ABSTRACT
A case of granulocytic sarcoma (chloroma) of hepatic localization is presented. It is a extramedullary strange tumour, composed of immature precursors of myeloid cells. Clinically it can show, before, during or after a acute myeloid leukemia, chronic myeloproliferative disorders or myelodysplastic syndromes. Our patient, 81 year-old male, presented a process of important acute jaundice, with negative image technics, what indicated us the intrahepatic origin, negative tumorals markers, negative serology and hepatic biopsy (the piece of greenish coloration is described) what showed a hepatic sinusoides diffuse infiltration by indifferentiation cellularity, with study immuno-histochemical that was positive for the myeloperoxydase, giving a diagnose compatible with hepatic infiltration for acute myeloid leukemia. The patient doesn't present affectation of peripheral blood, and he died for acute hepatic and renal failure after 8 days of entrance.
Subject(s)
Leukemia, Myeloid/pathology , Liver Neoplasms/pathology , Sarcoma, Myeloid/pathology , Acute Disease , Aged , Aged, 80 and over , Fatal Outcome , Humans , Leukemia, Myeloid/complications , Liver Neoplasms/complications , Male , Sarcoma, Myeloid/complicationsABSTRACT
El sarcoma granulocítico es un tumor extramedular, poco frecuente, constituido por precursores inmaduros mieloides. Puede aparecer en ausencia de enfermedad hematológica o con anterioridad a la misma, aunque lo más usual es que se asocie a una leucemia mieloide aguda o a otro proceso mieloproliferativo, o bien que se manifieste en el curso de un síndrome mielodisplásico. Nuestro paciente, varón de 81 años de edad, presentaba un cuadro de ictericia mucocutánea franca, aguda, con un patrón analítico de colestasis, unas técnicas de imagen negativas, lo cual nos indicaba su origen intrahepático, marcadores tumorales negativos, serología negativa. La biopsia hepática, macroscópicamente de coloración verdosa, mostraba una infiltración difusa de los sinusoides hepáticos por celularidad indiferenciada, con positividad para mieloperoxidasa en el estudio inmunohistoquímico. El paciente no presentaba afectación de sangre periférica (ninguna de las tres series) y falleció por un fallo hepatorrenal agudo a los 8 días de su ingreso (AU)
Subject(s)
Aged , Aged, 80 and over , Male , Humans , Fatal Outcome , Sarcoma, Myeloid , Acute Disease , Leukemia, Myeloid , Liver NeoplasmsABSTRACT
A case of primary adrenal bilateral non-Hodgking lymphoma, with depressed adrenal reserve is presented. This rare neoplasm causes rapid evolution and fatal outcome in most cases. In our patient, lethal outcome was associated with severe hypercalcemia and refractary hypotension. Many other complications are due to tumoral lysis syndrome associated with high steroid doses in adrenal insufficiency. This rare entity must be included in the differencial diagnosis of adrenal masses, uni or bilateral, because early diagnostic is important for preventing complications, potentially lethals and for improving survival. Image thecnics and ultrasound-guided or computed-tomography-guided FNA, are best diagnostic methods, but in many cases, definitive diagnostic is obtained by necropsy.
