Document Type : Case Reports
Dept. of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Dept. of Ophthalmology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Chloroma or granulocytic sarcoma (GS) is a malignant neoplasm of myeloid lineage that occur in a variety of anatomic sites other than the bone marrow including soft tissue, bone, lymph node, nasal fossa, skin and sometime in the orbit. In the subconjunctiva it is rarely reported. A 4-year-old girl with a history of treated acute myelogenous leukemia was referred to Farabi Eye Hospital, Tehran, Iran for the evaluation of subconjunctival mass that was appeared since one month ago. Cell blood count (CBC) of the patient was normal except for Hb=7gm/dl. General physical examination was normal except for the signs of anemia. Histopathological evaluation of subconjunctival mass showed a malignant large round cell neoplasm. Immunohistochemical studies confirmed granulocytic sarcoma. When confronting a large cell or undifferentiated round cell neoplasm, the possibility of myeloid sarcoma should be investigated. Myeloperoxidase (MPO), cluster designation (CD) molecules such as CD34, CD45, CD15, CD68 and lysozyme positivity or Leder staining are useful in this regard.
- William S. Spencer Ophthalmic Pathology. 4th ed. New York: W.B Saunders; 1996.
- Silverberg S. Principles and Practice of Surgical Pathology and Cytopathology. 4th ed. New York: Churchill Livingstone; 2006.
- Eggener SE, Abrahams A, Keeler TC. Granulocytic sarcoma of the testis. Urology 2004;63(3):584-5.
- Lagerveld BW, Wauters CA, Karthaus HF. Testicular granulocytic sarcoma without systemic leukemia. Urol Int 2005;75(1):94-6.
- Pathak B, Bruchim I, Brisson ML, Hammouda W, Bloom C, Gotlieb WH. Granulocytic sarcoma presenting as tumors of the cervix. Gynecol Oncol 2005;98(3):493-7.
- Shea B, Reddy V, Abbitt P, Benda R, Douglas V, Wingard J. Granulocytic sarcoma (chloroma) of the breast: a diagnostic dilemma and review of the literature. Breast J 2004;10(1):48-53.
- Rong Y, Wang D, Lou W, Kuang T, Jin D. Granulocytic sarcoma of the pancreas: a case report and review of the literatures. BMC Gastroenterol 2010;10:80.:80.
- Isik P, Tavil B, Tunc B, Yarali N, Demir A, Cetin M. Extramedullary orbital granulocytic sarcoma without bone marrow involvement: a report of two cases. Pediatr Hematol Oncol 2011;28(1):65-70.
- Thomas SA, Durairaj VD. Isolated myeloid sarcoma presenting in all four eyelids. Ophthal Plast Reconstr Surg 2007;23(4):336-8.
- Kim H, Je B, Lee Y, Kim B. Sino-orbital Granulocytic Sarcoma Causing Bilateral Proptosis As an Initial Manifestation of Acute Myelogenous Leukemia (AML): A Case Report. J Korean Soc Magn Reson Med ;14(1):74-7.
- Rajput D, Naval R, Yadav K, Tungaria A, Behari S. Bilateral proptosis and bitemporal swelling: A rare manifestation of acute myeloid leukemia. J Pediatr Neurosci 2010;5(1):68-71.
- Lee DA, Su WP. Acute myelomonocytic leukemia cutis presenting as a conjunctival lesion. Int J Dermatol 1985;24(6):369-70.
- Hon C, Shek TW, Liang R. Conjunctival chloroma (granulocytic sarcoma). Lancet 2002 ;359(9325):2247.
- Rosenberg C, Finger PT, Furlan L, Iacob CE. Bilateral epibulbar granulocytic sarcomas: a case of an 8-year-old girl with acute myeloid leukaemia. Graefes Arch Clin Exp Ophthalmol 2007;245(1):170-2.
- Nau JA, Shields CL, Shields JA, Eagle RC, Rice E. Clinicopathologic reports, case reports, and small case series: acute myeloid leukemia manifesting initially as a conjunctival mass in a patient with acquired immunodeficiency syndrome. Arch Ophthalmol 2002;120(12):1741-2.
- Feng X, Ying J, Li L, Shi S. The Diagnosis and Differential Diagnosis of Granulocytic Sarcoma. Chinese-German Journal Of Clinical Oncology 2008;7(10):603-7.
- Kariogla Z. Orbital Tumors Diagnosis and Treatment . New York: Springer; 2009.
- Yanoff M. Ocular Pathology . 6th ed. New York: Mosby; 2009.