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��<html> <head> <meta HTTP-EQUIV="Description" NAME="Description" CONTENT="OJHAS is India's first, online-only, peer reviewed, open access, biomedical journal; now archived in Cogprints"> <meta HTTP-EQUIV="Keywords" NAME="Keywords" CONTENT="online journal, peer review, cogprints, doaj, open access, biomedical, journal, health, allied science, ojhas, mangalore, india, Sufi AR, Singh T, Granulocytic Sarcoma, Acute Leukemia, Childhood"> <style type="text/css"> <!-- A:link { text-decoration: none; color:#ff0000 } A:visited { text-decoration: none; color:#000000 } A:hover { text-decoration: underline; color:#ff0000 } --> </style> <style type="text/css">BODY { SCROLLBAR-FACE-COLOR: #4863A0; SCROLLBAR-HIGHLIGHT-COLOR: #1589FF; SCROLLBAR-SHADOW-COLOR: #9999ff; SCROLLBAR-3DLIGHT-COLOR: #9999ff; SCROLLBAR-ARROW-COLOR: #ffffce; SCROLLBAR-TRACK-COLOR: #FFFFFF; SCROLLBAR-DARKSHADOW-COLOR: black } </style> <style type="text/css"> <!-- .dropcap { float:left; color:#62629C; font-size:80px; line-height:60px; padding-top:2px; font-family: Times; } --> </style> <title>OJHAS: 2011-4-9. 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Granulocytic Sarcoma as the First Sign of Acute Leukemia in Childhood.</title> </head> <body> <script type="text/javascript"> //HV Menu- by Ger Versluis (http://www.burmees.nl/) //Submitted to Dynamic Drive (http://www.dynamicdrive.com) //Visit http://www.dynamicdrive.com for this script and more function Go(){return} </script> <script type="text/javascript" src="../issue1/exmplmenu_var.js"></script> <script type="text/javascript" src="../issue1/menu_com.js"></script> <noscript> <p>Your browser does not support script</noscript> <table border="0" cellpadding="0" cellspacing="0" width="100%" style="border-collapse: collapse" bordercolor="#111111"> <tr> <td width="100%"><a href="http://ojhas.org"> <img border="0" src="../ojhaslogo2.gif" width="329" height="88" align="left"></a> </td> <tr> <td width="100%" height="1" bgcolor="crimson"></td> </tr> <tr> <td width="100%" height="1"></td> </tr> <tr> <td width="100%" height="1" bgcolor="crimson"></td> </tr> <tr> <td width="100%"> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%"> <tr> <td width="120" valign="top"><div align="left"> <table border="0" cellpadding="0" cellspacing="0" width="120" style="border-collapse: collapse" bordercolor="#111111"> <tr> <td width="120" height="1"></td> </tr> <tr> <td width="120" align="center"> <font size="1" face="Verdana" color="#62629C"> <strong style="font-weight: 400">ISSN 0972-5997</strong></font></td> </tr> <tr> <td width="120" align="center"> <font size="1" face="Verdana" color="#62629C"> <strong style="font-weight: 400">Published Quarterly</strong></font></td> </tr> <tr> <td width="120" align="center"> <font size="1" face="Verdana" color="#62629C"> <strong style="font-weight: 400">Mangalore, India</strong></font></td> </tr> <tr> <td width="120" align="center"> <strong style="font-weight: 400"> <font face="Verdana" size="1" color="#62629C"> <a href="mailto:editor.ojhas@gmail.com">editor.ojhas@gmail.com</a> </font></strong></td> </tr> <tr> <td width="120" height="8"></td> </tr> <tr> <td width="120" height="140" valign="top">&nbsp;</td> </tr> <tr> <td width="120" height="10" valign="top"><style type="text/css"> @import url(http://www.google.com/cse/api/branding.css); 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google_ad_width = 120; google_ad_height = 600; google_ad_format = "120x600_as"; google_ad_channel =""; google_color_border = "B4D0DC"; google_color_bg = "ECF8FF"; google_color_link = "0000CC"; google_color_url = "008000"; google_color_text = "6F6F6F"; //--></script> <script type="text/javascript" src="http://pagead2.googlesyndication.com/pagead/show_ads.js"> </script></td> <td width="10"></td> </tr> </table> </center></div></td> </tr> <tr> <td width="120" height="5"></td> </tr> </table> </div> </td> <td