Authors
Xiaoyong Chen, Jialing Lu, Junjie Hou, Jihao Zhou, Yang Wang, Xin Zhao, Chun Feng, Guoqiang Li, Lina Hu, Jizhang Bao, Beibei Qu, Yuanfei Mao, Peng Ke, Ying Xu
Published in
Acta haematologica. Pages 1-9. Aug 03, 2026. Epub Aug 03, 2026.
Abstract
Acute promyelocytic leukemia (APL), a subtype of acute myeloid leukemia, typically presents with severe bleeding. However, the occurrence of APL with isolated myeloid sarcoma (MS) as the sole initial presentation is extremely rare, lacking typical clinical and laboratory features, which complicates diagnosis and management.
A 45-year-old male was admitted for 2-month lower back pain. Spinal MRI showed T10 vertebral signal changes; histopathology confirmed the vertebral mass was myeloid origin, with PML::RARα fusion detected via PCR. Initial blood counts, coagulation tests, and bone marrow (BM) examinations were normal. However, 21 days postoperatively, the patient's platelet count and fibrinogen level declined. A subsequent BM examination revealed abundant abnormal promyelocytes, and FISH confirmed the presence of the PML::RARα fusion gene, diagnosing APL with MS and central nervous system (CNS) involvement. He achieved complete remission with all-trans retinoic acid-based chemotherapy.
This is a rare case of isolated thoracic vertebra promyelocytic sarcoma as the initial symptom, which later progressed to APL with MS and CNS involvement. Additionally, we performed a comprehensive literature review of 13 other cases of APL with spinal MS at the time of diagnosis. In aggregate, APL presenting with spinal MS as the sole initial manifestation is extremely rare.
PMID:
42545910
Bibliographic data and abstract were imported from PubMed on 04 Aug 2026.
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