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. 2009 Jul 13;20(10):506–511. doi: 10.1016/S1607-551X(09)70250-5

Chloroma of the Testis After Allogeneic Peripheral Blood Stem Cell Transplantation: A Case Report

Shih‐Wen Hu 1, Sheau‐Fang Yang 1, Chee‐Yin Chai 1,, Shu‐Pin Huang 1,2
PMCID: PMC11917811  PMID: 15553811

Abstract

Chloroma, or granulocytic sarcoma, is a rare extramedullary solid hematologic cancer that affects many sites, usually in concert with acute myeloid leukemia. It is infrequently associated with other myeloproliferative disorders or chronic myelogenous leukemia. Chloroma of the testis after allogeneic bone marrow transplantation is particularly sparsely represented in the literature. It is often incorrectly diagnosed as malignant lymphoma, especially large‐cell lymphoma, owing to the similarity of the histologic morphology, scanty eosinophilic myelocytes, and no or overlooked history of leukemia. Although erroneous diagnosis is decreasing with the advent of ancillary studies, the diagnosis of chloroma continues to be a nightmare for pathologists. It is thus suggested that an appropriate panel of marker studies be performed in conjunction with clinical correlation and circumspection to avoid reaching a misleading conclusion and improper treatment of patients. We report an interesting case of a 35‐year‐old male with a clinical history of chronic myelogenous leukemia post allogeneic peripheral blood stem cell transplantation and complete molecular remission, who was found to have chloroma of the left testis.

