Introduction Section 1 Section 2 Section 3 Conclusion and References


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Section 1 - Direct leukemic involvement of the Central Nervous System

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Nonmeningeal disease: Brain parenchyma

Brain Involvement
The brain may be directly involved by either chloroma or other leukemic masses. Chloromas (also known as granulocytic sarcoma) are rare masses consisting of immature granulocytic cells. It was first described by Burns in 1811 and named for its greenish color on gross examination. Dock in 1893 made the connection between chloroma and leukemia. This tumor occurs primarily in patients with AML, but may also arise in patients with other myeloproliferative disorders. Sites such as skin, bone and soft tissue are much more common than CNS. Intracranially, chloroma may be purely intraparenchymal or may be dural based; the latter may be indistinguishable from meningioma (case 8). Rarely, chloroma may coincide with or predate the onset of systemic leukemia. Other leukemias may be associated, rarely, with intracerebral masses (nonchloroma) and like chloroma, symptoms are nonspecific, related to increased intracranial pressure or mass effect. On CT, leukemic masses are typically iso or hyperdense precontrast, and enhance. On MRI, these masses are mildly hypointense on T1, iso or slightly hyperintense on T2, and enhance prominently with Gadopentetate dimeglumine (See case 7, case 8, and case 9).

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