Granulocytic sarcomas, also known as chloromas, are rare extramedullary tumors of myeloid or myelocytic origin. They are usually associated with both acute and chronic myelogenous leukemia and myeloproliferative disorders. Leukemia involvement of the central nervous system most commonly presents as meningeal leukemia; intracerebral granulocytic sarcoma (IGS) is rare. Signs and symptoms depend on the brain structures involved. Magnetic resonance imaging with and without gadolinium is the imaging of choice to evaluate the tumor; however, tissue biopsy is essential for definitive diagnosis. Treatment usually involves radiation followed by chemotherapy, depending on the previous systemic treatment. Because medical literature about IGS is scarce, optimal treatment is unclear. With the number of leukemia patients in remission, the incidence of IGS is expected to rise. This is because most chemotherapeutic agents do not cross the blood-brain barrier, making the brain a target for leukemia recurrence. Nurses play a vital role in helping patients and families understand the disease process, the treatments involved, and the necessary adjustments, such as performing mundane activities of daily living, especially when neurocognitive impairments are present.
Questions or comments about this article may be directed to Margaret Alvarez, MSN RN APN, at firstname.lastname@example.org. She is a neurosurgery inpatient nurse practitioner at the University of Chicago Medical Center, Chicago, IL.