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Sahu KK, Sherif AA, Mishra AK, Lal A, Singh A. Testicular Myeloid Sarcoma: A Systematic Review of the Literature. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:603-618. [PMID: 31371220 DOI: 10.1016/j.clml.2019.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/15/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Abstract
Myeloid sarcoma usually involves lymph nodes, and head and neck regions. Uncommon sites like testis and ovary are rarely involved and pose a diagnostic challenge. Nonspecific findings, difficulty in retrieving biopsy specimens, and associated infertility are few of the hurdles faced during diagnosis and treatment of testicular myeloid sarcoma. Our review is an attempt to study myeloid sarcoma involving testis.
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Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA.
| | | | - Ajay Kumar Mishra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Amos Lal
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Abijai Singh
- Department of Hospital Medicine, Mon Health Medical Centre, Morgantown, WV
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52
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Clinical and Radiographic Response of Extramedullary Leukemia in Patients Treated With Gemtuzumab Ozogamicin. J Pediatr Hematol Oncol 2019; 41:e174-e176. [PMID: 29734213 DOI: 10.1097/mph.0000000000001201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Extramedullary leukemia (EML) is common in pediatric acute leukemia and can present at diagnosis or relapse. CD33 is detected on the surface of myeloid blasts in many patients with acute myelogenous leukemia and is the target of the antibody drug conjugate gemtuzumab ozogamicin (GO). Here we present 2 patients with CD33 EML treated with GO. They achieved significant response, with reduction of EML on both clinical and radiographic exams, specifically fluorine fluorodeoxyglucose positron emission tomography/computed tomography, demonstrating potential for targeted therapy with GO as a means of treating EML in patients with CD33 leukemia and the utility of fluorine fluorodeoxyglucose positron emission tomography/computed tomography monitoring in EML.
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53
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An Unusual Cause of Epistaxis: Paranasal Sinus Myeloid Sarcoma. Case Rep Hematol 2019; 2019:1312630. [PMID: 30891319 PMCID: PMC6390259 DOI: 10.1155/2019/1312630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/24/2019] [Indexed: 11/17/2022] Open
Abstract
We report a case of a 65-year-old female who presented with right-sided headaches, blurring of vision in the right eye, cold-induced epistaxis, and facial numbness in the trigeminal nerve distribution. Laboratory studies revealed a significant number of myeloblasts on peripheral smear with granulated cytoplasm, irregular nuclei, and prominent vacuoles. Magnetic resonance imaging (MRI) of the brain demonstrated a T1-enhancing 1.5 cm right-sided dural-based lesion involving the medial sphenoid wing, cavernous sinus, infratemporal fossa, and sphenoid sinus region. An endoscopic biopsy of the lesion within the sphenoid sinus confirmed the diagnosis of myeloid sarcoma, with myeloblasts comprising 30% of cellularity by flow cytometry. A subsequent bone marrow biopsy revealed a hypercellular marrow with 23% blasts by flow cytometry that demonstrated a similar immunophenotypic pattern to those seen in the sinus mass. Fluorescence in situ hybridization (FISH) testing revealed the balanced translocation t(8;21)(q22;q22.1), consistent with a diagnosis of acute myeloid leukemia with RUNX1-RUNX1T1-balanced translocation by WHO 2016 criteria. Myeloid sarcoma represents a rare extramedullary presentation of acute myeloid leukemia (AML), either alone or in conjunction with blood or bone marrow involvement. This case emphasizes the need for a broad differential diagnosis and an aggressive work-up for any unusual paranasal sinus mass.
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54
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Khaja M, Omesh T, Niazi M, Shaikh D, Mudunuru SA, Reyes OA, Malik S. Co-Occurrence of Myeloid Sarcoma of the Lymph Node and Acute Monocytic Myeloid Leukemia: A Case Report and Literature Review. Case Rep Oncol 2018; 11:791-799. [PMID: 30627094 PMCID: PMC6323399 DOI: 10.1159/000494830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/23/2018] [Indexed: 12/13/2022] Open
Abstract
Background Acute myeloid leukemia (AML) is the most common leukemia in adults. According to the French-American-British (FAB) system, monocytic leukemia is classified as M5. Myeloid sarcoma further occurs in 3–5% of AML. This is defined as an extramedullary tumor of myeloid cells in the lymph nodes, soft tissues, periosteum, bone, central nervous system (CNS), spinal cord, intestine, mediastinum, prostate, uterus, or ovaries. Case Presentation Here, we describe the case of a 29-year-old female who presented with fever, swelling of gums, neck pain, and weakness, which had persisted for 1 week. The patient had a white blood cell (WBC) count of 53.5 K/μL, and a peripheral smear revealed a myeloid blast cell (blast) percentage of 8%. Computed tomography (CT) of the neck indicated lymphadenopathy. Fine needle aspiration of the cervical lymph node showed groups of atypical immature myeloid cells, mixed with occasional megakaryocytes, and infiltration of eosinophilic myeloid cells into the lymph node, consistent with myeloid sarcoma. Flow cytometry analysis revealed intermediate to large circulating blasts, with irregular nuclei, fine chromatin, and distinct nucleoli, indicative of AML, with monocytic differentiation. The patient responded well to chemotherapy with fludarabine, cytarabine, granulocyte colony stimulating factor (G-CSF), and idarubicin; WBC counts returned to normal and patient was discharged to home. Conclusion Myeloid sarcoma of the lymph node is a rare co-occurrence with AML. Results of our study are consistent with the conclusion that early diagnosis and appropriate treatment improve survival.
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Affiliation(s)
- Misbahuddin Khaja
- Division of Pulmonary and Critical Care Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
| | - Toolsie Omesh
- Division of Pulmonary and Critical Care Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
| | - Masooma Niazi
- Division of Pathology, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
| | - Danial Shaikh
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
| | - Sitarama Arvind Mudunuru
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
| | - Olga Alexandra Reyes
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
| | - Sandeep Malik
- Division of Hematology and Oncology, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
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55
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Fernandez HF, Sun Z, Litzow MR, Luger SM, Paietta E, Racevskis J, Levine RL, Patel JP, Abdel-Wahab O, Ketterling RP, Dewald GW, Bennett JM, Rowe JM, Lazarus HM, Tallman MS. Extramedullary acute myeloid leukemia presenting in young adults demonstrates sensitivity to high-dose anthracycline: a subset analysis from ECOG-ACRIN 1900. Haematologica 2018; 104:e147-e150. [PMID: 30467203 DOI: 10.3324/haematol.2018.197277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Hugo F Fernandez
- Department of Malignant Hematology & Cellular Therapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Zhuoxin Sun
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Mark R Litzow
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Selina M Luger
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Ross L Levine
- Human Oncology and Pathogenesis Program, Department of Medicine Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jay P Patel
- Human Oncology and Pathogenesis Program, Department of Medicine Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Omar Abdel-Wahab
- Human Oncology and Pathogenesis Program, Department of Medicine Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Rhett P Ketterling
- Division of Cytogenetics, Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Gordon W Dewald
- Division of Cytogenetics, Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - John M Bennett
- Hematology/Oncology/Pathology, University of Rochester, Rochester, NY, USA
| | - Jacob M Rowe
- Hematology and Bone Marrow Transplantation, Rambam Medical Center, Technion, Haifa, Israel
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Martin S Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
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56
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Khalatbari H, Parisi MT, Kwatra N, Harrison DJ, Shulkin BL. Pediatric Musculoskeletal Imaging: The Indications for and Applications of PET/Computed Tomography. PET Clin 2018; 14:145-174. [PMID: 30420216 DOI: 10.1016/j.cpet.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The use of PET/computed tomography (CT) for the evaluation and management of children, adolescents, and young adults continues to expand. The principal tracer used is 18F-fluorodeoxyglucose and the principal indication is oncology, particularly musculoskeletal neoplasms. The purpose of this article is to review the common applications of PET/CT for imaging of musculoskeletal issues in pediatrics and to introduce the use of PET/CT for nononcologic issues, such as infectious/inflammatory disorders, and review the use of 18F-sodium fluoride in trauma and sports-related injuries.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
| | - Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Neha Kwatra
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Douglas J Harrison
- Department of Pediatrics, MD Anderson Cancer Center, 7600 Beechnut Street, Houston, TX 77074, USA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
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57
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Zhu T, Xi XY, Dong HJ. Isolated myeloid sarcoma in the pancreas and orbit: A case report and review of literature. World J Clin Cases 2018; 6:477-482. [PMID: 30294614 PMCID: PMC6163140 DOI: 10.12998/wjcc.v6.i11.477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/06/2018] [Accepted: 08/12/2018] [Indexed: 02/05/2023] Open
Abstract
Myeloid sarcoma (MS) is a type of extramedullary solid haematological tumour. Myeloid sarcoma is classified into two types based on whether onset of the disease is complicated by haematologic diseases: extramedullary infiltration of leukaemia (leukaemic MS) and isolated myeloid sarcoma. The incidence of isolated myeloid sarcoma is low. In particular, isolated myeloid sarcoma involving the pancreas is extremely rare and prone to misdiagnosis. This case report describes the long and eventful diagnostic process of a case of myeloid sarcoma involving the pancreas and orbit. Due to a lack of typical clinical manifestations and imaging characteristics, the patient underwent several rounds of treatment without a confirmed diagnosis. Eventually, the final diagnosis was pathologically confirmed using several types of biopsies and immunohistochemical detection. To date, this type of disease has not been reported in the literature. This case report describes the detailed diagnostic process and discusses the strategies used for diagnosis, which will facilitate the diagnosis of such diseases in the future.
