PMC5982500_01
Baseline CT scan. (A) Left atrium of left ventricle anterior falx cerebri. (B) Left middle cranial fossa, right lateral wall of orbit. (C) Left paravertebral enhancing soft tissue at the level of L3. (D) Extradural soft tissue deposits at D4 and D8 level. Arrows showing where the mass lesion are
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F1
His computerized tomography (CT) scan of the brain revealed enhancing masses having smooth outline in (a) atrium of left lateral ventricle, 3.8x3 cm; (b) anterior falx cerebri, 2x1.7 cm; (c) dura based in the left anterior middle cranial fossa, and (d) the lateral extraconal space of right orbit, 15x8 mm [Figure 1A and B]. CT scan of the abdomen and spine revealed left paravertebral enhancing soft tissue at the level of L3 (2.26x0.96 cm) and extradural soft tissue deposits at D4 and D8 levels [Figure 1C and D].
(A) The atypical tumor cells containing moderate-to-abundant eosinophilic cytoplasm with distinct cytoplasmic boundaries, round-to-oval nucleus with finely granular chromatin and showing frequent apoptosis and atypical mitosis (400x, hematoxylin and eosin stain). (B) Leukocyte common antigen is positive (200x, immunohistochemistry [IHC]). (C) MPO positive (200x, IHC). (D) MIC-2 positive (200x, IHC)
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F2
He underwent CT-guided biopsy of the left paravertebral mass, and it revealed mononuclear cells that were immunopositive for myeloperoxidase (MPO) [Figure 2].
Postinduction chemotherapy CT scan. (A) Residual left atrial lesion. (B) Resolved middle cranial fossa and orbit lesions
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F3
AML was made. At the end of the induction chemotherapy, the bone marrow aspirate of our patient was in morphological remission, and the CT scan of the brain was repeated, which showed >90% reduction and minimal residual left atrial lesion and resolved middle cranial fossa and orbit lesions [Figure 3A and B].