Granulocytic sarcoma case presenting with leukemoid reaction and conglomerate lymphadenopathies

Abstract

Granulocytic sarcoma is a tumoral mass which exist at extramedullary areas and consist of myeloid progenitor cell lines. They are generally localized in bone, periost and soft tissue. Granulocytic sarcoma can present with the initial finding of acute myeloid leukemia. Fourty two years old female patient admitted to our clinic with sore throat and her physical examination tonsils was hypertrophic, hepatosplenomegaly and multiple conglomerate lymphadenopathies were determined. At the laboratory findings: hemoglobin level was 7.2 g / dl, leukocyte count was 144x109 / L, platelet count was 36x109 /L. As with peripheral blood smear and bone marrow aspiration findings acute or chronic myeloid leukemia were excluded. Excisional lymph node biopsy was performed to rule out preliminary lymphoma diagnosis. The result of the biopsy was consistent with granulocytic sarcoma and 7+3 remission-induction chemotherapy was started. The patient died secondary to progression of disease and sepsis. As a result at patients with leukomoid reaction and pathological lymphadenopathies it must be inmind that granulocytic sarcoma may be coexisting and the diagnosis must be confirmed with biopsy. / Granülositik sarkom, myeloid seri progenitör hücrelerini içeren ekstrameduller alanlarda yer alan tümöral bir kitledir. Genellikle kemik, periost, yumuşak dokuda lokalize olurlar. Granülositik sarkom, akut myeloid löseminin klinik bir başlangıç bulgusu olarak kendini gösterebilir. 42 yaşında kadın hasta, boğaz ağrısı nedenli kliniğimize başvuran olgumuzun fizik muayenesinde tonsiller hipertrofik, hepatosplenomegali ve multipl konglemere özellikte lenfadenopatileri mevcuttu. Laboratuvar incelemesinde, hemoglobin 7.2 gr/dl, lökosit 144x109 /L platelet 36x109 /L saptandı. Periferik yayma ve kemik iliği aspirasyon bulguları ile akut veya kronik myeloid lösemi düşünülmeyen hastaya lenfoma ön tanısı ile eksizyonel lenf nodu biyopisi yapıldı ve biyopsi sonucu granulositik sarkom ile uyumlu saptanarak 7+3 remisyon-indüksiyon kemoterapisi başlandı. Hasta progresyon ve sepsis nedeniyle ex oldu. Sonuç olarak; lökomoid reaksiyonla gelen ve patolojik lenfadenopatileri olan hastalarda tabloya granülositik sarkomun eşlik edebileceği düşünülmeli ve doku tanısı ile ön tanı desteklenmelidir.