PMC9174987_01
MRI (A, B) and 18-FDG-PET (C, D) of the neck displaying a laryngeal tumor mass at initial diagnosis [(A, C); arrow] and complete remission of the tumor formation after induction + consolidation I (B, D).
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Magnetic-resonance imaging (MRI) of the neck showed a large mass protruding into the right hemilarynx ( Figure 1A , arrow). The right piriform sinus and adjacent cervical lymph nodes showed significant tracer uptake ( Figure 1C , arrow).
(A) Skin biopsy with lichenoid leukaemic infiltration in the upper dermis. (B) Grooved nuclei and granulated eosinophilic cytoplasm are visible in the blasts. (C, D) There is a strong chloroacetate esterase reaction (C) in the infiltrate, as well as MPO reaction (D).
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Figures 2A-D ). Collectively, the lesion suspicious for larynx carcinoma and the skin lesions were identified as leukemic infiltrates, termed chloromas, of an acute myeloid leukemia. For further diagnostic and therapeutic steps, the patient was referred to the department of hematology.
(A) Overview of a bone marrow biopsy with discontinuous infiltration by acute promyelocytic leukemia (arrow: APL; *: areas with normal bone marrow. (B) Abnormal promyelocyctes show variable nuclear size and shape. Typical kidney shaped nuclei are visible. (C) Strong MPO reaction in all leukaemic promyelocyctes. (D) Partial and weak CD34 expression.
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Figures 3A, B ) expressing MPO ( Figure 3C ) and areas with normal hematopoiesis ( Figure 3A ) consisting of chloroacetate esterase expressing granulocytes, CD61-positive megakaryocytes and confluent clusters of regular erythropoesis. Furthermore, 20% of the blastoid cells were positive for CD34 ( Figure 3D ), but no CD45, CD61, CD68 or chloracetate esterase expression could be detected.