width="5" valign="top"></td> <td valign="top"><table border="1" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#99CCFF" width="100%"> <tr> <td width="100%"> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%"> <tr> <td width="100%" bgcolor="steelblue"> <font face="Verdana" size="2" color="#E8F1FF">OJHAS Vol. 10, Issue 4: (Oct-Dec 2011)</font></td> </tr> <tr> <td width="100%" height="3"></td> </tr> <tr> <td width="100%"><div align="left"><table border="0" cellpadding="0" cellspacing="0" width="250"> <tr> <td width="1" bgcolor="#F40000" height="1"></td> <td width="2" bgcolor="#F40000" height="1"></td> <td width="247" bgcolor="#F40000" height="1"></td> </tr> <tr> <td width="1" bgcolor="#F40000" height="25"></td> <td width="2" height="25" bgcolor="#FFE3E3"></td> <td width="247" height="25" bgcolor="#FFE3E3"><b> <font face="Verdana" size="2" color="#F40000">Case Report</font></b></td> </tr> </table> </div></td> </tr> <tr> <td width="100%"><strong><font face="Verdana" color="#0000A0">Granulocytic Sarcoma as the First Sign of Acute Leukemia in Childhood</font></strong></td> </tr> <tr> <td width="100%" height="20"></td> </tr> <tr> <td width="100%"> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%"> <tr> <td><div align="left"><table border="0" cellpadding="0" cellspacing="0" width="250"> <tr> <td width="1" bgcolor="#043713" height="1"></td> <td width="2" bgcolor="#043713" height="1"></td> <td width="247" bgcolor="#043713" height="1"></td> </tr> <tr> <td width="1" bgcolor="#043713" height="25"></td> <td width="2" height="25" bgcolor="#D7FBE1"></td> <td width="247" height="25" bgcolor="#D7FBE1"><b> <font face="Verdana" size="2" color="#043713">Authors</font></b></td> </tr> </table> </div><font face="Verdana" size="2" color="#000080"><b> Aalia R Sufi,</b> Government Medical College, Jammu and Kashmir,<br> <b>Tejit Singh,</b> Prof. &amp; Former Head, Department of Ophthalmology, Government Medical College, Srinagar, Jammu and Kashmir.</font></td> <td width="20">&nbsp;</td> <td width="300" rowspan="3" valign="top"> <div align="center"> <center><table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="300"> <tr> <td width="300"><script type="text/javascript"><!-- google_ad_client = "pub-1951438359291132"; google_ad_width = 300; google_ad_height = 250; google_ad_format = "300x250_as"; google_ad_type = "text_image"; //2007-01-25: Online Journal google_ad_channel = "0159592953"; //--></script> <script type="text/javascript" src="http://pagead2.googlesyndication.com/pagead/show_ads.js"> </script></td> </tr> </table> </center> </div> </td> </tr> <tr> <td>&nbsp;</td> <td width="20">&nbsp;</td> </tr> <tr> <td><div align="left"><table border="0" cellpadding="0" cellspacing="0" width="250"> <tr> <td width="1" bgcolor="#043713" height="1"></td> <td width="2" bgcolor="#043713" height="1"></td> <td width="247" bgcolor="#043713" height="1"></td> </tr> <tr> <td width="1" bgcolor="#043713" height="12"></td> <td width="2" height="12" bgcolor="#D7FBE1"></td> <td width="247" height="12" bgcolor="#D7FBE1"><b> <font face="Verdana" size="2" color="#043713">Address for Correspondence</font></b></td> </tr> </table> </div><font face="Verdana" size="2" color="#000080"> <b>Dr. Sufi Aalia R,</b><br> Government Medical College,<br>Jammu and Kashmir, India.</font> <br> <font face="Verdana" size="2"><font color="#000080"> <b>E-mail:</b> </font> <a href="mailto:aaliarasool_s@yahoo.com"> aaliarasool_s@yahoo.com</a></font></td> <td width="20">&nbsp;</td> </tr> </table> </td> </tr> <tr> <td width="100%" height="20"></td> </tr> <tr> <td width="100%"><div align="left"><table border="0" cellpadding="0" cellspacing="0" width="250"> <tr> <td width="1" bgcolor="#2D30B7" height="1"></td> <td width="2" bgcolor="#2D30B7" height="1"></td> <td width="247" bgcolor="#2D30B7" height="1"></td> </tr> <tr> <td width="1" bgcolor="#2D30B7" height="12"></td> <td width="2" height="12" bgcolor="#EBEBFA"></td> <td