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Affiliation(s)
- Ting Zhu
- Department of Digestive Disease, Weinan Central Hospital, Weinan 714000, Shaanxi Province, China
| | - Xu-Yan Xi
- Department of Surgical Oncology, Weinan Central Hospital, Weinan 714000, Shaanxi Province, China
| | - Hong-Juan Dong
- Department of Haematology, Xijing Hospital, the Military Medical University of the PLA Air Force, Xi’an 710032, Shaanxi Province, China
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Rose A, Brayer J. Connecting the Dots: A Case of Myeloid Sarcoma. Am J Med 2018; 131:e357-e359. [PMID: 29729239 DOI: 10.1016/j.amjmed.2018.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/01/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Ashley Rose
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa.
| | - Jason Brayer
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Fla
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59
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Myeloid Sarcoma Predicts Superior Outcome in Pediatric AML; Can Cytogenetics Solve the Puzzle? CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e249-e254. [DOI: 10.1016/j.clml.2018.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/13/2018] [Accepted: 03/27/2018] [Indexed: 12/13/2022]
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60
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Bakst RL, Dabaja BS, Specht LK, Yahalom J. Use of Radiation in Extramedullary Leukemia/Chloroma: Guidelines From the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 2018; 102:314-319. [PMID: 30191865 DOI: 10.1016/j.ijrobp.2018.05.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 10/16/2022]
Abstract
Survival times for patients with leukemia generally have improved in recent decades, and this improvement has been attributed to an enhanced understanding of the genetics driving the cause of the disease and improved combinations of chemotherapy and targeted therapy. Durable control of systemic disease in blood and bone marrow has significantly improved survival, but extramedullary relapse can pose therapeutic challenges for which radiation therapy can have an important role. This report discusses the current role of radiation therapy for patients with leukemia, specifically the extramedullary manifestations of leukemia.
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Affiliation(s)
- Richard L Bakst
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
| | - Bouthaina Shbib Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lena K Specht
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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61
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Cheng Y, Yu C, Zhu S, Guo L, Zhang Y, Zhang Y, Ma X. Nonleukemic granulocytic sarcoma of orbit after blunt trauma: A case report and review of literature. Medicine (Baltimore) 2018; 97:e0373. [PMID: 29642189 PMCID: PMC5908642 DOI: 10.1097/md.0000000000010373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Granulocytic sarcoma without invasion of bone marrow or blood is very rare. The diagnosis of it is usually overlooked and the treatment has not reached a consensus. Meanwhile, the onset of this kind of disease is not clear. PATIENT CONCERNS Diagnose patients in early stage and help choose the right treatment strategies. DIAGNOSES The ultimate diagnosis was nonleukemic granulocytic sarcoma after blunt trauma. INTERVENTIONS Surgery was the initial treatment option. Chemotherapy including idarubicin (70 mg, D1-D3) and cytosine arabinoside (100 mg, D1-D7) and radiotherapy of total 3,060 cGy were then administered but failed to control the disease. Hematopoietic stem cell transplantation was finally administered. OUTCOMES No evidence of disease progression or spread according to the latest follow-up. LESSONS The etiology of nonleukemic granulocytic still remains unclear, though trauma seems to be a potential predisposing factor and deserves more attention for early diagnosis and timely and proper treatment. Systemic chemotherapy is more effective than radiotherapy or surgery. Hematopoietic stem cell transplantation is an alternative choice after the failure of chemotherapy.
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62
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Kawamoto K, Miyoshi H, Suzuki T, Kiyasu J, Yokoyama S, Sasaki Y, Sone H, Seto M, Takizawa J, Ohshima K. Expression of programmed death ligand 1 is associated with poor prognosis in myeloid sarcoma patients. Hematol Oncol 2018; 36:591-599. [PMID: 29602174 DOI: 10.1002/hon.2506] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 01/26/2018] [Accepted: 02/11/2018] [Indexed: 12/19/2022]
Abstract
Myeloid sarcoma (MS) is a rare condition and is an extramedullary tumour of immature myeloid cells. It is now known that the programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) pathway suppresses the host antitumor responses and that these products are expressed on both tumour cells and tumour-infiltrating cells in various malignancies. However, little is known about the significance of PD-1/PD-L1 expression on tumour cells and tumour microenvironmental cells in MS. To investigate the clinicopathological significance of PD-1/PD-L1 expression in MS, we analyzed 98 patients by immunohistochemistry. Of these, 10.2% of cases had neoplastic tumour cells positive for PD-L1 (nPD-L1+ ). However, the rate of nPD-L1+ was <5% (range: 0.27 to 2.97%). On the other hand, PD-L1 expression on 1 or more of stromal cells in the tumour microenvironment (miPD-L1+ ) was observed in 37.8% of cases. Because all nPD-L1+ cases expressed PD-1 on less than 5% of tumour cells, we compared the miPD-L1+ and miPD-L1- groups. There was a correlation between miPD-L1+ status and the number of PD-1-expressing tumour -infiltrating lymphocytes (PD-1+ TILs; P = .0229). miPD-L1+ was found to be associated with poorer overall survival and progression-free survival (P = .00392, P = .00261, respectively). Multivariate analysis also confirmed miPD-L1+ to be an independent poor prognostic factor. In conclusion, our study indicated that the immunotherapy blocking the PD-1/PD-L1 pathway may improve the clinical outcome of MS.
