Radiologic Spectrum of Extramedullary Relapse of Myelogenous Leukemia in Adults
Jan Fritz1,2,
Wichard Vogel3,
Roland Bares4 and
Marius Horger1
1 Department of Diagnostic Radiology, Eberhard-Karls-University Tübingen,
Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
2 Russell H. Morgan Department of Radiology and Radiological Science, Johns
Hopkins University School of Medicine, Baltimore, MD 21287.
3 Division of Oncology, Department of Internal Medicine,
Eberhard-Karls-University Tübingen, Tübingen, Germany.
4 Division of Nuclear Medicine, Department of Diagnostic Radiology,
Eberhard-Karls-University Tübingen, Tübingen, Germany.
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Fig. 1 —21-year-old man with chloroma of mandibular branch (V3) of
trigeminal nerve. Coronal contrast-enhanced T1-weighted MR image shows altered
signal intensity of Meckel's cave (arrow) and right mandibular nerve
in continuation throughout foramen ovale caused by chloroma. Trigeminal nerve
was only site of involvement in this patient who complained of neuralgia.
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Fig. 2 —37-year-old man with pachymeningeal chloroma. T2-weighted
coronal MR image shows small left parasagittal meningeal mass near superior
sagittal venous sinus (white arrow) showing T2 hyperintensity. In
addition, there is right hemispheric glioma (black arrows) with large
perifocal edema and compression of right lateral ventricle.
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Fig. 3A —22-year-old man with chloroma of upper lip and vestibular
mucosa. Axial contrast-enhanced CT scans at level of maxilla show infiltration
of upper vestibular mucosa with involvement of upper lip and its frenulum.
These images also show almost symmetric growth of tumor (arrows),
which has already destroyed maxilla (region 12–13), invading hard
palate.
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Fig. 3B —22-year-old man with chloroma of upper lip and vestibular
mucosa. Axial contrast-enhanced CT scans at level of maxilla show infiltration
of upper vestibular mucosa with involvement of upper lip and its frenulum.
These images also show almost symmetric growth of tumor (arrows),
which has already destroyed maxilla (region 12–13), invading hard
palate.
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Fig. 4A —32-year-old woman with chloroma of breast. Axial unenhanced
CT scan of chest shows dense, ovoid 3-cm mass (arrows) embedded in
left breast parenchyma, which is isodense to surrounding parenchyma and
musculature. Asymmetry between breasts led to detection of this chloroma. Note
also solitary pulmonary nodule with cavitation in left lung caused by septic
embolism.
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Fig. 4B —32-year-old woman with chloroma of breast. B-mode sonogram
shows heterogeneous slightly hypoechoic mass with ill-defined margins, whereas
color Doppler signal indicates multiple strong caliber arterial feeder vessels
and draining veins.
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Fig. 5A —40-year-old man with chloroma of heart. Axial
contrast-enhanced cardiac CT scan shows circular involvement of right heart
along tricuspid valve with intramural growth and secondary infiltration of
pericardium (arrows). There is also segmental thickening of
interatrial and interventricular septum. Consecutive large pericardial
effusions were drained.
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Fig. 5B —40-year-old man with chloroma of heart. Multiplanar
reconstruction contrast-enhanced cardiac CT shows relative hypodensity of mass
due to high vascular density of normal myocardium (white arrow).
Echocardiography (not shown) disclosed tricuspid valve insufficiency. Note
also right ventricular electrode of bipolar pacemaker (black arrows)
and pericardial drain (asterisk).
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Fig. 6A —Chloroma of lung. Axial CT scan of chest in 43-year-old man
shows infiltrative growth patterns. Partial upper lobe atelectasis is caused
by central bronchus stenosis (not shown) due to proximal peribronchial
chloroma. Most of mass seen in right upper lobe represents chloroma, leading
to enlargement of the involved pulmonary lobe.
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Fig. 7A —Pleural chloroma. Axial contrast-enhanced CT scan at level of
cardiac ventricles in 60-year-old man with pleural chloroma shows plaquelike
granulocytic sarcoma (arrow) along right parietal costal pleural
lining.
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Fig. 7B —Pleural chloroma. Axial contrast-enhanced CT scan at level of
left atrium in same patient reveals pulmonary involvement (arrow) of
collapsed right lower lung lobe accompanied by pleural infiltration.
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Fig. 7C —Pleural chloroma. Axial contrast-enhanced CT scan in
28-year-old woman at level of aortic arch shows epipleural chloroma (white
arrow) in paravertebral location extending to ipsilateral neuroforamen
(black arrow).
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Fig. 8 —47-year-old man with chloroma of liver. Coronal
contrast-enhanced CT scan of liver shows multifocal granulocytic sarcoma as
homogeneously hypodense hepatic masses (arrows). On sonograms,
hepatic chloromas presented as homogeneously hypoechoic masses (not
shown).
