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Leukemia
Karen L. Salzman, MD; Miral D. Jhaveri, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Extramedullary leukemic tumors (EML)
              • Extramedullary myeloblastoma, extramedullary myeloid cell tumors (EmMCT)
            • Synonyms

              • Granulocytic sarcoma, chloroma
            • Definitions

              • Solid tumor of myeloblasts/myelocytes/promyelocytes
                • In patients with myeloproliferative disorder
              • Multiple other intracranial manifestations of leukemia/treatment complications
                • Posterior reversible encephalopathy syndrome (PRES)
                • Invasive fungal infection
                • Late development of cavernous angiomas after radiation therapy
                • Post-transplantation lymphoproliferative disease (PTLD) after bone marrow transplantation
                • Venous thrombosis associated with chemotherapy (L-asparaginase)
                • Vasculitis
                  • Primary manifestation of leukemia
                  • Secondary to treatment (trans retinoic acid)
                  • Secondary to infection (e.g., Aspergillus)

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Bar M et al: Central nervous system involvement in acute myeloid leukemia patients undergoing hematopoietic cell transplantation. Biol Blood Marrow Transplant. 21(3):546-51, 2015
                                            2. Cheng CL et al: Risk factors and clinical outcomes of acute myeloid leukaemia with central nervous system involvement in adults. BMC Cancer. 15(1):344, 2015
                                            3. Bhojwani D et al: Methotrexate-induced neurotoxicity and leukoencephalopathy in childhood acute lymphoblastic leukemia. J Clin Oncol. 32(9):949-59, 2014
                                            4. Rozovski U et al: Incidence of and risk factors for involvement of the central nervous system in acute myeloid leukemia. Leuk Lymphoma. 1-6, 2014
                                            5. Morioka S et al: Effects of chemotherapy on the brain in childhood: diffusion tensor imaging of subtle white matter damage. Neuroradiology. 55(10):1251-7, 2013
                                            6. Spataro R et al: Neurological picture. Petechial brain haemorrhages in acute lymphoblastic leukaemia. J Neurol Neurosurg Psychiatry. 84(8):908, 2013
                                            7. Faraci M et al: Magnetic resonance imaging in childhood leukemia survivors treated with cranial radiotherapy: a cross sectional, single center study. Pediatr Blood Cancer. 57(2):240-6, 2011
                                            8. Dicuonzo F et al: Posterior reversible encephalopathy syndrome associated with methotrexate neurotoxicity: conventional magnetic resonance and diffusion-weighted imaging findings. J Child Neurol. 24(8):1013-8, 2009
                                            9. Koenig MK et al: Central nervous system complications of blastic hyperleukocytosis in childhood acute lymphoblastic leukemia: diagnostic and prognostic implications. J Child Neurol. 23(11):1347-52, 2008
                                            10. Hakyemez B et al: Parlak M. Intracranial myeloid sarcoma: conventional and advanced MRI findings. Br J Radiol. 80(954):e109-12, 2007
                                            11. Denier C et al: Spectrum and prognosis of neurologic complications after hematopoietic transplantation. Neurology. 67(11):1990-7, 2006
                                            12. Glass J: Neurologic complications of lymphoma and leukemia. Semin Oncol. 33(3):342-7, 2006
                                            13. Nikolic B et al: CT changes of an intracranial granulocytic sarcoma on short-term follow-up. AJR Am J Roentgenol. 180(1):78-80, 2003
                                            14. Ahn JY et al: Meningeal chloroma (granulocytic sarcoma) in acute lymphoblastic leukemia mimicking a falx meningioma. J Neurooncol. 60(1):31-5, 2002
                                            15. Guermazi A et al: Granulocytic sarcoma (chloroma): imaging findings in adults and children. AJR Am J Roentgenol. 178(2):319-25, 2002
                                            16. Lee B et al: Granulocytic sarcoma of the temporal bone. AJNR Am J Neuroradiol. 23(9):1497-9, 2002
                                            17. Chen CY et al: Childhood leukemia: central nervous system abnormalities during and after treatment. AJNR Am J Neuroradiol. 17(2):295-310, 1996
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Extramedullary leukemic tumors (EML)
                                                        • Extramedullary myeloblastoma, extramedullary myeloid cell tumors (EmMCT)
                                                      • Synonyms

