Granulocytic sarcoma of the spine

OBJECTIVE: Granulocytic sarcomas (chloromas) are tumors consisting of primi tive myeloid cells. They are rare manifestations of acute and chronic leuke mias and can occasionally precede the development of systemic disease by we eks to years. Spinal complications of chloromas, such as cord compression s econdary to epidural tumor or cauda equina syndrome, have been described bu t are uncommon. METHODS: We present eight new cases of spinal chloroma. Three patients disp layed significant motor deficit in the form of paraparesis or paraplegia. A ll patients complained of lower back pain, with other complaints including generalized pain, abdominal pain, numbness and pain in the lower extremitie s and perianal region, and poor appetite. The average age of the patients w as 37 years. Treatment strategies included surgery, chemotherapy, and radio therapy. Three patients underwent surgical decompression. Six patients rece ived chemotherapy, and six patients received radiotherapy at doses of 2000 to 3000 cGy in up to 30 fractions. RESULTS: Patient survival ranged from 18 days to 9.5 years after diagnosis. A review of the previously reported cases of granulocytic sarcoma in addit ion to our new cases reveals that the most effective treatment is multimoda lity therapy coupled with early diagnosis. CONCLUSION: Increased awareness of this entity will facilitate early diagno sis and minimize potentially preventable neurological morbidity.