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Affiliation(s)
- Keisuke Kawamoto
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan.,Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Hiroaki Miyoshi
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Takaharu Suzuki
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Junichi Kiyasu
- Department of Hematology, Iizuka Hospital, Iizuka, Japan
| | - Shintaro Yokoyama
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Yuya Sasaki
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Masao Seto
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Jun Takizawa
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
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Hoversten K, Vallapureddy R, Lasho T, Finke C, Ketterling R, Hanson C, Gangat N, Tefferi A, Patnaik MM. Nonhepatosplenic extramedullary manifestations of chronic myelomonocytic leukemia: clinical, molecular and prognostic correlates. Leuk Lymphoma 2018; 59:2998-3001. [PMID: 29582697 DOI: 10.1080/10428194.2018.1452212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | | | - Terra Lasho
- b Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Christy Finke
- b Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Rhett Ketterling
- c Department of Laboratory Medicine and Pathology , Division of Cytogenetics, Mayo Clinic , Rochester , MN , USA
| | - Curtis Hanson
- d Department of Laboratory Medicine and Pathology , Mayo Clinic , Rochester , MN , USA
| | - Naseema Gangat
- b Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Ayalew Tefferi
- b Division of Hematology , Mayo Clinic , Rochester , MN , USA
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Sharma A, Das AK, Pal S, Bhattacharyya S. Fine-needle aspiration cytology of granulocytic sarcoma presenting as a breast lump - Report of a rare case with a comprehensive literature search. J Lab Physicians 2018; 10:113-115. [PMID: 29403218 PMCID: PMC5784281 DOI: 10.4103/jlp.jlp_114_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Myeloid sarcoma is a neoplasm of myeloid cells that can arise before or concurrent with or may follow acute myeloid leukemia. Very rarely, it can present as an isolated breast lump. We have diagnosed a case of myeloid sarcoma by fine-needle aspiration cytology (FNAC), in a 52-year-old woman who presented with the right-sided breast lump. FNAC showed hypercellular smears with immature myeloid cells few neutrophils and many large round cells with high nuclear-cytoplasmic ratio, prominent nucleoli and a moderate amount of granular cytoplasm. The blast cells were myeloperoxidase positive and complete blood count, and peripheral blood examination were normal. We report this case for its rarity and as a note of caution to a pathologist to consider myeloid sarcoma in the differential diagnosis of breast lump to provide the correct diagnosis and avoid incorrect treatment of a curable disease.
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Affiliation(s)
- Abhishek Sharma
- Department of Pathology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Anjan Kr Das
- Department of Pathology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Subrata Pal
- Department of Pathology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Subodh Bhattacharyya
- Department of Pathology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
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65
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Gajendra S, Goel S, Sharma R, Dhiman P, Sachdev R. Myeloid Sarcoma Presented as Generalized Lymphadenopathy: Mimicking Malignant Lymphoma. Indian J Hematol Blood Transfus 2018; 34:173-177. [PMID: 29398826 DOI: 10.1007/s12288-017-0807-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/22/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Smeeta Gajendra
- 1Department of Pathology and Lab Medicine, Medanta The Medicity, Sector 38, Gurgaon, Haryana 122001 India
| | - Shalini Goel
- 1Department of Pathology and Lab Medicine, Medanta The Medicity, Sector 38, Gurgaon, Haryana 122001 India
| | - Rashi Sharma
- 1Department of Pathology and Lab Medicine, Medanta The Medicity, Sector 38, Gurgaon, Haryana 122001 India
| | - Pratibha Dhiman
- 2Department of Medical Oncology and Hematology, Medanta The Medicity, Sector 38, Gurgaon, Haryana 122001 India
| | - Ritesh Sachdev
- 1Department of Pathology and Lab Medicine, Medanta The Medicity, Sector 38, Gurgaon, Haryana 122001 India
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66
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Markoc F, Bozdogan N, Yükrük FA, Gumuc EB, Akdur NC. Granulocytic Sarcomas: Difficulties in Diagnosis. TUMORI JOURNAL 2018; 96:149-53. [DOI: 10.1177/030089161009600124] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Granulocytic sarcoma is an uncommon tumor composed of myeloid blasts and/or immature myeloid cells in an extramedullary site which is usually associated with acute or chronic myeloid leukemia. The tumor may also be the initial manifestation of leukemia. The histomorphological diagnosis of granulocytic sarcoma can be challenging to pathologists, especially in the absence of a known hematological disorder. In this case, differentiation of granulocytic sarcoma from malignant lymphomas and other small round cell tumors is very critical. Seven cases of granulocytic sarcoma are reported in this paper. One patient had granulocytic sarcomas at two different sites. Hematoxylin-eosin-stained sections were reexamined. Blastic, poorly differentiated, and well differentiated histopathological variants were found in two, five and one cases, respectively. Immunohistochemical studies were performed on formalin-fixed tissue from all cases using a avidin-biotin-peroxidase complex technique. The panel included antibodies against LCA, CD43, CD34, c-kit, myeloperoxidase, CD68 KP1, CD15, and CD99. All cases stained positively with LCA, CD43, CD34, myeloperoxidase, and CD68. Five cases were positive for c-kit, three cases were positive for CD15, and two cases were positive for CD99. An immunohistochemical panel including at least myeloperoxidase, CD68 and CD34 can be used for detection of myeloid differentiation. It is also important that granulocytic sarcoma be considered in the differential diagnosis of CD99-positive round cell tumors.
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Affiliation(s)
- Fatma Markoc
- Department of Pathology, Ankara Abdurrahman Yurtarslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Nazan Bozdogan
- Department of Pathology, Ankara Abdurrahman Yurtarslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Fisun Ardic Yükrük
- Department of Pathology, Ankara Abdurrahman Yurtarslan Oncology Training and Research Hospital, Ankara, Turkey
| | | | - Noyan Can Akdur
- Department of Pathology, Ankara Training and Research Hospital, Ankara, Turkey
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67
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Dominguez Rullán JA, Fernández Lizarbe E, Capuz B, Piris M, Sancho García S. Radiotherapy for isolated granulocytic sarcoma: Case report and review of literature. Clin Transl Radiat Oncol 2018; 8:1-3. [PMID: 29594235 PMCID: PMC5862674 DOI: 10.1016/j.ctro.2017.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 11/23/2022] Open
Abstract
Isolated chloroma should be considered as a systemic disease. Consolidation radiotherapy has been related with prolonged failure free survival. Excellent local control of chloroma is achieved with low-dose radiotherapy.
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Abstract
Myeloid sarcoma is an extramedullary collection of blasts of the myeloid series that partially or totally effaces the architecture of the tissue in which it is found. These tumors have been described in many sites of the body, but the skin, lymph nodes, gastrointestinal tract, bone, soft tissue, and testes are most common. They can arise in a patient following the diagnosis of acute myeloid leukemia, but they may also be precursors of leukemia and should be considered diagnostic for acute myeloid leukemia. The differential diagnosis of this neoplasm includes malignant lymphoma, with which it is often mistaken, leading to diagnostic and therapeutic delays. We present the case of an 84-year-old African American man with a history of renal disease secondary to hypertension and coronary artery disease without any prior history of malignancies who presented with airway obstruction. He was diagnosed with a myeloid sarcoma of the mediastinum compressing his trachea.
