Extramedullary Relapse of Acute Promyelocytic Leukemia in the Middle Ear after All-Trans Retinoic Acid Combined with Chemotherapy
Abstract
A 69-year-old man with acute promyelocytic leukemia in molecular remission and no detectable PML::RARA transcripts in his peripheral blood cells developed acute otitis media. After 10 months, tympanomastoidectomy was performed for suspected secondary cholesteatoma. A histological examination confirmed extramedullary relapse with PML::RARA-positive cell infiltration. The patient achieved a second molecular remission after treatment with arsenic trioxide. Our findings suggest that (1) a diagnostic sample may be obtained from mastoid air cells rather than from the middle ear cavity, (2) molecular remission does not preclude extramedullary relapse, and (3) all-trans retinoic acid and arsenic trioxide combination therapy may reduce the risk of extramedullary relapse.
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BibTeX
@article{tsuge2026extramedullary,
title = {{Extramedullary Relapse of Acute Promyelocytic Leukemia in the Middle Ear after All-Trans Retinoic Acid Combined with Chemotherapy}},
author = {Noriko Tsuge and Taisuke Kobayashi and Masahiro Komori and Ichiro Murakami and Tatsuya Negishi and Shohei Shigeto and Yuta Tsunaga and Keito Ohara and Shinichiro Watanabe and Shohei Yoshida and Kensuke Kojima},
journal = {Internal Medicine},
year = {2026},
month = sep,
doi = {10.2169/internalmedicine.8006-26},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_8006-26/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Extramedullary Relapse of Acute Promyelocytic Leukemia in the Middle Ear after All-Trans Retinoic Acid Combined with Chemotherapy
AU - Noriko Tsuge
AU - Taisuke Kobayashi
AU - Masahiro Komori
AU - Ichiro Murakami
AU - Tatsuya Negishi
AU - Shohei Shigeto
AU - Yuta Tsunaga
AU - Keito Ohara
AU - Shinichiro Watanabe
AU - Shohei Yoshida
AU - Kensuke Kojima
PY - 2026
DA - 2026/09/29
JO - Internal Medicine
DO - 10.2169/internalmedicine.8006-26
UR - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_8006-26/_article
AB - A 69-year-old man with acute promyelocytic leukemia in molecular remission and no detectable PML::RARA transcripts in his peripheral blood cells developed acute otitis media. After 10 months, tympanomastoidectomy was performed for suspected secondary cholesteatoma. A histological examination confirmed extramedullary relapse with PML::RARA-positive cell infiltration. The patient achieved a second molecular remission after treatment with arsenic trioxide. Our findings suggest that (1) a diagnostic sample may be obtained from mastoid air cells rather than from the middle ear cavity, (2) molecular remission does not preclude extramedullary relapse, and (3) all-trans retinoic acid and arsenic trioxide combination therapy may reduce the risk of extramedullary relapse.
SN - 1349-7235
SN - 0918-2918
ER -