PMC5209593_01
Patient with left Horner's syndrome: normal right eye (a) and external examination in comparison to left eye (b) with ptosis, miosis, and enophthalmos.
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On neurological examination the patient was noticed to have left-sided ptosis, miosis, enophthalmos (Figure 1), and reported facial anhidrosis on the left side, alongside ipsilateral weakness predominantly involving his intrinsic hand muscles, long finger flexors, and numbness involving the medial border of his arm, hand, and little finger (see Video 1 in Supplementary Material available online at http://dx.doi.org/10.1155/2016/3015947).
Magnetic Resonance Imaging (MRI) of the cervical spine and brachial plexus at cervical-thoracic levels: T2-weighted images with left paraspinal soft tissue mass and brachial plexus infiltration in sagittal (a), coronal (b), and axial (c) views and intraspinal extension (d).
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Computed Tomography (CT) scan of soft tissue neck demonstrating right occipital (solid arrow) and right jugulomandibular (dotted arrow) cervical lymphadenopathies.
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Extensive lymphadenopathy was noted on imaging studies (Figure 3), particularly involving the submandibular, left, and right internal jugular lymph nodes.
Histopathological analysis. (a) Low magnification view with effacement of lymph node architecture. (b) High magnification view with numerous immature cells (blasts). (c) A proportion of the immature cells are positive for myeloperoxidase by immunohistochemistry. (d) A proportion of the immature cells are positive for CD117 by immunohistochemistry.
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The excisional biopsy of right cervical lymph node, meanwhile, confirmed myeloid sarcoma or chloroma with immunophenotyping revealing 32% blasts displaying myeloid-associated antigen expression and aberrant expression of CD5, CD7, and CD 117 (Figure 4).