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Affiliation(s)
- Aaron R Belknap
- Department of Pathology (Belknap) and Division of Hematopathology (Krause), Baylor University Medical Center at Dallas and the Charles A. Sammons Cancer Center, Dallas, Texas
| | - John R Krause
- Department of Pathology (Belknap) and Division of Hematopathology (Krause), Baylor University Medical Center at Dallas and the Charles A. Sammons Cancer Center, Dallas, Texas
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Arber DA, Borowitz MJ, Cessna M, Etzell J, Foucar K, Hasserjian RP, Rizzo JD, Theil K, Wang SA, Smith AT, Rumble RB, Thomas NE, Vardiman JW. Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology. Arch Pathol Lab Med 2017; 141:1342-1393. [PMID: 28225303 DOI: 10.5858/arpa.2016-0504-cp] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - A complete diagnosis of acute leukemia requires knowledge of clinical information combined with morphologic evaluation, immunophenotyping and karyotype analysis, and often, molecular genetic testing. Although many aspects of the workup for acute leukemia are well accepted, few guidelines have addressed the different aspects of the diagnostic evaluation of samples from patients suspected to have acute leukemia. OBJECTIVE - To develop a guideline for treating physicians and pathologists involved in the diagnostic and prognostic evaluation of new acute leukemia samples, including acute lymphoblastic leukemia, acute myeloid leukemia, and acute leukemias of ambiguous lineage. DESIGN - The College of American Pathologists and the American Society of Hematology convened a panel of experts in hematology and hematopathology to develop recommendations. A systematic evidence review was conducted to address 6 key questions. Recommendations were derived from strength of evidence, feedback received during the public comment period, and expert panel consensus. RESULTS - Twenty-seven guideline statements were established, which ranged from recommendations on what clinical and laboratory information should be available as part of the diagnostic and prognostic evaluation of acute leukemia samples to what types of testing should be performed routinely, with recommendations on where such testing should be performed and how the results should be reported. CONCLUSIONS - The guideline provides a framework for the multiple steps, including laboratory testing, in the evaluation of acute leukemia samples. Some aspects of the guideline, especially molecular genetic testing in acute leukemia, are rapidly changing with new supportive literature, which will require on-going updates for the guideline to remain relevant.
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70
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Wang P, Li Q, Zhang L, Ji H, Zhang CZ, Wang B. A myeloid sarcoma involving the small intestine, kidneys, mesentery, and mesenteric lymph nodes: A case report and literature review. Medicine (Baltimore) 2017; 96:e7934. [PMID: 29049187 PMCID: PMC5662353 DOI: 10.1097/md.0000000000007934] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Myeloid sarcomas (MSs) are rare malignant hematological tumors. They most commonly occur in patients with acute or chronic myeloid leukemia. A de novo MS with no evidence of blood system disease is rare, but may represent the first sign of a systemic illness that precedes a full-blown disease. Herein, we report the computed tomography (CT) findings of an extremely rare case of a nonleukemic MS that progressed to acute myelogenous leukemia (AML) and simultaneously involved the small intestine, kidneys, mesentery, and mesenteric lymph nodes. Moreover, we provide CT findings before and after AML chemotherapy, which have not been reported previously. PATIENT CONCERNS A 25-year-old man with intermittent upper abdominal pain for 6 months was admitted to the hospital on November 28, 2015. Initial CT showed concentric wall thickening of the jejunum with an adjacent mesenteric soft tissue mass and mesenteric lymph nodes enlargement. Both kidneys were involved as indicated by the presence of well-defined mildly dilated lesions. During the laparoscopic surgery, the small intestinal tumor, mesenteric soft tissue mass, and mesenteric lymph nodes were removed. DIAGNOSES The pathological diagnosis was an MS. INTERVENTIONS The patient refused systemic chemotherapy and was rehospitalized with persistently aggravated abdominal distension on February 17, 2016. Follow-up CT showed diffuse small bowel wall thickening, widespread infiltration of the peritoneum, omentum, and mesentery, mesenteric lymph node enlargement, and large amounts of ascites fluid. The lesions in both kidneys were substantially larger and more numerous than on initial CT. Then the patient was treated with conventional AML chemotherapy. OUTCOMES The patient achieved complete hematological remission on bone marrow examination. Follow-up CT in September 4, 2016, showed none of the abnormalities seen on initial CT. Currently, the patient is in complete remission. LESSONS If the radiological examination shows lesions at multiple sites, and these lesions are soft tissue masses with homogenous enhancement, MS should be considered in the differential diagnosis, and an aspiration biopsy should be performed to provide a definitive pathological diagnosis. If MS is diagnosed, systemic chemotherapy is crucial to recovery; otherwise, the disease may progress rapidly. Medical imaging is helpful for diagnosing MS and for monitoring treatment response.
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Affiliation(s)
- Ping Wang
- Shandong Medical Imaging Research Institute, School of Medicine, Shandong University, Jinan
- Department of Radiology
| | | | | | - Hong Ji
- Department of Pathology, The Affiliated Hospital of Binzhou Medical University, School of Medicine, Binzhou Medical University, Binzhou
| | | | - Bin Wang
- Medical Imaging Research Institute, Department of Radiology, School of Medicine, Binzhou Medical University, Yantai, Shandong, China
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Goyal G, Bartley AC, Patnaik MM, Litzow MR, Al-Kali A, Go RS. Clinical features and outcomes of extramedullary myeloid sarcoma in the United States: analysis using a national data set. Blood Cancer J 2017; 7:e592. [PMID: 28841208 PMCID: PMC5596389 DOI: 10.1038/bcj.2017.79] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- G Goyal
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA
| | - A C Bartley
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, USA
| | - M M Patnaik
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA
| | - M R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA
| | - A Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA
| | - R S Go
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA
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72
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[Two cases of myeloid sarcomas with review of literature]. Rev Med Interne 2017; 38:774-777. [PMID: 28668372 DOI: 10.1016/j.revmed.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/01/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Myeloid sarcomas are uncommon proliferations of immature myeloid cells occurring in any extramedullary organ. We report here two cases of myeloid sarcomas in patients with, respectively, a polycythemia vera and a myelodysplastic syndrome. CASE REPORTS The first is an 81-year-old woman who presented with osteolytic lesions. Diagnosis has been highlighted using anatomopathological study after bone marrow biopsy, but it was delayed because of a very localized basin lesion and few positive myeloid markers. The second patient is an 86-year-old man who presented with pancytopenia and several lymph nodes. Lymph node cytology failed because of the rarity of blast cells. Diagnosis was done after anatomopathological study on lymph node biopsy which revealed a localized form of myeloid sarcoma. CONCLUSION The diagnosis of myeloid sarcoma must be considered when unusual tumors occur in patients with a chronic myeloid disease. In that case, therapeutic options are those of an acute myeloid leukemia.
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Isolated Extramedullary Relapse of Acute Leukemia after Allogeneic Stem Cell Transplantation: Different Kinetics and Better Prognosis than Systemic Relapse. Biol Blood Marrow Transplant 2017; 23:1087-1094. [DOI: 10.1016/j.bbmt.2017.03.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/20/2017] [Indexed: 11/19/2022]
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Kaur V, Swami A, Alapat D, Abdallah AO, Motwani P, Hutchins LF, Jethava Y. Clinical characteristics, molecular profile and outcomes of myeloid sarcoma: a single institution experience over 13 years. ACTA ACUST UNITED AC 2017; 23:17-24. [PMID: 28574302 DOI: 10.1080/10245332.2017.1333275] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Myeloid sarcoma (MS) is characterized by extramedullary infiltration by immature myeloid cells. Owing to rarity of this disease, the clinical features and overall outcomes are yet to be clarified. OBJECTIVE To define clinical characteristics, epidemiology, pathologic findings, treatment options and outcomes in MS. METHODS We conducted a retrospective review of 23 patients diagnosed with MS at our institute over a period of 13 years (2002-2015). RESULTS MS presented mostly as a manifestation of relapsed acute myeloid leukemia, seen in 39% of patients. Skin and subcutaneous soft tissues were the most common sites of anatomic involvement (69.5%). Ninety five percent (n = 19) were positive for classical myeloid markers with either cytochemical staining (chloracetate-esterase, MPO), flow-cytometry (CD33, CD34, CD13 and CD117), or immunohistochemistry (CD34, CD43, CD68 and lysozyme). Of these, 52% were positive for CD33 (n = 12), 35% for CD68 (n = 8), 30% for CD34 (n = 7), and 26% for lysozyme (n = 6). Cytogenetic abnormalities were seen in 63% (n = 12/19) patients on bone-marrow aspirate, with five patients displaying a complex (n = 3) or monosomal (n = 2) karyotype. Twenty seven percent patients with a normal karyotype had presence of deleterious mutations (FLT3, ASXL, STAG and JAK2) on further testing with myeloid mutation panel. The Median overall survival (OS) of the entire cohort was 15.9 months (95% CI, 7.4-24.4 months). The OS was significantly better for patients <65 years (24.6 vs. 3.4 months, p = 0.009) of age, and for those attaining a complete remission (CR) to induction therapy (25.7 vs. 0.8 months, p < 0.001). All patients who underwent allogeneic hematopoietic stem cell transplant attained long-term remissions, with a median follow-up of 54 (range 32-120) months. CONCLUSION Failure to achieve CR with induction therapy, and age >65 years are associated with poor outcomes in MS. Allogeneic stem-cell transplant in first remission appears to be the most effective modality for achieving long-term remissions.
