Isolated granulocytic sarcoma of the orbit
A 10-year-old boy presented with progressive proptosis
of the left globe for the last 8 months. He had no consti-
tutional symptoms. On examination, he had a large mass
involving the left orbit. Rest of the physical examination
was unremarkable. Computed tomography (CT) and
magnetic resonance imaging of the orbit revealed a large
enhancing mass located in the left orbit, causing propto-
sis with invasion into the left ethmoid and maxillary
sinuses with some destruction of the intervening bones.
Axial [(18)F] fluorodeoxyglucose positron emission tomo-
graphy (FDG PET) CT (Fig. 1A) revealed that the mass
was hypermetabolic.
A complete haemogram and bone marrow biopsy was
normal. Fine needle aspiration cytology and biopsy
(Fig. 2) of the mass revealed an infiltrating neoplasm
composed of small round cells that were positive for leu-
cocyte common antigen and myeloperoxidase. Thus, a
diagnosis of isolated orbital granulocytic sarcoma was
made. Repeat FDG PET CT (Fig. 1B) after 1 month of
induction chemotherapy (daunomycin and cytosine ara-
binoside) and first consolidation therapy (high-dose cyto-
sine arabinoside 18 g/m2) revealed marked decrease in
the size of the mass as well as FDG avidity. The patient
was given two additional courses of consolidation with
high-dose cytosine arabinoside followed by local radio-
therapy (24 Gy over 12 fractions). Patient is in remission
at 3-month follow-up after completion of therapy.
Our case is unique in providing exquisite pre- and
post-chemotherapy FDG PET CT images.
Jyoti Kumar1, Ashu Seith1, Sameer Bakhshi2,Rakesh Kumar3, Atin Kumar1, Seema Sen4
Departments of 1Radiology, 2Medical Oncology,3Nuclear Medicine and 4Pathology, All India
Institute of Medical Sciences, New Delhi, India
Correspondence Dr Ashu Seith, MD, Associate
Professor, Department of Radiology, All India Institute
of Medical Sciences, New Delhi 110 029, India.
Tel: 91 11 26593326; Fax: 91 11 26588663;
e-mail: [email protected]
A B
Figure 1 (A) Axial FDG PET CT images of the orbit reveal a large hypermetabolic mass in the left orbit extending into the ipsilateral maxillary
sinus with bone destruction. (B) Repeat FDG PET CT images of the orbit after 1 month of induction chemotherapy revealed dramatic decrease in
the size of the mass as well as FDG avidity.
Figure 2 Biopsy shows large round to oval cells with irregular nuclei
and indistinct cytoplasmic outlines (H&E ·400).
doi:10.1111/j.1600-0609.2007.00830.x European Journal of Haematology ISSN 0902-4441
CLINICAL PICTURE
456ª 2007 The Authors
Journal compilation 78 (456) ª 2007 Blackwell Munksgaard