width="247" height="12" bgcolor="#EBEBFA"><b> <font face="Verdana" size="2" color="#2D30B7">Citation</font></b></td> </tr> </table> </div></td> </tr> <tr> <td width="100%"> <p align="justify"><font face="Verdana" size="2" color="#000080"> Sufi AR, Singh T. Granulocytic Sarcoma as the First Sign of Acute Leukemia in Childhood. <i>Online J Health Allied Scs. </i> 2011;10(4):9</font></td> </tr> <tr> <td width="100%" height="1" bgcolor="steelblue"></td> </tr> <tr> <td width="100%" height="20"> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%"> <tr> <td width="50%"> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%"> <tr> <td width="100%"><div align="left"><table border="0" cellpadding="0" cellspacing="0" width="250"> <tr> <td width="1" bgcolor="#2D30B7" height="1"></td> <td width="2" bgcolor="#2D30B7" height="1"></td> <td width="247" bgcolor="#2D30B7" height="1"></td> </tr> <tr> <td width="1" bgcolor="#2D30B7" height="12"></td> <td width="2" height="12" bgcolor="#EBEBFA"></td> <td width="247" height="12" bgcolor="#EBEBFA"><b> <font face="Verdana" size="2" color="#2D30B7">URL</font></b></td> </tr> </table> </div></td> </tr> <tr> <td width="100%"> <font size="2" face="Verdana" color="#003399"> <a target="_blank" href="http://www.ojhas.org/issue40/2011-4-9.htm"> http://www.ojhas.org/issue40/2011-4-9.htm</a></font></td> </tr> <tr> <td width="100%"><div align="left"><table border="0" cellpadding="0" cellspacing="0" width="250"> <tr> <td width="1" bgcolor="#2D30B7" height="1"></td> <td width="2" bgcolor="#2D30B7" height="1"></td> <td width="247" bgcolor="#2D30B7" height="1"></td> </tr> <tr> <td width="1" bgcolor="#2D30B7" height="12"></td> <td width="2" height="12" bgcolor="#EBEBFA"></td> <td width="247" height="12" bgcolor="#EBEBFA"><b> <font face="Verdana" size="2" color="#2D30B7">Open Access Archives</font></b></td> </tr> </table> </div></td> </tr> <tr> <td width="100%"><font size="2" face="Verdana" color="#003399"> <a href="http://cogprints.org/view/subjects/OJHAS.html"> http://cogprints.org/view/subjects/OJHAS.html</a></font><BR> <font size="2" face="Verdana" color="#003399"> <a target="_blank" href="http://openmed.nic.in/view/subjects/ojhas.html"> http://openmed.nic.in/view/subjects/ojhas.html</a></font></td> </tr> <tr> <td width="100%">&nbsp;</td> </tr> </table> </td> <td width="25%" valign="top"><div align="center"> <center> <table border="1" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#0000FF" width="250"> <tr> <td width="250" bgcolor="#E8FBFD"> <p align="center"><a rel="license" href="http://creativecommons.org/licenses/by-nd/2.5/in/"> <img alt="Creative Commons License" style="border-width:0" src="http://i.creativecommons.org/l/by-nd/2.5/in/88x31.png" width="88" height="31" /></a><br />This work is licensed under a <a rel="license" href="http://creativecommons.org/licenses/by-nd/2.5/in/">Creative Commons Attribution-No Derivative Works 2.5 India License</a></td> </tr> </table></center> </div> </td> <td width="25%" valign="top"> <div align="right"> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="131"> <tr> <td width="131" bgcolor="steelblue" colspan="5"><p align="center"><b> <font face="Verdana" size="2" color="#FFFFFF">This Article</font></b></td> </tr> <tr> <td width="1" bgcolor="steelblue"></td> <td width="43"> <a target="_blank" href="2011-4-9.pdf"> <img border="0" src="../issue14/pdf.gif" width="42" height="48"></a></td> <td width="43"> <a target="_blank" href="http://cogprints.org/8859/1/"> <img border="0" src="../issue14/cogpri.gif" width="42" height="48"></a></td> <td width="43"><a target="_blank" href="http://openmed.nic.in/3860/"> <img border="0" src="../issue14/opmed.gif" width="42" height="48"></td> <td width="1" bgcolor="steelblue"></td> </tr> <tr> <td width="1" bgcolor="steelblue" height="1"></td> <td width="43" bgcolor="steelblue" height="1"></td> <td width="43" bgcolor="steelblue" height="1"></td> <td width="43" bgcolor="steelblue" height="1"></td> <td