PMC4605259_01
A morphology slide showing many neoplastic cells.
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fig1
Many of the neoplastic cells found on morphology were myeloblasts with eosinophilic cytoplasm, fine chromatin, and prominent nucleoli (left side of Figure 1). There were also clusters of myeloid cells showing monocytic differentiation with ovoid nuclei and abundant pale cytoplasm (right side of Figure 1).
Baseline PET Scan following one course of chemotherapy showing metabolic activity in the mass. Note after clarification from nuclear medicine radiologist: myocardial uptake is present as patient did not comply with 6-hour glucose fasting prior to scan.
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fig2
A baseline positron emission tomography (PET) scan performed at a similar time demonstrated metabolic activity of this paravertebral mass (shown in Figure 2).
PET scan following four courses of chemotherapy still demonstrating metabolic activity.
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fig3
Following three courses of FLAG-IDA chemotherapy a repeat PET scan was performed (shown in Figure 3).
PET scan following palliative radiotherapy now metabolically negative. Note after clarification from nuclear medicine radiologist: myocardial uptake is present as patient did not comply with 6-hour glucose fasting prior to scan.
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fig4
Table 1) a repeat PET scan showed that the myeloid sarcoma was now metabolically negative (Figure 4). The PET scan did demonstrate metabolic activity in the lung but was thought to reflect postradiotherapy change rather than metastases.
Slides from final PET scan showing metastatic spread with metabolic activity in multiple sites of the body.
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fig5
AML transformation although no bone marrow biopsy was performed. After deliberation the patient had a further PET scan, six months after the previous scan (slides shown in Figure 5).