of 10 months following granulocytic sarcoma1,9. Rarely, overt leukemia can occur after a long period since the onset of granulocytic sarcoma17. Our patient has shown an unusual clinical course in that she was in complete remission from AML for a long time and that there were no signs of systemic involvement for a long time following the development of granulocytic sarcoma. She remained asymptomatic for a long time after achieving complete remission of AML M1. Nine years later, she presented with multiple granulocytic sarcoma. Although cutaneous multiple lesions show a tendency to progress rapidly, no systemic leukemic involvement has been observed for seventeen months of the follow-up period. From our case, we see that multiple granulocytic sarcomas can develop even in patients who have shown complete remission of AML for an extended period of time. Therefore, we think that careful periodic follow-up including hematologic evaluation is needed for such patients as aleukemic granulocytic sarcoma can be a first sign of hematologic relapse of leukemia. REFERENCES 1. Neiman RS, Barcos M, Berard C, Bonner H, Mann R, Rydell RE, et al. Granulocytic sarcoma: a clinicopathologic study of 61 biopsied cases. Cancer 1981;48:1426-1437. 2. Wiernik PH, Serpick AA. Granulocytic sarcoma (chloroma). Blood 1970;35:361-369. 3. Duguid JK, Mackie MJ, McVerry BA. Skin infiltration associated with chronic myelomonocytic leukaemia. Br J Haematol 1983;53:257-264. 4. Murakami Y, Nagae S, Matsuishi E, Irie K, Furue M. A case of CD56+ cutaneous aleukaemic granulocytic sarcoma with myelodysplastic syndrome. Br J Dermatol 2000;143:587- 590. 5. de Arruda Câmara VM, Morais JC, Portugal R, da Silva Carneiro SC, Ramos-e-Silva M. Cutaneous granulocytic sarcoma in myelodysplastic syndrome. J Cutan Pathol 2008;35:876-879. Multiple Granulocytic Sarcomas 6. Long JC, Mihm MC. Multiple granulocytic tumors of the skin: report of six cases of myelogenous leukemia with initial manifestations in the skin. Cancer 1977;39:2004- 2016. 7. Firat F, Ozen G, Yildiz G, Sağlam A, Onder S, Tan E, et al. Late relapse of acute myeloblastic leukemia as myeloid sarcoma causing radiculopathy. Leuk Res 2010;34:e348- e350. 8. Byrd JC, Weiss RB. Recurrent granulocytic sarcoma. An unusual variation of acute myelogenous leukemia associated with 8;21 chromosomal translocation and blast expression of the neural cell adhesion molecule. Cancer 1994;73: 2107-2112. 9. Harris DW, Ostlere LS, Rustin MH. Cutaneous granulocytic sarcoma (chloroma) presenting as the first sign of relapse following autologous bone marrow transplantation for acute myeloid leukaemia. Br J Dermatol 1992;127:182-184. 10. Orlandi E, Morra E, Lazzarino M, Castagnola C, Paulli M, Rosso R, et al. Multiple granulocytic sarcoma during complete hematologic remission of acute nonlymphoid leukemia. Acta Haematol 1989;81:41-43. 11. Mason TE, Demaree RS Jr, Margolis CI. Granulocytic sarcoma (chloroma), two years preceding myelogenous leukemia. Cancer 1973;31:423-432. 12. Takahashi T, Tsukuda H, Kimura H, Yoshimoto M, Tsujisaki M. Extramedullary relapse of AML with t(9;11)(p22;q23) associated with clonal evolution from trisomy 8 into tetrasomy 8. Intern Med 2010;49:447-451. 13. Cho-Vega JH, Medeiros LJ, Prieto VG, Vega F. Leukemia cutis. Am J Clin Pathol 2008;129:130-142. 14. Cronin DM, George TI, Sundram UN. An updated approach to the diagnosis of myeloid leukemia cutis. Am J Clin Pathol 2009;132:101-110. 15. Imrie KR, Kovacs MJ, Selby D, Lipton J, Patterson BJ, Pantalony D, et al. Isolated chloroma: the effect of early antileukemic therapy. Ann Intern Med 1995;123:351-353. 16. Yamauchi K, Yasuda M. Comparison in treatments of nonleukemic granulocytic sarcoma: report of two cases and a review of 72 cases in the literature. Cancer 2002;94: 1739-1746. 17. Krause JR. Granulocytic sarcoma preceding acute leukemia: a report of six cases. Cancer 1979;44:1017-1021. Vol. 23, Suppl. 2, 2011 S273