Chloroma of Perianal Region Masquerading as Perianal Abscess
A 50-year-old female complained of a swelling in her perianal region for the last two months and all the relevant biochemical and hematological investigation were found to be normal. On peripheral blood film examination patient was mildly anemic with a total leukocyte count of 4000/cmm and differential leucocyte count of P 50 L48 M1 E1 B0 with normal platelet count. Clinical diagnosis of perianal abscess [] was made. The abscess was drained, but it didn’t heal and persisted in the perianal region. After two months, wedge biopsy was taken and submitted for histopathological examination. Macroscopically, a partially skin covered soft tissue piece measuring 1.0 × 0.8 × 0.3 cm was received. The biopsy revealed skin and subcutaneous tissue with dense infiltration by small round cells in sheets and trabeculae, enveloping the adnexal structures and infiltrating the subcutaneous fat []. A provisional diagnosis of malignant small round cell tumor was given and the biopsy was subjected to panel of immunohistochemical markers. The initial panel of cytokeratin, neuron specific enolase synaptophysin, chromogranin was negative and LCA was positive []. Subsequent IHC showed that cells were negative for CD 20 and tdt; (Terminal deoxynucleotidyl transferase) positive for myeloperoxidase [] and focal positive for CD3. The peripheral blood film examined showed pancytopenia. Bone marrow showed a cellular marrow with a blast count of approximately 50%. Finally, the diagnosis of Acute Myeloid Leukemia with granulocytic sarcoma (GS)/chloroma of the perianal region were given. To our knowledge, there has not been a previous report of acute leukemia presenting as granulocytic sarcoma masquerading as perianal abscess.