width="1" bgcolor="steelblue" height="1"></td> </tr> </table> </div> </td> </tr> </table> </td> </tr> <tr> <td width="100%" bgcolor="steelblue" height="15"> <font face="Verdana" size="1" color="#E8F1FF">Submitted: July 17, 2011; Suggested revision: Oct 20, 2011; Revised: Oct 24, 2011; Accepted: Jan 4, 2012; Published: Jan 15, 2012</font></td> </tr> <tr> <td width="100%"></td> </tr> <tr> <td width="100%" height="1" bgcolor="#DC143C"></td> </tr> <tr> <td width="100%" height="5"></td> </tr> <tr> <td width="100%"> <div align="center"> <center> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="468"> <tr> <td width="468"><script type="text/javascript"><!-- google_ad_client = "pub-1951438359291132"; google_ad_width = 468; google_ad_height = 60; google_ad_format = "468x60_as"; google_ad_type = "text_image"; google_ad_channel =""; google_color_border = "336699"; google_color_bg = "FFFFFF"; google_color_link = "0000FF"; google_color_url = "008000"; google_color_text = "000000"; //--></script>&nbsp;<script type="text/javascript" src="http://pagead2.googlesyndication.com/pagead/show_ads.js"> </script></td> </tr> </table> </center> </div> </td> </tr> <tr> <td width="100%" height="5"></td> </tr> <tr> <td width="100%" bgcolor="#DC143C" height="1"></td> </tr> <tr> <td width="100%">&nbsp;</td> </tr> <tr> <td width="100%" height="20"></td> </tr> </table> <div align="center"><center> <table border="0" cellpadding="0" cellspacing="0" width="100%" style="border-collapse: collapse" bordercolor="#111111"> <tr> <td width="100%" height="10" bgcolor="#FD7E00"><font face="Verdana" size="2" color="#FFFFFF"><b>Abstract:</b></font></td> </tr> <tr> <td width="100%" height="70" bgcolor="#FFEFDF"> <p align="justify"><font face="Verdana" size="2" color="#000080">Acute myeloid leukemia (AML) may rarely involve the orbit as a solid tumor termed granulocytic sarcoma. This report describes the case of a child who presented with rapidly progressive unilateral proptosis and was diagnosed as rhabdomyosarcoma. However subsequent examination of the peripheral blood film revealed AML. Thus proptosis may present as the initial manifestation of AML.�</font><br> <font face="Verdana" size="2" color="#000080"><b>Key Words:</b> Granulocytic sarcoma; Acute myeloid leukemia; Proptosis.</font> </td> </tr> <tr> <td width="100%" height="10"></td> </tr> </table> </center></div><div align="left"> <table border="0" cellpadding="0" cellspacing="0" width="150" style="border-collapse: collapse" bordercolor="#111111"> <tr> <td width="1"></td> <td width="2"></td> <td width="147">&nbsp;</td> </tr><tr> <td width="1" bgcolor="#EC00EC"></td> <td width="2" bgcolor="#EC00EC"></td> <td width="147" bgcolor="#EC00EC"></td> </tr> <tr> <td width="1" bgcolor="#EC00EC"></td> <td width="2"></td> <td width="147" bgcolor="#FFE6FF"><font face="Verdana" size="2" color="#0000A0"><b>Introduction</b></font></td> </tr> </table> </div> <p align="justify"><font size="2" face="Verdana" color="#000080">The orbit, especially in children can be involved in a number of diseases either ophthalmic or non-ophthalmic. The common lesions include orbital cellulitis, dermoid cysts, rhabdomyosarcoma and hemangioma.<sup>1</sup> However certain rare causes also exist, like granulocytic sarcoma. Thus the differential diagnosis should be kept in mind and a thorough clinical examination and appropriate investigations should be carried out to facilitate early treatment.</font></p> <div align="left"> <table border="0" cellpadding="0" cellspacing="0" width="150" style="border-collapse: collapse" bordercolor="#111111"> <tr> <td width="1"></td> <td width="2"></td> <td width="147">&nbsp;</td> </tr><tr> <td width="1" bgcolor="#EC00EC"></td> <td width="2" bgcolor="#EC00EC"></td> <td width="147" bgcolor="#EC00EC"></td> </tr> <tr> <td width="1" bgcolor="#EC00EC"></td> <td width="2"></td> <td width="147" bgcolor="#FFE6FF"> <b><font face="Verdana" size="2" color="#0000A0">Case Report</font></b></td> </tr> </table> </div> <p align="justify"><font face="Verdana" size="2" color="#000080">Eight years old child presented with proptosis of right eye with ocular pain and&nbsp;&nbsp; redness over a span of 15 days.