Case Presentation
We present a 2-year-old male patient who was referred to the pediatric hematology oncology clinic with left pariatotemporal mass. The laborautary test results were for white blood cell (WBC) 71320 10’9/L, hemaglobuline 8,3 g/dl and platalet 81000 10’9/L respectevily. In computed tomography (CT) of brain; a mass lesion of approximately 8x9 cm in size extending from the left parietotemporal lobe to the inferior, extending towards the skin / subcutaneous, causing lytic changes in the left posterior temporal bone was observed. (figure 1a) A rapid peripheral blood smear (PBS) planned to identify the leukocytosis and cytopenia.The observation of PBS reported %5-6 myeloid blast formation. The flow cytometric evaulation of peripheral blood showed %10 myelobalasts. A neurosurgery consultation was planned. The brain antieudema protective treatment with prednisilone 40 mgr/kg first 3 days and subsuquent to 30 mgr/kg 4 days was initiated. Soft tissue tumor and the bone marrow metastasis or AML and granulocytic sarcoma were the initiall diagnositc features. Flowcytometric peripheral blood test was reported %8 myeloblast. In confirmation of diagnosis AML, %20 and higher blast percentage was needed. In this period to decrease the WBC count to safe values cytosine arabinoside treatment of 100mg/m2 dosage for 24 hours was iniated. In the second day of follow ups, WBC count was 42000 10’9/L and bone marrow aspiration (BMA) and cerebrospinal fluid was planned. The flow cytometric evaulation of BMA showed %10 myeloblasts. The genetic panel for AML was sent form bone marrow aspirate. In the 3th day of treatment; the genetic tests reported t(8,21) positivity in this paitent. The AML diagnosis was comfirmed and AML BFM 2019 protocol was initiated to the patient.The markable involution of tumoral mass from first day to first month serebral CT and physical view are in figure 1a-b and figure 2a-b respectively.