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Affiliation(s)
- Varinder Kaur
- a Department of Medicine, Division of Hematology and Oncology, Emily Couric Cancer Center , University of Virginia , Charlottesville , VA , USA.,b Division of Hematology and Oncology , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Arjun Swami
- c Government Medical College , Chandigarh , India
| | - Daisy Alapat
- d Department of Pathology , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Al Ola Abdallah
- b Division of Hematology and Oncology , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , AR , USA.,e Department of Hematology and Oncology , University of Kansas Medical Center , Kansas City , KS , USA
| | - Pooja Motwani
- b Division of Hematology and Oncology , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Laura F Hutchins
- b Division of Hematology and Oncology , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Yogesh Jethava
- b Division of Hematology and Oncology , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , AR , USA
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Bashoura L, Eapen GA, Faiz SA. Pulmonary Manifestations of Lymphoma and Leukemia. Clin Chest Med 2017; 38:187-200. [DOI: 10.1016/j.ccm.2016.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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76
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Extramedullary Relapse in a CML Patient after Allogeneic Stem Cell Transplantation. Case Rep Hematol 2017; 2017:6350267. [PMID: 28421151 PMCID: PMC5379078 DOI: 10.1155/2017/6350267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 12/11/2022] Open
Abstract
Myeloid or granulocytic sarcoma (GS) is a tumoral lesion consisting of immature granulocytic cells. It is a rare entity during the course of CML patients especially after allogeneic stem cell transplantation (SCT). Relapse without bone marrow involvement is much rarer. We report a case of CML patient who relapsed with isolated granulocytic sarcoma after allogeneic SCT during cytogenetic and molecular remission. 28-year-old male was diagnosed as CML and allogeneic SCT was performed because of refractory disease to tyrosine kinase inhibitors. Complete cytogenetic and molecular response was achieved after allogeneic SCT followed by dasatinib treatment. Approximately 5 years after the transplantation, very rapidly progressive lesion was documented and diagnosed as GS although he was at molecular and cytogenetic remission. The patient died during chemotherapy due to sepsis. GS relapse after allogeneic SCT is a very rare type of relapse in CML patients with molecular and cytogenetic remission. Since it is a very aggressive disease with a poor prognosis, combined chemoradiotherapies with other possible options like DLI or second allogeneic SCT should be considered as soon as the diagnosis is confirmed.
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Liang Y, Gao J, Wu D, Li S, Chen H, Ding L, Tong J, Xu Y. Long-Term Remission following Autologous Hematopoietic Cell Transplantation in a Patient with Multiple Nonleukemic Myeloid Sarcoma and a Review of the Literature. Acta Haematol 2017; 137:117-122. [PMID: 28301836 DOI: 10.1159/000455998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/09/2017] [Indexed: 12/18/2022]
Abstract
Multiple nonleukemic myeloid sarcoma (MS) is a rare form of MS that is developed in multiple anatomic sites other than bone marrow at diagnosis, without a preceding myeloid neoplasm. The prevalence, prognosis, and optimal management of multiple nonleukemic MS have not been addressed. The role of allogenic or autologous hematopoietic cell transplantation (HCT) for nonleukemic MS is also less well defined. We present a case of MS characterized by systemic lymphadenopathies and multiple effusions, which presumably had a very poor prognosis. The patient was treated with acute myeloid leukemia-type induction chemotherapy and autologous peripheral blood stem cell transplantation, and, unexpectedly, she has remained disease free for more than 6 years. We also reviewed the literature on this rare disease, and found that multiple nonleukemic MS was associated with younger age and a worse prognosis when compared with the overall nonleukemic MS population. We suggest that autologous HCT represents a valid option for young patients with chemosensitive disease and should be performed at the status of minimal residual disease-negative complete remission.
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Affiliation(s)
- Yun Liang
- Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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78
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Chandra P, Dhake S, Purandare N, Agrawal A, Shah S, Rangarajan V. Role of FDG PET/CT in Diagnostic Evaluation of Granulocytic Sarcomas: A Series of 12 Patients. Indian J Nucl Med 2017; 32:198-202. [PMID: 28680203 PMCID: PMC5482015 DOI: 10.4103/ijnm.ijnm_10_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Granulocytic sarcoma (GS) is a rare extramedullary manifestation in patients with acute myeloid leukemia (AML), which can precede the diagnosis or occur in the posttreatment setting. Unlike its established role in other hematological malignancies like Hodgkin's on non-Hodgkin's disease, the exact role of positron emission tomography/computed tomography (PET/CT) in AML with or without GS remains to be defined. MATERIALS AND METHODS We retrospectively reviewed PET/CT scans of 12 patients with histologically proven GS. Marrow examination of these patients identified nine patients with isolated GS (without existent leukemia) and three patients with coexistent leukemia. RESULTS PET/CT accurately identified all clinically evident GS in all 12 patients at initial staging and at follow-up with tumors, showing moderate to high 2-deoxy-2-fluoro-D-glucose uptake. Coexistent marrow disease was seen on PET/CT in three patients, which was confirmed on histopathology. In the same patients, PET/CT also detected additional sites of extramedullary disease in 66.6% (n = 8), which was either clinically occult or not evident on routine CT. CONCLUSION PET/CT appears to be a highly sensitive imaging modality in diagnostic evaluation of GS. The most important indication of using PET/CT in these cases is to identify additional sites of clinically occult extramedullary disease, which can potentially impact treatment decisions and outcomes.
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Affiliation(s)
- Piyush Chandra
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sanket Dhake
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nilendu Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
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79
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Karaosmanoglu AD, Onur MR, Tabari A, Karcaaltincaba M, Arellano RS. Role of multimodality imaging in the diagnosis of lymphoproliferative malignancies and hematologic disorders of the kidneys. Abdom Radiol (NY) 2017; 42:242-253. [PMID: 27535385 DOI: 10.1007/s00261-016-0873-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Lymphoproliferative and hematologic disorders of the kidney may present with focal or diffuse renal parenchymal involvement in clinical practice. Radiologic findings of lymphoproliferative and hematologic disorders of the kidney may mimick primary neoplastic and inflammatory disorders of the kidney. All cross-sectional imaging modalities including ultrasonography, computed tomography, and magnetic resonance imaging may be used in the diagnosis of these diseases. Percutaneous biopsy may be used in problematic cases for definitive diagnosis.
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Affiliation(s)
- Ali Devrim Karaosmanoglu
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
- Hacettepe Universitesi Tıp Fakültesi Hastanesi, Sıhhiye, 06100, Ankara, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey.
