K): [in a new window]   Fig. 2B. —32-year-old man with acute myeloid leukemia who had leukemic relapse in nasopharynx and was treated with local radiotherapy and chemotherapy. Patient presented 18 months later with headache and confusion. T1-weighted spin-echo MR image (TR/TE, 500/9) of brain shows mass isointense to gray matter in the right temporal lobe.

View larger version (141K): [in a new window]   Fig. 2C. —32-year-old man with acute myeloid leukemia who had leukemic relapse in nasopharynx and was treated with local radiotherapy and chemotherapy. Patient presented 18 months later with headache and confusion. Contrast-enhanced T1-weighted spin-echo MR image (700/20) reveals thick, enhancing rim around mass. Mild vasogenic edema is noted with some mass effect.

View larger version (135K): [in a new window]   Fig. 3A. —68-year-old man with acute myeloid leukemia and symptoms referable to cauda equina. T1-weighted spin-echo MR image (TR/TE, 860/9) shows intraspinal masses (arrowheads), which are isointense to muscle with thickened epidura, and lesion in sacrum (arrow).

View larger version (113K): [in a new window]   Fig. 3B. —68-year-old man with acute myeloid leukemia and symptoms referable to cauda equina. T2-weighted fast spin-echo MR image (4120/90) shows masses (arrowheads) to be enlarged and hyperintense nerve roots with thickened spinal epidural tissue.

View larger version (120K): [in a new window]   Fig. 3C. —68-year-old man with acute myeloid leukemia and symptoms referable to cauda equina. Contrast-enhanced T1-weighted MR image (850/9) shows enhancement of both thickened nerve roots and epidural tissue. Abnormal area in left sacrum (arrow) shares similar signal changes with nerve roots and epidura.

View larger version (91K): [in a new window]   Fig. 4. —49-year-old woman with acute myeloid leukemia relapse in bone marrow. Axial enhanced CT scan shows skin and lung nodules with irregularly thickened enhancing rims. Smaller lung nodules (arrows) and infiltration of right pectoralis muscle (P) are also visible.

View larger version (153K): [in a new window]   Fig. 5A. —33-year-old woman with chronic myeloid leukemia and painful swollen left thigh. Aspiration biopsy confirmed granulocytic sarcoma as cause. Sonogram of thigh shows heterogeneous hypoechoic mass (cursors labeled 1 marking width, cursors labled 2 marking depth).

View larger version (133K): [in a new window]   Fig. 5B. —33-year-old woman with chronic myeloid leukemia and painful swollen left thigh. Aspiration biopsy confirmed granulocytic sarcoma as cause. Contrast-enhanced CT scan shows mass to be hypodense with peripheral rim enhancement. Mass (arrows) arose deep within vastus lateralis and intermedius muscles, abutting femoral shaft with adjacent cortical erosion.

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