                                                        • Granulocytic sarcoma, chloroma
                                                      • Definitions

                                                        • Solid tumor of myeloblasts/myelocytes/promyelocytes
                                                          • In patients with myeloproliferative disorder
                                                        • Multiple other intracranial manifestations of leukemia/treatment complications
                                                          • Posterior reversible encephalopathy syndrome (PRES)
                                                          • Invasive fungal infection
                                                          • Late development of cavernous angiomas after radiation therapy
                                                          • Post-transplantation lymphoproliferative disease (PTLD) after bone marrow transplantation
                                                          • Venous thrombosis associated with chemotherapy (L-asparaginase)
                                                          • Vasculitis
                                                            • Primary manifestation of leukemia
                                                            • Secondary to treatment (trans retinoic acid)
                                                            • Secondary to infection (e.g., Aspergillus)

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Bar M et al: Central nervous system involvement in acute myeloid leukemia patients undergoing hematopoietic cell transplantation. Biol Blood Marrow Transplant. 21(3):546-51, 2015
                                                                                      2. Cheng CL et al: Risk factors and clinical outcomes of acute myeloid leukaemia with central nervous system involvement in adults. BMC Cancer. 15(1):344, 2015
                                                                                      3. Bhojwani D et al: Methotrexate-induced neurotoxicity and leukoencephalopathy in childhood acute lymphoblastic leukemia. J Clin Oncol. 32(9):949-59, 2014
                                                                                      4. Rozovski U et al: Incidence of and risk factors for involvement of the central nervous system in acute myeloid leukemia. Leuk Lymphoma. 1-6, 2014
                                                                                      5. Morioka S et al: Effects of chemotherapy on the brain in childhood: diffusion tensor imaging of subtle white matter damage. Neuroradiology. 55(10):1251-7, 2013
                                                                                      6. Spataro R et al: Neurological picture. Petechial brain haemorrhages in acute lymphoblastic leukaemia. J Neurol Neurosurg Psychiatry. 84(8):908, 2013
                                                                                      7. Faraci M et al: Magnetic resonance imaging in childhood leukemia survivors treated with cranial radiotherapy: a cross sectional, single center study. Pediatr Blood Cancer. 57(2):240-6, 2011
                                                                                      8. Dicuonzo F et al: Posterior reversible encephalopathy syndrome associated with methotrexate neurotoxicity: conventional magnetic resonance and diffusion-weighted imaging findings. J Child Neurol. 24(8):1013-8, 2009
                                                                                      9. Koenig MK et al: Central nervous system complications of blastic hyperleukocytosis in childhood acute lymphoblastic leukemia: diagnostic and prognostic implications. J Child Neurol. 23(11):1347-52, 2008
                                                                                      10. Hakyemez B et al: Parlak M. Intracranial myeloid sarcoma: conventional and advanced MRI findings. Br J Radiol. 80(954):e109-12, 2007
                                                                                      11. Denier C et al: Spectrum and prognosis of neurologic complications after hematopoietic transplantation. Neurology. 67(11):1990-7, 2006
                                                                                      12. Glass J: Neurologic complications of lymphoma and leukemia. Semin Oncol. 33(3):342-7, 2006
                                                                                      13. Nikolic B et al: CT changes of an intracranial granulocytic sarcoma on short-term follow-up. AJR Am J Roentgenol. 180(1):78-80, 2003
                                                                                      14. Ahn JY et al: Meningeal chloroma (granulocytic sarcoma) in acute lymphoblastic leukemia mimicking a falx meningioma. J Neurooncol. 60(1):31-5, 2002
                                                                                      15. Guermazi A et al: Granulocytic sarcoma (chloroma): imaging findings in adults and children. AJR Am J Roentgenol. 178(2):319-25, 2002
                                                                                      16. Lee B et al: Granulocytic sarcoma of the temporal bone. AJNR Am J Neuroradiol. 23(9):1497-9, 2002
                                                                                      17. Chen CY et al: Childhood leukemia: central nervous system abnormalities during and after treatment. AJNR Am J Neuroradiol. 17(2):295-310, 1996