- Hacettepe Universitesi Tıp Fakültesi Hastanesi, Sıhhiye, 06100, Ankara, Turkey.
| | - Azadeh Tabari
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., White 270, Boston, MA, 02114, USA
| | - Musturay Karcaaltincaba
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
- Hacettepe Universitesi Tıp Fakültesi Hastanesi, Sıhhiye, 06100, Ankara, Turkey
| | - Ronald S Arellano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., White 270, Boston, MA, 02114, USA
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80
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Qian X, Gigantelli JW, Abromowitch M, Morgan LA, Suh DW. Myeloid Sarcoma in the Orbit. J Pediatr Ophthalmol Strabismus 2016; 53:e64-e68. [PMID: 27977030 DOI: 10.3928/01913913-20161102-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/26/2016] [Indexed: 11/20/2022]
Abstract
The authors describe a case of myeloid sarcoma of the orbit in a pediatric patient. An 8-month-old male infant presented to the ophthalmology clinic with a left orbital mass, which had been increasing in size over the previous 2 months. The mass was initially diagnosed at another clinic as an infantile hemangioma, and had been treated with a topical formulation of timolol. In the ophthalmology clinic, orbital magnetic resonance imaging showed a solid enhancing mass. A biopsy was performed, and histopathology revealed myeloid sarcoma. The disease responded well to a standard chemotherapy regimen. Myeloid sarcoma is a rare, extra-medullary presentation that can occur as an isolated tumor, concurrently with or at relapse of acute myeloid leukemia. Because few cases of myeloid sarcoma in the orbit have been reported, this case report aids in the management of myeloid sarcoma in pediatric patients. The report describes an 8-month-old male infant, the youngest patient to develop myeloid sarcoma without preexisting acute myeloid leukemia. [J Pediatr Ophthalmol Strabismus. 2016;53:e64-e68.].
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81
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Majdoul S, Colson-Durand L, To NH, Belkacemi Y. Adaptive Radiotherapy for an Uncommon Chloroma. Case Rep Oncol 2016; 9:593-598. [PMID: 27920690 PMCID: PMC5118684 DOI: 10.1159/000450599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 11/19/2022] Open
Abstract
Granulocytic sarcomas, also referred to as chloromas or myeloid sarcomas, are extramedullary neoplasms that are composed of immature myeloid cells. This uncommon disease is known to be radiosensitive. However, the total dose and dose per fraction are not standardized. In addition, during the course of radiation therapy, significant reduction of the tumor is usually obtained. Thus, target volume reduction may require an intermediate radiotherapy plan evaluation for an adaptive treatment. A second plan at mid-dose is highly recommended.
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Affiliation(s)
- Soufya Majdoul
- Department of Radiation Oncology and Henri Mondor Breast Center, INSERM U955 E07, and University of Paris-Est Créteil (UPEC), Créteil, France
| | - Laurianne Colson-Durand
- Department of Radiation Oncology and Henri Mondor Breast Center, INSERM U955 E07, and University of Paris-Est Créteil (UPEC), Créteil, France
| | - Nu Hanh To
- Department of Radiation Oncology and Henri Mondor Breast Center, INSERM U955 E07, and University of Paris-Est Créteil (UPEC), Créteil, France
| | - Yazid Belkacemi
- Department of Radiation Oncology and Henri Mondor Breast Center, INSERM U955 E07, and University of Paris-Est Créteil (UPEC), Créteil, France
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82
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Starry Sky Pattern in Hematopoietic Neoplasms: A Review of Pathophysiology and Differential Diagnosis. Adv Anat Pathol 2016; 23:343-355. [PMID: 27677083 DOI: 10.1097/pap.0000000000000127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The starry sky pattern is a distinctive histologic feature wherein a rapidly proliferating hematolymphoid neoplasm contains scattered histiocytes with abundant pale cytoplasm in a background of monomorphic neoplastic cells. The cytoplasm of these histiocytes typically contains cellular remnants, also known as tingible bodies, incorporated through active phagocytosis. Although common and widely recognized, relatively little is known about the pathophysiological underpinnings of the starry sky pattern. Its resemblance to a similar pattern seen in the germinal centers of secondary follicles suggests a possible starting point for understanding the molecular basis of the starry sky pattern and potential routes for its exploitation for therapeutic purposes. In this review, we discuss the historical, pathophysiological, and clinical implications of the starry sky pattern.
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83
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Clinicopathological, Cytogenetic, and Prognostic Analysis of 131 Myeloid Sarcoma Patients. Am J Surg Pathol 2016; 40:1473-1483. [DOI: 10.1097/pas.0000000000000727] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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84
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Özdemir ZC, Turhan AB, Aras BD, Acu B, Bör Ö. Hepatic myeloid sarcoma preceding acute megakaryoblastic leukemia with t(1;22) in an infant: Case report. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2016. [DOI: 10.1016/j.phoj.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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85
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Koppisetty S, Edelman BL, Rajpurkar A. Myeloid sarcoma of the periprostatic tissue and prostate: Case report and review of literature. Urol Ann 2016; 8:348-54. [PMID: 27453659 PMCID: PMC4944630 DOI: 10.4103/0974-7796.184890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Myeloid sarcoma (MS) is a rare extramedullary tumor composed of immature cells of myeloid lineage that destroy the original tissue architecture in which it is found. It is most commonly identified in patients with acute myelogenous leukemia, and less often in myelodysplastic syndromes (MDSs) and other myeloproliferative disorders. It is most commonly reported in the periosteum, bone, skin, and lymph nodes but has been reported in many other sites of the body. Herein, we describe a case of MS involving the periprostatic tissue and review of literature of MS of the prostate. Our patient was initially diagnosed with MDS and was in remission following successful treatment. Six months later, the patient was diagnosed with prostate adenocarcinoma, and MS of the periprostatic tissue was incidentally discovered in the postprostatectomy pathology specimen. An extensive review of literature from 1997 to 2014 revealed a total of eight cases of MS involving the prostate. Of the eight cases of MS of the prostate, four were primary MS (absence of a history of leukemia) and four were secondary MS. Three received local radiation to the prostate with relief of obstructive symptoms, and one of them had a repeat prostate biopsy negative for leukemic cells. Despite being a rare entity, MS should be considered as a differential diagnosis of soft tissue masses, especially in patients with a history of hematological malignancies.
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Affiliation(s)
- Shalini Koppisetty
- Department of Urology, Michigan United Physicians, Pontiac, Michigan, USA
| | - Brain L Edelman
- Department of Pathology, St. Joseph Mercy Oakland Hospital, Pontiac, Michigan, USA
| | - Atul Rajpurkar
- Department of Urology, Michigan United Physicians, Pontiac, Michigan, USA
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Gossai N, Cafferty R, Weigel B. Chemotherapy Options for Poor Responders to Neoadjuvant Chemotherapy for Orbital Granulocytic Sarcoma. Curr Treat Options Oncol 2016; 17:38. [PMID: 27300546 DOI: 10.1007/s11864-016-0411-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OPINION STATEMENT Granulocytic sarcoma (GS) is a rare manifestation of myeloid proliferation, characterized by formation of a mass comprised of immature cells of myeloid origin. Orbital granulocytic sarcoma is rarer still, with only a small fraction of GS patients having orbital involvement. Given the rarity of orbital GS, no unified therapy plan has been identified, as large prospective trials are not feasible, but it is widely accepted that patients with GS ought to be treated with systemic intensive chemotherapy consistent with standard of care regimens for acute myelogenous leukemia (AML) or chronic myelogenous leukemia (CML). Development of a treatment plan for GS in poor responders involves a systemic leukemia plan as novel therapeutics have not been investigated for treatment GS per se, but used more widely for AML. GS is most commonly associated with AML and thus will be addressed in that context in this review. Patients with GS associated with CML should receive CML-specific therapy. When conventional and traditional cytotoxic GS/AML chemotherapy regimens are insufficient, patients often require a combination of novel therapeutics, stem cell transplantation (SCT), and radiation. Much of the recent advancement in AML therapy, as well as in AML translational research, has been in targeting molecular facets of the disease and enabling more specificity with treatment. The aim of treating patients for whom conventional treatment was unsuccessful with personalized therapy has not yet been realized, but many of the novel therapeutics reviewed below have demonstrated promise and are cause for optimism. In our center, when a GS/AML patient is refractory to frontline therapy, we rely on novel chemotherapy therapeutic options as outlined below.
