Acute myelogenous leukemia presenting as atypical mastoiditis with facial paralysis

doi:10.1016/S0165-5876(84)80041-5

International Journal of Pediatric Otorhinolaryngology

Volume 7, Issue 2, May 1984, Pages 173-177

https://doi.org/10.1016/S0165-5876(84)80041-5 Get rights and content

Summary

Symptomatic otologic involvement by leukemic infiltration is unusual, most often occurring in the already-diagnosed leukemic patient as postauricular mass, acute hemorrhagic otitis media, mastoiditis, cranial neuropathy, vertigo, hearing loss, or leptomeningitis. We think ours is the first reported patient whose leukemia presented as atypical mastoiditis and facial paralysis due to granulocytic sarcoma (chloroma). At mastoidectomy, tan lobulated rubbery tumor filled the mastoid antrum and middle ear cleft. Complete remission and full return of facial nerve function was achieved with 2500 R local radiation and systemic chemotherapy. We discuss the role and extent of surgery in atypical acute mastoiditis when unsuspected middle ear and mastoid tumor, with inconclusive intra-operative histopathologic data, is found.

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Acute external otitis as debut of acute myeloid leukemia - A case and review of the literature
2018, International Journal of Pediatric Otorhinolaryngology
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Regarding the young population, acute external otitis as well as necrotizing external otitis has been described during immunosuppressive therapy, and in relation to relapse of acute leukemia [6–8]. Acute otitis media has been found along with acute leukemia debut and relapse [9–11]. Only one case report described necrotizing external otitis as debut symptom of childhood acute lymphocytic leukemia [5].
Acute leukemia is a well known childhood cancer. The relation between leukemia and otological symptoms has long been established but is highly rare as a debut symptom of leukemia. External otitis is a common condition affecting many children, and most cases are successively treated with topical medicine. Here we present a child with acute external otitis later shown to be the debut symptom of acute myeloid leukemia, to our knowledge the first specific case described. We have reviewed the literature to find red flags for suspicion of severe disease in case of acute external otitis.
Plexus and peripheral nerve metastasis
2018, Handbook of Clinical Neurology
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Granulocytic sarcomas are accumulations of immature cells of the granulocytic series (Zappia et al., 1990) and are associated with acute or chronic leukemias and myeloproliferative disorders (Zappia et al., 1990). The majority of granulocytic sarcomas reported to cause facial neuropathies are due to acute myeloid leukemia (Todd and Bowman, 1984; Zappia et al., 1990; Wuillemin et al., 1993; Eser et al., 2001). Treatment of leukemia and lymphoma with cranial nerve palsy includes focal radiotherapy and sometimes intrathecal or systemic chemotherapy (Ha et al., 1999).
Cancer in the form of solid tumors, leukemia, and lymphoma can infiltrate and metastasize to the peripheral nervous system, including the cranial nerves, nerve roots, cervical, brachial and lumbosacral plexuses, and, rarely, the peripheral nerves. This review discusses the presentation, diagnostic evaluation, and treatment options for metastatic lesions to these components of the peripheral nervous system and is organized based on the anatomic distribution. As skull base metastases (also discussed in Chapter 14) result in cranial neuropathies, these will be covered in detail, as well as cancers that directly infiltrate the cranial nerves. Particular emphasis is placed on the clinical, imaging, and electrodiagnostic features that differentiate neoplastic plexopathies from radiation-induced plexopathies. Neurolymphomatosis, in which malignant lymphocytes invade the cranial nerves, nerve roots, brachial and lumbosacral plexuses, and peripheral nerves, is a rare manifestation of lymphoma and leukemia. Diagnoses of neurolymphomatosis are often missed or delayed given its varied presentations, resulting in poorer outcomes. Thus this disease will also be discussed in depth.
Bilateral peripheral facial palsy and mastoid infiltration as symptoms of relapsed acute myeloid leukemia
2015, Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale
La paralysie faciale a frigore (PFF) est la plus fréquente des paralysies faciales périphériques (PFP), bien que d’autres étiologies doivent être prise en considération.
Une patiente âgée de 60 ans a présenté une PFP bilatérale récidivante. Malgré des antécédents de leucémie aiguë myéloblastique (LAM), elle a d’abord été traitée selon un diagnostic de PFP de type PFF. Face à la récidive de cette PFP, des examens complémentaires ont été pratiqués à la recherche d’une autre étiologie. Le profil immuno-histochimique comprenait quelques lymphocytes T réactifs positifs à la CD3, des cellules atypiques positives à la myélopéroxidase, et des cellules néoplasiques focalement positives à la CD34 avec des protéines proto-oncogènes c-kit. Ces résultats confirmant ainsi l’hypothèse d’une infiltration mastoïdienne induite par une récidive de la LAM.
En cas d’atteinte néoplasique, toute découverte d’une PFP nécessite des investigations complémentaires afin d’exclure une lésion de l’os temporal.
Bilateral peripheral facial palsy and mastoid infiltration as symptoms of relapsed acute myeloid leukemia
2015, European Annals of Otorhinolaryngology, Head and Neck Diseases
