内容紹介
Summary
We report a case of myeloid sarcoma(MS)that primarily developed in the spleen. The patient was a 60s man with a chief complainant of low-grade fever following a dental implant. Although he underwent intensive antibiotic treatment, including levofloxacin, meropenem, and vancomycin, no significant decline in fever was observed. Abdominal contrast-enhanced CT revealed an LDA occupying the majority of his spleen, which was diagnosed as a splenic abscess. Although a CT-guided biopsy and drainage for the spleen were considered, a puncture of the spleen was not performed due to the substantial concern of bleeding. Subsequently, a splenectomy was performed and HE staining revealed mitosis of tumor cells and massive necrosis. Immunohistochemical analysis revealed that the tumor cells were positive for myeloperoxidase, CD43, CD45, and CD68. Finally, the splenic LDA was diagnosed as MS instead of a splenic abscess. He was treated with systemic chemotherapy. MS primarily develops in the spleen is quite rare: we found only 2 case reports of this disease. The prognosis of MS is poor due to the complications of AML. Accordingly, MS should be considered as a differential diagnosis for accurate diagnosis and treatment of splenic LDA.
要旨
症例は60歳台,男性。狭心症に対し2016年12月に経皮的冠動脈形成術(PCI),2017年1月に歯科インプラント治療の既往がある。2017年2月ごろから37℃台の微熱が持続していたため,精査目的に4月に当院内科を紹介受診した。熱源検索目的に施行したCT検査で,脾臓内部に辺縁部が淡く造影される低吸収域を認め脾膿瘍が疑われた。抗菌薬投与が行われたが症状,炎症反応の改善に乏しく5月に開腹脾臓摘出術を施行した。摘出標本の病理組織診断にてmyeloid sarcoma(MS)と診断した。MSは骨髄芽球様細胞が髄外性に腫瘤を形成する疾患で,髄外好発部位はリンパ節(15～25%),皮膚(13～22%),骨(9～25%),消化管(7～15%)であり,他に軟部組織や中枢神経系の報告もある。しかし自験例のように脾臓に発症した症例は1963～2017年までの報告例の検索で,自験例を含め2例のみであり極めてまれな症例であった。
目次
We report a case of myeloid sarcoma(MS)that primarily developed in the spleen. The patient was a 60s man with a chief complainant of low-grade fever following a dental implant. Although he underwent intensive antibiotic treatment, including levofloxacin, meropenem, and vancomycin, no significant decline in fever was observed. Abdominal contrast-enhanced CT revealed an LDA occupying the majority of his spleen, which was diagnosed as a splenic abscess. Although a CT-guided biopsy and drainage for the spleen were considered, a puncture of the spleen was not performed due to the substantial concern of bleeding. Subsequently, a splenectomy was performed and HE staining revealed mitosis of tumor cells and massive necrosis. Immunohistochemical analysis revealed that the tumor cells were positive for myeloperoxidase, CD43, CD45, and CD68. Finally, the splenic LDA was diagnosed as MS instead of a splenic abscess. He was treated with systemic chemotherapy. MS primarily develops in the spleen is quite rare: we found only 2 case reports of this disease. The prognosis of MS is poor due to the complications of AML. Accordingly, MS should be considered as a differential diagnosis for accurate diagnosis and treatment of splenic LDA.
要旨
症例は60歳台,男性。狭心症に対し2016年12月に経皮的冠動脈形成術(PCI),2017年1月に歯科インプラント治療の既往がある。2017年2月ごろから37℃台の微熱が持続していたため,精査目的に4月に当院内科を紹介受診した。熱源検索目的に施行したCT検査で,脾臓内部に辺縁部が淡く造影される低吸収域を認め脾膿瘍が疑われた。抗菌薬投与が行われたが症状,炎症反応の改善に乏しく5月に開腹脾臓摘出術を施行した。摘出標本の病理組織診断にてmyeloid sarcoma(MS)と診断した。MSは骨髄芽球様細胞が髄外性に腫瘤を形成する疾患で,髄外好発部位はリンパ節(15～25%),皮膚(13～22%),骨(9～25%),消化管(7～15%)であり,他に軟部組織や中枢神経系の報告もある。しかし自験例のように脾臓に発症した症例は1963～2017年までの報告例の検索で,自験例を含め2例のみであり極めてまれな症例であった。