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Affiliation(s)
- Nathan Gossai
- Division of Pediatric Hematology/Oncology, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, 55455, USA
| | - Rachel Cafferty
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Brenda Weigel
- Division of Pediatric Hematology/Oncology, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, 55455, USA.
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87
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Chambers I, Truong P, Kallail KJ, Palko W. Extensive Bone Marrow Necrosis and Osteolytic Lesions in a Case of Acute Myeloid Leukemia Transformed from Polycythemia Vera. Cureus 2016; 8:e639. [PMID: 27433418 PMCID: PMC4945328 DOI: 10.7759/cureus.639] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/13/2016] [Indexed: 11/22/2022] Open
Abstract
Acute myeloid leukemia (AML) is the most common leukemia in adults. In rare cases, bone marrow necrosis (BMN) and osteolytic lesions are presenting features of AML. The following case describes a patient with known polycythemia vera (PV) that presented with signs of multiple myeloma, including hypercalcemia, anemia, and lytic lesions of the thoracic spine and skull. Laboratory workup was not indicative of myeloma. A bone marrow biopsy was performed, which revealed extensive BMN and initial pathology was consistent with metastatic carcinoma. However, no immunohistochemical stains could be performed due to the extent of BMN; a repeat biopsy was therefore performed. Flow cytometry and CD45 staining were consistent with PV that had transformed to AML. Due to the patient's comorbidities, she was a poor candidate for stem cell transplant and did not wish to pursue chemotherapy. Ultimately, she pursued hospice care. Based on our literature review, both BMN and osteolytic lesions are rare manifestations of AML and have not been reported to occur simultaneously. These findings can lead to a diagnostic dilemma and suspicion of other malignancies. This case demonstrates that AML should remain in the differential diagnosis in those patients who present with BMN and osteolytic lesions.
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Affiliation(s)
- Isaac Chambers
- Internal Medicine, University of Kansas School of Medicine-Wichita
| | - Phu Truong
- Wesley Medical Center, University of Kansas School of Medicine-Wichita
| | - K James Kallail
- Internal Medicine, University of Kansas School of Medicine-Wichita
| | - William Palko
- Wesley Medical Center, University of Kansas School of Medicine-Wichita
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88
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Abu-Zeinah GF, Weisman P, Ganesh K, Katz SS, Dogan A, Abou-Alfa GK, Stein EM, Jarnagin W, Mauro MJ, Harding JJ. Acute myeloid leukemia masquerading as hepatocellular carcinoma. J Gastrointest Oncol 2016; 7:E31-5. [PMID: 27284485 DOI: 10.21037/jgo.2015.12.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is often diagnosed on the basis of high quality imaging without a biopsy in the cirrhotic liver. This is a case of a 64-year-old Caucasian man with no history of liver disease or cirrhosis that presented with fatigue, weight loss, and abdominal distension and was found to have a large, isolated liver mass with arterial enhancement and portal venous washout on triple-phase computed tomography (CT) suspicious for HCC. The patient was initially referred for a surgical evaluation. Meanwhile, he developed fevers, pancytopenia, and worsening back pain, and a subsequent spinal MRI revealed a heterogeneous bone marrow signal suspicious for metastatic disease. A bone marrow biopsy that followed was diffusely necrotic. A core biopsy of the patient's liver mass was then performed and was diagnostic of acute monocytic-monoblastic leukemia. Findings from peripheral flow cytometry and a repeat bone marrow biopsy were also consistent with this diagnosis, and induction chemotherapy with cytarabine and idarubicin was initiated. This case describes a rare presentation of myeloid sarcoma (MS) as an isolated, hypervascular liver mass that mimics HCC in its radiographic appearance. Due to the broad differential for a liver mass, a confirmatory biopsy should routinely be considered prior to surgical intervention.
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Affiliation(s)
- Ghaith F Abu-Zeinah
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Paul Weisman
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Karuna Ganesh
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Seth S Katz
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Ahmet Dogan
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Ghassan K Abou-Alfa
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Eytan M Stein
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - William Jarnagin
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Michael J Mauro
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - James J Harding
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
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89
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Chen Z, Wang W, Cortes JE, Liu E, Miranda RN, Zhao C, Yuan J, Lu X, Yang W, Ameri MD, Kantarjian HM, Medeiros LJ, Hu S. Differential clinical and prognostic impact of myeloid sarcoma vs medullary myeloid blast phase of chronic myelogenous leukemia in the era of tyrosine kinase inhibitor therapy. Blood Cancer J 2016; 6:e418. [PMID: 27152845 PMCID: PMC4916296 DOI: 10.1038/bcj.2016.27] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Z Chen
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - W Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J E Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E Liu
- Department of Pathology, Institute of Hematology & Blood Diseases Hospital, Tianjin, China
| | - R N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Zhao
- Department of Pathology, University of Iowa, Iowa City, IA, USA
| | - J Yuan
- Department of Pathology, University of Nebraska, Omaha, NE, USA
| | - X Lu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - W Yang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M D Ameri
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - H M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L J Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Hu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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90
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Solh M, Solomon S, Morris L, Holland K, Bashey A. Extramedullary acute myelogenous leukemia. Blood Rev 2016; 30:333-9. [PMID: 27094614 DOI: 10.1016/j.blre.2016.04.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/28/2016] [Accepted: 04/01/2016] [Indexed: 12/26/2022]
Abstract
Extramedullary leukemia (EM AML), also known as myeloid sarcoma, is a rare manifestation of acute myelogenous leukemia and often accompanies bone marrow involvement. EM AML is diagnosed based on H&E stains with ancillary studies including flow cytometry and cytogenetics. Isolated EM AML is often misdiagnosed as large cell lymphoma or other lymphoproliferative disorder. The clinical presentation is often dictated by the mass effect and the location of the tumor. The optimal treatment remains unclear. High-dose chemotherapy, radiation, surgical resection, and allogeneic stem cell transplantation are all modalities that can be incorporated into the therapy of EM AML. Cytarabine-based remission induction regimens have been the most commonly used in the upfront setting. There are limited data about the optimal consolidation. Transplantation is ideally offered for high risk disease or in the relapsed setting. In this manuscript, we will review the recent literature about EM AML, focusing on therapy and proposing a treatment algorithm for managing this rare form of leukemia. Further studies addressing risk stratification, role of molecular and genetic aberrations, and optimal treatment strategies are warranted.