Citation Excerpt :
Leukemia is a malignant disease characterized by abnormal proliferation of white blood cells and their precursors. Symptomatic otologic involvement by leukocyte infiltration is unusual, most often occurring in patients previously diagnosed with leukemia [5]. In 2002, Rhee et al. suggested that recurrent PFP is associated with relapsed leukemia [6].
Although Bell's palsy (BP) is the most common cause of peripheral facial palsy (PFP), other etiologies merit investigation.
A 60-year-old female patient presented with recurrent bilateral PFP. Although the patient had a history of acute myeloid leukemia (AML), she had initially been diagnosed with BP-related PFP and had been treated accordingly. When the PFP recurred, additional diagnostic tests were performed. The resulting immunohistochemical profile included CD3 positivity in a few reactive T lymphocytes; positivity for myeloperoxidase in atypical cells; and focal positivity for CD34 and proto-oncogene c-kit proteins in neoplastic cells, thus confirming the suspicion of mastoid infiltration caused by relapsed AML.
In patients with neoplastic disease, a finding of PFP calls for extensive investigation in order to rule out the involvement of the temporal bone.
Burkitt's leukemia with temporal infiltration presenting as acute mastoiditis in a 7-month-old child
2013, Archives de Pediatrie
Nous rapportons le cas d’une enfant de 7 mois présentant une mastoïdite aiguë avec otorrhée gauche. L’hémogramme avait mis en évidence une hyperleucocytose à 79 000/mm³. Un Streptococcus pneumoniae avait été isolé dans les prélèvements bactériologiques réalisés lors du drainage de l’abcès mastoïdien. Le frottis sanguin avait révélé la présence de cellules blastiques circulantes et l’os mastoïdien prélevé lors de l’intervention était infiltré par des cellules blastiques. Le diagnostic de leucémie de Burkitt avec localisation et lyse osseuse temporale gauche avait donc été posé. Un traitement selon le protocole LMB (Lymphome Malin B), (2001) de la Société française d’oncologie pédiatrique avait permis une rémission clinique et paraclinique sans rechute 30 mois après son arrêt. Le scanner de contrôle était normal avec restitution ad integrum du rocher gauche. Toute mastoïdite aiguë atypique dans sa présentation ou son évolution doit faire rechercher une affection sous-jacente de type hémopathie maligne, histiocytose ou tumeur solide. Une affection otitique peut être le mode de révélation d’une leucémie aiguë. À notre connaissance, il n’existe pas de cas de leucémie de Burkitt avec atteinte lytique temporale mastoïdienne rapporté dans la littérature chez un enfant de moins de 1 an.
A 7-month-old girl presented with left acute mastoiditis and a white blood cell count of 79,000/mm³. A surgically obtained bacteriological sample showed Streptococcus pneumoniae. Direct blood examination revealed leukemic blast cells. Histological samples showed leukemic infiltration of the left temporal bone. The final diagnosis was Burkitt's leukemia with left temporal bone leukemic infiltration. The patient received chemotherapy according to the LMB 2001 protocol from the Société française d’oncologie pédiatrique. Clinical, biological, and imaging follow-up 30 months after the end of treatment showed remission with complete recovery in the left temporal bone. Atypical presentation of acute mastoiditis (AM) should prompt investigation into whether there is a rare underlying pathology, such as a hemopathy, histiocytosis, or solid tumor. The first sign of leukemia may be acute middle ear disease. To our knowledge, no other cases of Burkitt's leukemia with temporal bone leukemic infiltration presenting as AM have been reported in a child under 1 year of age.
Acute myelogenous leukemia presenting as atypical mastoiditis
2012, International Journal of Pediatric Otorhinolaryngology Extra
Citation Excerpt :
Surgical interventions have been described with granulocytic sarcoma (Table 1). Surgical findings at mastoidectomy include a green gelatinous fluid, a yellow amorphous tissue, and a tan lobulated rubber tumor, all positive fore granulocytic sarcoma [1,3,4]. Surgical intervention is not without risks.
Acute leukemia presenting as otitis media is a rare presentation of the disease [1], [2], [3], [4], [5]. We present a patient that was diagnosed with acute myelogenous leukemia (AML) who had signs and symptoms of acute otitis media and mastoiditis. His workup revealed granulocytic sarcoma involving the superior sagittal sinus, sigmoid sinus, internal jugular vein, and parotid gland. This extensive involvement of granulocytic sarcoma has not been described. This case report highlights the importance of complete hematologic and radiologic workup prior to consideration for surgical intervention for mastoiditis.

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^*: Presented paper, 11th Annual Meeting of SENTAC, San Diego, CA, December 4–6, 1983.

^**: Present adress: House Ear Institute, Los Angeles, CA, U.S.A.

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Case ReportAcute myelogenous leukemia presenting as atypical mastoiditis with facial paralysis*

Summary

Mastoid chloroma as relapse in acute myeloid leukaemia

J. Laryng.

Perseveration of laboratory test ordering: a syndrome affecting clinicians

J. Amer. med. Ass.

Diseases of the Ear

Granulocytic sarcoma: a clinicopathologic study of 61 biopsied cases

Cancer

Case Report
Acute myelogenous leukemia presenting as atypical mastoiditis with facial paralysis*