A Case of Extramedullary Relapse of APL on the Tympanic Membrane

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  • 鼓膜に髄外再発した急性前骨髄球性白血病例
  • 臨床 鼓膜に髄外再発した急性前骨髄球性白血病例
  • リンショウ コマク ニ ズイガイ サイハツ シタ キュウセイ ゼン コツズイキュウセイ ハッケツビョウレイ

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Abstract

<p>Temporal bone lesions are rarely seen in patients with acute promyelocytic leukemia (APL) during the remission phase. We report a case of APL who showed extramedullary relapse on the tympanic membrane while in the complete remission phase. A 48-year-old male patient with APL in complete remission after the initial therapy presented with left ear fullness. Endoscopic examination revealed a mass on the left tympanic membrane, and temporal bone CT showed a mass localized on the left tympanic membrane. He was diagnosed as having extramedullary relapse of APL based on the histopathological findings of the lesion on the tympanic membrane. There were no APL cells in the blood or bone marrow. However, PCR analysis revealed the presence of PML-RARα in the bone marrow. Based on these findings, we diagnosed the patient as having molecular recurrence of APL, and administered chemotherapy. During the treatment, the ear lesion decreased steadily in size, and finally disappeared. Absence of PML-RARα in the bone marrow specimen after the treatment indicated that the patient had entered the second remission phase. Subsequently, hematopoietic stem-cell transplantation was performed, and the patient remains in remission. In a patient with a history of leukemia presenting with temporal bone lesions, extramedullary relapse should be considered in the differential diagnosis even if the patient is in the remission phase.</p>

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