In a child with bilateral proptosis

CHLOROMA

  1. Features
    Type of AML
    Presents as solid tumor from localized proliferation of malignant myeloblasts
    Seen in 2-14% AML

  2. Pathology
    Green appearance due to MPO expression
    Associated with MAL t8:21 translocation

  3. Clinical features:
    Localized, usually in bone, periosteum, soft tissues, lymph nodes or skin
    Sites: Orbit, paranasal sinus, GIT, genitourinary tract, breast, cervix, salivary glands, mediastinum, pleura, peritoneum, bile duct

  4. Diagnosis:
    Presence of eosinophilic myelocytes in hematoxylin and eosin stained biopsy sections
    Auer rods detection
    Myeloid origin confirmed by cytochemical or immunohistochemical methods
    Biopsy must be done with special immunohistochemical staining for myeloid markers, FISH, cytogenetics for AML related alterations
    Flow immunophenotyping

  5. Treatment:
    Intensive AML directed chemotherapy
    Radiation therapy for non responsive cases