Keywords: chloroma, granulocytic sarcoma, chronic myelogenous leukemia, testis

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References

  • 1. Yavuz S, Paydas S, Disel U, et al. Ovarian granulocytic sarcoma. Leuk Lymphoma. 2004; 45: 183–185. [DOI] [PubMed] [Google Scholar]
  • 2. Antmen B, Haytac MC, Sasmaz I, et al. Granulocytic sarcoma of gingiva: an unusual case with aleukemic presentation. J Periodontol. 2003; 74: 1514–1519. [DOI] [PubMed] [Google Scholar]
  • 3. Sastre JL, Ulibarrena C, Armesto A, et al. Testicular granulocytic sarcoma as a form of relapse in a patient with acute megakaryoblastic leukemia. Sangre (Barc). 1998; 43: 248–250 [In Spanish]. [PubMed] [Google Scholar]
  • 4. Eggener SE, Abrahams A, Keeler TC. Granulocytic sarcoma of the testis. Urology. 2004; 63: 584. [DOI] [PubMed] [Google Scholar]
  • 5. Bekassy AN, Hermans J, Gorin NC, et al. Granulocytic sarcoma after allogeneic bone marrow transplantation: a retrospective European multicenter survey. Acute and Chronic Leukemia Working Parties of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant. 1996; 17: 801–808. [PubMed] [Google Scholar]
  • 6. Miyoshi I, Saito T, Taguchi H, et al. Granulocytic sarcoma of the testis. Br J Haematol. 2004; 124: 695. [DOI] [PubMed] [Google Scholar]
  • 7. Lee JJ, Kim HJ, Kook H, et al. Granulocytic sarcoma as isolated extramedullary relapse after donor lymphocyte infusion in a patient with CML who relapsed after allogeneic bone marrow transplantation: a case report. J Korean Med Sci. 1998; 13: 434–436. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8. Au WY, Chan AC, Lie AK, et al. Isolated extramedullary relapse after allogeneic bone marrow transplantation for chronic myeloid leukemia. Bone Marrow Transplant. 1998; 22: 99–102. [DOI] [PubMed] [Google Scholar]
  • 9. Martel L, Reddy K, Greco M, et al. Isolated cavernous sinus extramedullary relapse of chronic myelogenous leukemia following allogeneic stem cell transplant. Ann Hematol. 2002; 81: 108–110. [DOI] [PubMed] [Google Scholar]
  • 10. de Oliveira JS, Chauffaille Mde L, Colleoni GW, et al. Granulocytic sarcoma presented as a reactivation of chronic myeloid leukemia following allogeneic marrow transplantation. Rev Paul Med. 1998; 116: 1689–1691. [DOI] [PubMed] [Google Scholar]
  • 11. Servin‐Abdad L, Caldera H, Cardenas R, et al. Granulocytic sarcoma of the pancreas: a report of one case and review of the literature. Acta Haematol. 2003; 110: 188–192. [DOI] [PubMed] [Google Scholar]
  • 12. Ahmed S, Anwar M, Siddiqui SA, et al. Granulocytic sarcoma in patients with chronic myeloid leukemia. J Pak Med Assoc. 1995; 45: 180–181. [PubMed] [Google Scholar]
  • 13. Tatsui CE, Koerbel A, Prevedello DM, et al. Central nervous system granulocytic sarcoma after bone marrow transplant: case report. Arq Neuropsiquiatr. 2002; 60: 852–855. [PubMed] [Google Scholar]
  • 14. Colle I, Lacor P, Peeters P, et al. Granulocytic sarcoma (chloroma): a report of two cases. Acta Clin Belg. 1996; 51: 106–110. [DOI] [PubMed] [Google Scholar]
  • 15. Chen J, Yanuck RR 3rd, Abbondanzo SL, et al. c‐Kit (CD117) reactivity in extramedullary myeloid tumor/granulocytic sarcoma. Arch Pathol Lab Med. 2001; 125: 1448–1452. [DOI] [PubMed] [Google Scholar]
  • 16. Toth E, Balint I, Deak B, et al. Complex pathological diagnosis of granulocytic sarcoma: apropos of a case. Pathol Res Pract. 2002; 198: 55–57. [DOI] [PubMed] [Google Scholar]
  • 17. Menasce LP, Banerjee SS, Beckett E, et al. Extra‐medullary myeloid tumor (granulocytic sarcoma) is often misdiagnosed: a study of 26 cases. Histology. 1999; 34: 391–398. [DOI] [PubMed] [Google Scholar]
  • 18. Muller S, Sangster G, Crocker J, et al. An immunohistochemical and clinicopathological study of granulocytic sarcoma ('chloroma'). Hematol Oncol. 1986; 4: 101–112. [DOI] [PubMed] [Google Scholar]
  • 19. Bayer‐Garner IB, Schwartz MR, Lin P, et al. CD117, but not lysozyme, is positive in cutaneous plasmacytoma. Arch Pathol Lab Med. 2003; 127: 1596–1598. [DOI] [PubMed] [Google Scholar]
  • 20. Liu YH, Zhuang HG, Liao XB, et al. Diagnosis and differential diagnosis of granulocytic sarcomas. Zhonghua Xue Ye Xue Za Zhi. 2003; 24: 568–571. [PubMed] [Google Scholar]
  • 21. Fellbaum C, Hansmann ML. Immunohistochemical differential diagnosis of granulocytic sarcomas and malignant lymphomas on formalin‐fixed material. Virchows Arch A Pathol Anat Histopathol. 1990; 416: 351–355. [DOI] [PubMed] [Google Scholar]
  • 22. Ferry JA, Srigley JR, Young RH. Granulocytic sarcoma of the testis: a report of two cases of a neoplasm prone to misinterpretation. Mod Pathol. 1997; 10: 320–325. [PubMed] [Google Scholar]
  • 23. Guden M, Goktas S, Sumer F, et al. Retrospective analysis of S.W. Hu, S.P. Huang, S.F. Yang, and C.Y. Chai 74 cases of seminoma treated with radiotherapy. Int J Urol. 2003; 10: 435–438. [DOI] [PubMed] [Google Scholar]
  • 24. Richter HJ, Leder LD. Lymph node metastases with PAS‐positive tumor cells and massive epithelioid granulomatous reaction as diagnostic clue to occult seminoma. Cancer. 1979; 44: 245–249. [DOI] [PubMed] [Google Scholar]
  • 25. de Bono JS, Fraser JA, Lee F, et al. Metastatic extragonadal seminoma associated with cardiac transplantation. Ann Oncol. 2000; 11: 749–752. [DOI] [PubMed] [Google Scholar]
  • 26. Suh YK, Shin HJ. Fine‐needle aspiration biopsy of granulocytic sarcoma: a clinicopathologic study of 27 cases. Cancer. 2000; 90: 364–372. [PubMed] [Google Scholar]
  • 27. Chiou SY, Chiou HJ, Chou YH, et al. Sonographic features of primary testicular granulocytic sarcoma. J Ultrasound Med. 2003; 22: 1413–1416. [DOI] [PubMed] [Google Scholar]
  • 28. Bhattacharjee K, Bhattacharjee H, Das D, et al. Chloroma of the orbit in a non‐leukemic adult: a case report. Orbit. 2003; 22: 293–297. [DOI] [PubMed] [Google Scholar]
  • 29. Glossmann JP, Staak JO, Wickenhauser C, et al. Extramedullary acute myeloid leukemia (granulocytic sarcoma) with arm paresis, maculopapular exanthema and organ involvement. Leuk Lymphoma. 2003; 44: 1619–1621. [DOI] [PubMed] [Google Scholar]
  • 30. Economopoulos T, Alexopoulos C, Anagnostou D, et al. Primary granulocytic sarcoma of the testis. Leukemia. 1994; 8: 199–200. [PubMed] [Google Scholar]

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