</font></p> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%"> <tr> <td valign="top"> <p align="justify"><font face="Verdana" size="2" color="#000080">Vision in right eye was 20/200 (later decreased to 20/400). Proptosis of 6 mm was noted with downward and lateral displacement of globe [Fig 1]. Extra ocular movements were restricted superiorly and inferiorly. Conjuctiva was congested and chemosed, cornea showed exposure keratitis, minimal hypopyon, pupil reacted sluggishly to light, intraocular pressure was 22 mmHg, fundus examination revealed normal disc with dilated tortuous vessels. Left eye was normal.</font></p> <p align="right">&nbsp;</p> <p align="right">&nbsp;</p> <p align="right">&nbsp;</p> <p align="right"><b><font size="2" face="Verdana" color="#000080"> Figure 1: Photograph showing unilateral proptosis.</font></b></td> <td width="20">&nbsp;</td> <td width="400"> <img border="0" src="2011-4-9-1.gif" width="400" height="354"></td> </tr> </table> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%"> <tr> <td valign="top"> <p align="justify"><font face="Verdana" size="2" color="#000080">A provisional diagnosis of rhabdomyosarcoma was made due to the acute onset of proptosis and young age, rhabdomyosarcoma being the commoner primary orbital malignancy in children. CT Scan revealed 3 x 3 cm well defined mass in superior aspect of right orbit with contrast enhancement, superior rectus was not seen separately. No bone destruction, no intracranial extension was seen [Fig 2]. Radiologists suggested hemangioma.</font></p> <p align="justify">&nbsp;</p> <p align="right"><b><font size="2" face="Verdana" color="#000080">Figure 2: &nbsp;CT scan showing a lesion in the right orbit.&nbsp;</font></b></p> </td> <td width="20">&nbsp;</td> <td width="179"> <img border="0" src="2011-4-9-2.gif" width="179" height="186"></td> </tr> </table> <p align="justify"><font face="Verdana" size="2" color="#000080">Subsequently peripheral blood film (PBF) was ordered which showed lymphopenia and thrombocytopenia,&nbsp; hypochromic macrocytes with anisocytosis, polymorphs 30%. lymphocytes 25%, >blasts 45% [Fig 3]</font>.</p> <p align="justify"><font face="Verdana" size="2" color="#000080">On the&nbsp; basis of the PBF report, patient was diagnosed as a case of Acute Myeloid Leukemia. Further tests were done, bone marrow examination revealed: blasts 30%, 18 - 20 microns in size with high nucleocytoplasmic ratio, open chromatin and 2-3 nucleoli, Auer rod present, myeloperoxide positive, lymphopenia and thrombocytopenia. On account of severe thrombocytopenia, we did not proceed with orbital biopsy.</font></p> <div align="center"> <center> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="800"> <tr> <td width="50%"> <img border="0" src="2011-4-9-3.gif" width="400" height="408"></td> <td width="50%" valign="bottom"> <img border="0" src="2011-4-9-4.gif" width="400" height="393"></td> </tr> <tr> <td width="50%" align="center"> <font size="2" face="Verdana" color="#000080"><b>Figure 3: &nbsp;High power (100X) view of peripheral blood film slide showing myeloblast.</b></font></td> <td width="50%" valign="bottom" align="center"> <font size="2" face="Verdana" color="#000080"><b>Figure 4: &nbsp;Photograph showing regression of proptosis after chemotherapy</b></font></td> </tr> </table> </center> </div> <p align="justify"><font face="Verdana" size="2" color="#000080">Patient received Inj. Arabinoside C 65mg for 7 days and Daunorubucin 35 mg per day for 3 days. Patient showed drastic regression&nbsp; of proptosis, but developed corneal abscess [Fig 4]. The patient returned home and was lost to further follow-up.