20 Feb

Primary Granulocytic Sarcoma Presenting with Pleural and Pulmonary Involvement

Primary Granulocytic Sarcoma Presenting with Pleural and Pulmonary InvolvementGranulocytic sarcoma (chloroma) is an unusual extramed-ullary manifestation of acute myelogenous leukemia, chronic myelogenous leukemia, and the myeloproliferative syndrome. The tumor rarely occurs in the absence of concurrent or remote peripheral blood or bone marrow involvement by leukemia. This patient developed pleural and pulmonary involvement by primary granulocytic sarcoma. Our review of the literature suggests that this is the first example of granulocytic sarcoma involving the pleura and lung but not the bone marrow. read only

Case Report
The patient, a previously healthy 36-year-old white woman, developed a flu-like illness and mild pericarditis in May 1987. At that time she had a large pericardial effusion with small pleural effusions and poor left ventricular function. The pleural effusions resolved, and an echocardiogram showed resolution of the pericardial effusion and improved left ventricular function.
She did well until the latter part of July 1987, when she noted increased dyspnea on exertion. Chest roentgenograms revealed partial atelectasis of the left lower lobe with a left-sided pleural effusion (Fig 1A and B). She was given antibiotics, without effect. Her dyspnea on exertion and pleural effusion worsened. She had a nonproductive cough.
The patient was admitted on July 30, 1987 with a large left pleural effusion and left lower lobe atelectasis. The electrocardiogram showed a sinus rhythm, and nonspecific ST and T wave changes. The echocardiogram showed thickened pericardium with no evidence of constriction and a mildly thickened left ventricular wall with mildly impaired left ventricular function. A left thoracocentesis was performed. Straw-colored fluid was obtained with a total protein of 3.4 g/dl, a glucose of 90 mg/dl, a specific gravity of 1.023, and a lactate dehydrogenase (LDH) of 182 IU/L. There were 5,800 white blood cells/cu mm with 2 percent neutrophils, 91 percent lymphocytes, and 7 percent monocytes.

Figure 1A and B. Posteroanterior and lateral chest radiographs showing loss of volume in the left side of the chest and a left pleural effusion.

Figure 1A and B. Posteroanterior and lateral chest radiographs showing loss of volume in the left side of the chest and a left pleural effusion.

Categories: Pulmonary Involvement
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