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Fig. 9 —39-year-old man with chloroma of liver. Coronal
contrast-enhanced CT scan of liver shows peribiliary granulocytic sarcoma
(arrows) in patient presenting with mild jaundice several months
after allogeneic hematopoietic cell transplantation, consistent with
extramedullary relapse of myelogenous leukemia.
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Fig. 10A —33-year-old woman with chloroma of bowel, peritoneum, and
omentum. Axial (A) and coronal (B) contrast-enhanced CT scans of
abdomen reveal intestinal chloroma presenting as segmental wall thickening of
colon (white arrow, A). Note also ill-defined bowel margins
and increased, diffuse wall enhancement (black arrow, A). Note
reticular and small nodular thickening of peritoneum and greater omentum
(arrows, B) representing chloroma.
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Fig. 10B —33-year-old woman with chloroma of bowel, peritoneum, and
omentum. Axial (A) and coronal (B) contrast-enhanced CT scans of
abdomen reveal intestinal chloroma presenting as segmental wall thickening of
colon (white arrow, A). Note also ill-defined bowel margins
and increased, diffuse wall enhancement (black arrow, A). Note
reticular and small nodular thickening of peritoneum and greater omentum
(arrows, B) representing chloroma.
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Fig. 12 —33-year-old woman with chloroma of adnexa. Axial
contrast-enhanced CT scan of pelvis shows enlargement of left adnexa
representing chloroma seeding (arrow) in patient also presenting with
bowel-wall infiltration.
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Fig. 13A —Chloroma of skeletal muscle. Two coronal contrast-enhanced CT
scans of pelvis in 49-year-old man show different forms of muscular
infiltration (arrows) causing swelling of muscle belly with increased
peripheral enhancement and partial central hypodensity.
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Fig. 13B —Chloroma of skeletal muscle. Two coronal contrast-enhanced CT
scans of pelvis in 49-year-old man show different forms of muscular
infiltration (arrows) causing swelling of muscle belly with increased
peripheral enhancement and partial central hypodensity.
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Fig. 13C —Chloroma of skeletal muscle. Coronal T2-weighted MR image
with fat saturation in 55-year-old woman shows increased signal intensity
(arrow). There was increased contrast enhancement on T1-weighted MR
sequences (not shown).
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Fig. 14 —66-year-old man with intramedullary chloroma. Sagittal
multiplanar reconstruction image of unenhanced CT of left femur shows multiple
intramedullary nodules (arrows) of different density. There is no
involvement of cortical bone or surrounding soft tissue.
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Fig. 15 —25-year-old woman with chloroma of bone. Sagittal T2-weighted
fat-saturated MR image shows granulocytic sarcoma with homogeneous signal
hyperintensity in tibial head (arrows), strongly enhancing after IV
gadopentetate dimeglumine (not shown).
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Fig. 16A —40-year-old man with chloroma of bone. Axial T1-weighted
gadolinium-enhanced MR image shows large, homogeneously enhancing granulocytic
sarcoma of left fibular head (black arrows). Expansive growth of this
tumor compresses surrounding muscles. Circular growth around fibular bone
suggests medullary origin. Note also mild enhancement of medullary space
(white arrow).
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Fig. 16B —40-year-old man with chloroma of bone. Whole-body
18F-FDG PET image (left figure part) shows increased focal
FDG uptake (standardized uptake value average, 5.6) (black arrow).
Fused coronal PET/CT image (right figure part) shows extraosseous
extension (white arrow). No additional foci were found.
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Fig. 17 —44-year-old woman with chloroma of bone. Axial CT scan at
level of femoral condyles (bone window setting) shows subtle sclerosis
(arrows) in right lateral femoral condylus caused by granulocytic
sarcoma.
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Fig. 18A —Chloroma of skin. Two axial contrast-enhanced CT scans show
subcutaneous granulocytic sarcoma presenting as ill-defined nodule
(arrow, A) or diffuse infiltration of subcutaneous tissue
(arrows, B). Patient in A is 51-year-old man; patient
in B is 47-year-old man.
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Fig. 18B —Chloroma of skin. Two axial contrast-enhanced CT scans show
subcutaneous granulocytic sarcoma presenting as ill-defined nodule
(arrow, A) or diffuse infiltration of subcutaneous tissue
(arrows, B). Patient in A is 51-year-old man; patient
in B is 47-year-old man.
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Fig. 19 —19-year-old man with subcutaneous granulocytic sarcoma of
skin. B-mode sonogram shows heterogeneous, centrally hypoechoic mass
(asterisk) with dorsal acoustic enhancement. Power Doppler signal
indicates increased surrounding vascularity.
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Copyright © 2007 by the American Roentgen Ray Society.
