Primary granulocytic sarcoma of lip – A rare extramedullary presentation of myeloid leukemia

Abstract

A sixty year old male presented with a swelling in the upper lip. On cytopathology, the patient was diagnosed as a case of granulocytic sarcoma. His bone marrow examination was unremarkable. Patient was then treated by radiotherapy alone 30 Gray in 15 fractions and achieved complete response. Eighteen months after follow up the patient is absolutely normal. To our knowledge this is the first ever reported case of granulocytic sarcoma of lip.

A 60-year-old male presented with history of gradually progressive swelling in right upper lip for 1 month. On examination, a non-tender, firm, lumpy swelling was noted in the right upper lip [Figure 1]. Fine needle aspiration cytology (FNAC) of the lump was suggestive of granulocytic sarcoma featuring scattered single large cells with high N:C ratio, and oval to round, irregular, concentrically placed nuclei with granular single to multiple nucleoli. The cells had scanty to moderate amount of basophilic cytoplasm. The background consisted of RBCs, neutrophils, and lymphocytes [Figure 2]. Bone marrow aspiration and biopsy showed no marrow involvement by leukemic cells. In tumor board, the patient was planned for local radiotherapy and systemic chemotherapy. He received 30 Gy in 15 fractions local radiation with Co-60; but due to financial constraints, he did not receive chemotherapy. Eighteen months following radiotherapy, the patient is completely asymptomatic [Figure 3]. His bone marrow and peripheral blood picture is still absolutely normal. To our knowledge, this is the first ever reported case of granulocytic sarcoma of lip.

Figure 1.

Pretreatment lesion involving right upper lip

Figure 2.

Microphotograph of the cytological smear of fine needle aspirate from the lip swelling showing immature myeloid cells including blasts (May Grunwald Giemsa, ×400)

Figure 3.

Three months post-treatment picture showing complete disappearance of the upper lip lesion