A Rare Case of Relapsed Pediatric Acute Promyelocytic Leukemia with Skin Involvement by Myeloid Sarcoma.

Content Provider	Europe PMC
Author	Araújo, Nathalia Silva Júnior, Claudio José dos Santos Gomes, Vitória Mikaelly da Silva Leite, Luiz Arthur Calheiros Bomfim, Luana Novaes Gusmão, Amanda Katielly Firmino da Silva Alves, Maria Jordana Rocha Gomes Romão, Cyndi Myrelle da Silva Barros Batinga, Arthur Moacir Costa Sampaio da Silva, Maria Rosa de Sousa Rodrigues, Célio Fernando
Copyright Year	2018
Abstract	Patient: Male, 9Final Diagnosis: Acute promyelocytic leukemia (APL)Symptoms: BleedingMedication: —Clinical Procedure: —Specialty: HematologyObjective:Rare diseaseBackground:Acute promyelocytic leukemia (APL) is a very rare leukemia in children. Extramedullary involvement by APL has been reported in between 3–5% of cases, mainly associated with cases of relapse. A rare case of relapse of APL in a 9-year-old child is presented with skin involvement with myeloid sarcoma.Case Report:A 9-year-old male child was admitted to the Oncology Service of the hospital complaining of fever, progressive fatigue, oral petechiae with severe bleeding in the oral cavity. Bone marrow examination showed some promyelocytes. Flow cytometry showed 86% immature myeloid cells with the t(15;17) translocation, and molecular analysis showed expression of the PML/RARα fusion protein, which confirmed the diagnosis of APL. The patient completed a course of daunorubicin, cytarabine, and AII trans-retinoic acid (ATRA) with complete remission. After six months, the patient was re-admitted to hospital with a violaceous lesion on the scalp, with relapse of APL. Histological and immunohistochemistry of the lesion involving the skin of the scalp showed a myeloid sarcoma invading the dermis.Conclusions:Myeloid sarcoma, also called granulocytic sarcoma, is an extramedullary tumor of immature myeloid cells, which very rarely presents in children with APL. The mechanisms that lead to myeloid sarcoma in children with APL and the possible association with ATRA therapy remain to be investigated.
Volume Number	19
PubMed Central reference number	PMC5912010
PubMed reference number	29650946
Journal	The American Journal of Case Reports [Am J Case Rep]
e-ISSN	19415923
DOI	10.12659/AJCR.907847
Language	English
Publisher	International Scientific Literature, Inc.
Publisher Date	2018-04-13
Access Restriction	Open
Rights License	This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) © Am J Case Rep, 2018
Subject Keyword	Antineoplastic Combined Chemotherapy Protocols Child Leukemia, Promyelocytic, Acute Recurrence
Content Type	Text
Resource Type	Article
Subject	Medicine