</font></p> <div align="left"> <table border="0" cellpadding="0" cellspacing="0" width="150" style="border-collapse: collapse" bordercolor="#111111"> <tr> <td width="1"></td> <td width="2"></td> <td width="147">&nbsp;</td> </tr><tr> <td width="1" bgcolor="#EC00EC"></td> <td width="2" bgcolor="#EC00EC"></td> <td width="147" bgcolor="#EC00EC"></td> </tr> <tr> <td width="1" bgcolor="#EC00EC"></td> <td width="2"></td> <td width="147" bgcolor="#FFE6FF"> <font size="2" color="#0000A0" face="Verdana"><b>Discussion</b></font></td> </tr> </table> </div> <p align="justify"><font face="Verdana" size="2" color="#000080">Granulocytic sarcoma or chloroma is a tumor composed of granulocytic precursor cells occurring in an extramedullary location.<sup>2 </sup>The term chloroma " green tumor " is derived from the greenish gross coloration of this lesion, attributable to the myeloperoxidase </font> <font size="2" face="Verdana" color="#000080">in the cells of granulocytic lineage.<sup>3 </sup>The theory for the formation of these lesions is that normal hematopoietic progenitor cells selectively bind to bone marrow stroma and then begin to proliferate and differentiate, while in vitro they bind to skin fibroblasts . Binding of these cells to the fibroblasts localized in non  hematopoietic tissues may result in the formation of extramedullary myeloid metaplasia.<sup>4 </sup> The predilection for bone or subperiosteal involvement in the axial skeleton is thought to be related to the active hematopoiesis in these locations.<sup>5</sup> Orbital cases can be explained by their origin from adjacent bone, or less commonly, the lacrimal gland or extraocular muscles. Myeloid sarcomas are most common in certain subtypes of AML, in particular M5a (monoblastic), </font> <font size="2" face="Verdana" color="#000080">M5b (monocytic), M4 (myelomonocytic), and M2 (myeloblastic with maturation).<sup>6</sup> </font></p> <p align="justify"><font size="2" face="Verdana" color="#000080">The differential diagnosis of acute childhood proptosis includes orbital cellulitis, inflammatory pseudotumor, ruptured dermoid cyst, rhabdomyosarcoma, hemangioma, chocolate cyst of lymphangioma, neuroblastoma, granulocytic sarcoma. Of all the orbital lesions only 5% are malignant and granulocytic sarcoma accounts for only 1 of 250 malignant cases with the incidence being slightly higher in Africa and Asia.<sup>7</sup> </font></p> <p align="justify"><font size="2" face="Verdana" color="#000080">In a study of&nbsp; 86 Indian patients with AML, 8 (9.3%) were found to have orbital deposits in one or both eyes.<sup>8</sup> Majority of the cases present as bilateral&nbsp; proptosis. However our case showed the rare unilateral presentation.</font></p> <p align="justify"><font size="2" face="Verdana" color="#000080">In many cases proptosis precedes the systemic manifestations of AML. Most cases in patients without a previous diagnosis progress to AML within one&nbsp; year and even earlier in the case of an initial orbital disease. However, some patients do not develop hematologic evidence of the disease as long as 30 months following the presence of an orbital tumor.<sup>9 </sup> In our case too, proptosis preceded the systemic manifestation of AML. In the absence of systemic features it becomes difficult to diagnose granulocytic sarcoma. In such cases PBF, a simple and inexpensive investigation proves effective in diagnosis and acts as an easy tool in saving time and money spent on CT and MRI and thus initiating early treatment.</p> <div align="left"> <table border="0" cellpadding="0" cellspacing="0" width="150" style="border-collapse: collapse" bordercolor="#111111"> <tr> <td width="1"></td> <td width="2"></td> <td width="147">&nbsp;</td> </tr><tr> <td width="1" bgcolor="#EC00EC"></td> <td width="2" bgcolor="#EC00EC"></td> <td width="147" bgcolor="#EC00EC"></td> </tr> <tr> <td width="1" bgcolor="#EC00EC"></td> <td width="2"></td> <td width="147" bgcolor="#FFE6FF"> <font size="2" color="#0000A0" face="Verdana"><b> References</b></font></td> </tr> </table> </div> <ol style="color: #000080; font-size: 10pt; font-family: Verdana"> <li> <p align="justify">Sethi&nbsp;A, Ghose&nbsp;S, Gujral&nbsp;S, Jain P, Kumar R. Childhood proptosis: The invaluable, though often overlooked peripheral blood smear. <i>Indian J Ophthalmol</i> 2001;49(2):121-123.