Bilateral adrenal granulocytic sarcomas (chloromas)

Case contributed by Michael P Hartung
Diagnosis almost certain

Presentation

Abdominal pain, history of CML.

Patient Data

Age: 70 years
Gender: Female

Left larger than right adrenal masses. Porta hepatis adenopathy. 

Case Discussion

Bone marrow biopsy confirmed AML. The adrenal masses were not biopsied separately, but granulocytic sarcoma involving both adrenal glands is a sensible explanation and has been described in this setting, although it is very rare1. A staging PET exam showed elevated uptake involving several muscular/osseous sites poorly seen on this study. The differential diagnosis for such large masses would be lymphoma or adrenocortical carcinoma (which occurs in ~10% of cases of carcinoma). 

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