</font></li> <li><font size="2" face="Verdana" color="#000080">Alkatan H, Chaudhry I. Myeloid sarcoma of the orbit. <i>Annals of Saudi Medicine</i> 2008;28(6):461-465.&nbsp; </font></li> <li><font size="2" face="Verdana" color="#000080">Shields JA, Stopyra GA, Marr BP, Shields CL. Bilateral Orbital Myeloid Sarcoma as Initial Sign of Acute Myeloid Leukemia: Case Report and Review of the Literature. <i> Arch Ophthalmol&nbsp;</i>2003;121:138-142.</font></li> <li><font size="2" face="Verdana" color="#000080">Bekassy AN, Hermans J, Gorrin NC, Gratwohl A . Granulocytic sarcoma after allogenic BMT: a retrospective European multicenter survey. <i>Bone Marrow Transplant</i> 1996;17:801-808.</font></li> <li><font size="2" face="Verdana" color="#000080">Davis JL, Parke DW 2<sup>nd</sup>, Font RL. Granulocytic sarcoma of the orbit. A clinicopathologic study. <i>Ophthamol</i> 1985;92(12):1758-1762.</font></li> <li><font size="2" face="Verdana" color="#000080">Byrd JC, Edenfield J, Shields DJ, et al. Extramedullary myeloid cell tumors in acute non-lymphocytic leukemia: a clinical review. J Clin Oncol 1995; 13: 1800-1816.</font></li> <li><font size="2" face="Verdana" color="#000080">Zimmerman LE, Font RL. Ophthalmologic manifestations of granulocytic sarcoma (myeloid sarcoma or chloroma): the third Pan American Association of Ophthalmology and American Journal of Ophthalmology Lecture. <i>Am J Ophthalmol</i> 1975;80:975-990.</font></li> <li><font size="2" face="Verdana" color="#000080"> Ghose S, Kumar R,Chaudhuri S, Jain Y,Gujral S, Singh H, et al. Importance of bone marrow examination in childhood proptosis In: Pasricha JK. (ed). Indian Ophthalmology Year Book 1997, Proc 55<sup>th</sup> All India Ophthalmol Soc&nbsp;Conf. New Delhi. 1997. pp 414-416.</font></li> <li><font size="2" face="Verdana" color="#000080">da Fonseca Junior NL, Paves L, Nakanami DM, Seivas MT, Manso PG. Sarcoma granulocitico em orbita: relato de caso. <i>Arq Bras Ofthalmol</i> 2005;68(4):557-560.</li> </ol> <font size="3" face="Times New Roman"> </ol> </td> </tr> </table> </center></div></td> </tr> </tr> </table> </td> </tr> <tr> <td width="100%" height="1" bgcolor="crimson"></td> </tr> <tr> <td width="100%" height="1"></td> </tr> <tr> <td width="100%" height="1" bgcolor="crimson"></td> </tr> <tr> <td width="100%"></td> </tr> <tr> <td width="100%"><div align="center"> <center> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="729"> <tr> <td width="729"><script type="text/javascript"><!-- google_ad_client = "pub-1951438359291132"; google_alternate_color = "FFFFFF"; google_ad_width = 728; google_ad_height = 90; google_ad_format = "728x90_as"; google_ad_channel =""; google_color_border = "B4D0DC"; google_color_bg = "ECF8FF"; google_color_link = "0000CC"; google_color_url = "008000"; google_color_text = "6F6F6F"; //--></script> <script type="text/javascript" src="http://pagead2.googlesyndication.com/pagead/show_ads.js"> </script></td> </tr> </table> </center> </div></td> </tr> <tr> <td width="100%" height="20"></td> </tr> <tr> <td width="100%"> <p align="center"> <img border="0" src="../novabanner.gif" width="569" height="98"></td> </tr> <tr> <td width="100%"></p> <div align="center"><center><table border="0" cellpadding="0" cellspacing="0" width="100%"> <tr> <td width="20%"></td> <td width="60%"><p align="right"><font face="Verdana" size="1">ADVERTISEMENT</font></td> <td width="20%"></td> </tr> </table> </center></div></td> </tr> <tr> <td width="100%"></td> </tr> <tr> <td width="100%" height="10"></td> </tr> </table> </center></div></td> </tr> </table> </body> </html>