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Affiliation(s)
- Melhem Solh
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA.
| | - Scott Solomon
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Lawrence Morris
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Kent Holland
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Asad Bashey
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
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91
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Myeloid Cell Nuclear Differentiation Antigen (MNDA) Expression Distinguishes Extramedullary Presentations of Myeloid Leukemia From Blastic Plasmacytoid Dendritic Cell Neoplasm. Am J Surg Pathol 2016; 40:502-9. [DOI: 10.1097/pas.0000000000000595] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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92
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Norsworthy KJ, Bhatnagar B, Singh ZN, Gojo I. Myeloid Sarcoma of the Hepatobiliary System: A Case Series and Review of the Literature. Acta Haematol 2016; 135:241-51. [PMID: 27007946 DOI: 10.1159/000444516] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/08/2016] [Indexed: 12/26/2022]
Abstract
Myeloid sarcoma (MS) is a rare extramedullary presentation of myeloid malignancies, most commonly seen in association with acute myeloid leukemia (AML). Although MS can develop in any organ, the involvement of the hepatobiliary system is rare. With clinical manifestations of jaundice, abdominal pain and other gastrointestinal symptoms, MS presenting at this location can be a challenge to diagnose, particularly in patients with no known history of hematologic malignancy. This may cause delay in proper management. Here we report 3 cases from a single institution and a review of the literature concerning the epidemiology, clinical presentation, treatment and outcomes in patients with MS of the liver, biliary tree and pancreas.
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Affiliation(s)
- Kelly J Norsworthy
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md., USA
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93
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Tan SN, Gendeh HS, Sani A, Mat-Baki M. Myeloid sarcoma: An unusual and rare laryngeal presentation. Int J Surg Case Rep 2016; 21:99-103. [PMID: 26957189 PMCID: PMC4802227 DOI: 10.1016/j.ijscr.2016.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/06/2016] [Accepted: 02/07/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Myeloid Sarcoma (MS) or Granulocytic Sarcoma is an uncommon laryngeal malignancy. It may arise from myelodysplastic syndromes, malignancy or de novo. Presentation in the larynx is rare and some may present with Acute Myeloid Leukaemia (AML) whereby the later may be asymptomatic. CASE PRESENTATION A 44-year-old South East Asian lady presented with a six months history of hoarseness, shortness of breath, reduced exercise tolerance, weight loss and laryngeal irritation. Symptoms progressed to coughing with liquids two months prior. On examination, she had a resting biphasic stridor and laryngoscopy revealed right immobile vocal cord with a firm right ventricle mass extending into the right paraglottic space. She was pale and haematology investigations revealed microcytic hypochromic anaemia. Magnetic Resonance Imaging (MRI) of the neck and thorax showed thickening of the right false cord, true cord and aryepiglottic fold. A biopsy taken during endolaryngeal microsurgery (ELMS) confirmed myeloid sarcoma of the right ventricle and para glottic mass. Further investigation revealed a background of AML and she then underwent chemotherapy. DISCUSSION MS is a rarity with only nine reported cases between the years of 1954 until 2015. Immunohistochemistry and immunophenotyping are definite for diagnosis confirmation as MS cells often exhibit myeloperoxidase (MPO), lymphocyte common antigen (LCA) and CD117 markers. MS is treated with are chemotherapy (either systemic or intrathecal), radiotherapy, surgical excision or in combination. Systemic chemotherapy has better efficacy and prognosis as compared to localised treatment of radiotherapy or surgical excision. However, there has yet to be a definitive chemotherapy protocol. Prognosis is poor with a 5-year survival rate of 48%. CONCLUSION Although laryngeal MS is a rare phenomenon, early recognition is key and patients should always be investigated for an underlying myeloproliferative or dysplastic disease.
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Affiliation(s)
- S N Tan
- Department of Otorhinolarygology-Head & Neck Surgery, School of Medicine, KPJ Healthcare University College, Malaysia
| | - H S Gendeh
- Department of Otorhinolarygology-Head & Neck Surgery, University Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia
| | - A Sani
- Department of Otorhinolarygology-Head & Neck Surgery, University Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia
| | - M Mat-Baki
- Department of Otorhinolarygology-Head & Neck Surgery, University Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia.
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94
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[Radiotherapy of chloroma or granulocytic sarcoma: A literature review]. Cancer Radiother 2016; 20:60-5. [PMID: 26775223 DOI: 10.1016/j.canrad.2015.05.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/17/2015] [Accepted: 05/22/2015] [Indexed: 02/08/2023]
Abstract
Granulocytic sarcoma, or chloroma, is a rare clinical entity, usually associated with a blood disease, including acute myeloid leukemia. Management strategies are based on the combination of systemic therapy and local therapy (surgery or radiation). Data for radiotherapy dose are derived from retrospective studies and case reports. We conducted a literature review using the Pubmed search engine to clarify the terms and indications for radiotherapy of chloromas.
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95
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Sandrasegaran K, Menias CO, Verma S, Abdelbaki A, Shaaban A, Elsayes KM. Imaging features of haematological malignancies of kidneys. Clin Radiol 2015; 71:195-202. [PMID: 26688550 DOI: 10.1016/j.crad.2015.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/02/2015] [Accepted: 11/10/2015] [Indexed: 11/26/2022]
Abstract
Haematological malignancies are relatively uncommon neoplasms of kidneys. Nevertheless, the incidence of these neoplasms is increasing, partly due to more widespread use of computed tomography and magnetic resonance imaging. This article discusses the clinical and imaging features of renal lymphoma, leukaemia, extra-osseous multiple myeloma, and post-transplant lymphoproliferative disorder. Although there is overlap of imaging features with other more common malignancies, such as transitional and renal cell cancers, the combination of imaging findings and the appropriate clinical picture should allow the radiologist to raise a provisional diagnosis of a haematological neoplasm. This has management implications including the preference for image-guided core biopsies and a shift towards medical rather than surgical therapy.
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Affiliation(s)
- K Sandrasegaran
- Department of Diagnostic Radiology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - C O Menias
- Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, AZ, USA
| | - S Verma
- Department of Diagnostic Radiology, University of Cincinnati, Cincinnati, OH, USA
| | - A Abdelbaki
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Shaaban
- Department of Diagnostic Radiology, University of Utah, Salt Lake City, UT, USA
| | - K M Elsayes
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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96
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Yu Y, Qin X, Yan S, Wang W, Sun Y, Zhang M. Non-leukemic myeloid sarcoma involving the vulva, vagina, and cervix: a case report and literature review. Onco Targets Ther 2015; 8:3707-13. [PMID: 26677338 PMCID: PMC4677758 DOI: 10.2147/ott.s92815] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Myeloid sarcoma (MS) is defined as a tumor mass consisting of myeloid blast with or without maturation occurring at an anatomical site other than bone marrow with normal architectural effacement. It can also precede the onset of leukemia which is called non-leukemic MS. Non-leukemic MS is a kind of rare disease and easy to be misdiagnosed as other common malignancies due to the rarity and nonspecific manifestation. We herein report an unusual case of non-leukemic MS involving the vulva, vagina, and cervix in a female patient. The bone marrow aspiration and biopsy of the patient revealed no hematological abnormality. Immunohistochemical staining of the biopsies was strongly positive for myeloperoxidase, CD68, leukocyte common antigen (LCA), CD117, CD34, CD38, CD79a, and negative for cytokeratin (CK), epithelial memberane antigen (EMA), CD2, CD3, CD20, CD5, CD138. Then a diagnosis of non-leukemic MS was made. Unfortunately, our patient received only one cycle of chemotherapy consisting of cytosine arabinoside and daunorubicin, then refused any further treatment and died 4 months after diagnosis. Although systemic chemotherapy is widely accepted to be a promising strategy, its benefit still needs to be further assessed. Certain questions still need to be answered for this disease: 1) Why can approximately 20% of the patients with non-leukemic MS remain disease-free after local therapy alone? 2) How many cycles of chemotherapy are needed for these patients after achievement of complete remission? 3) What are the prognostic or risk factors in these patients who have no abnormality of karyotype, fusion genes, or gene mutation to predict responsiveness to chemotherapy and outcome? 4) What is the risk factor for relapse? The rarity of non-leukemic MS makes it almost impossible to conduct large-scale randomized trials, but judicious study for each patient with MS is helpful for a further understanding of the nature of the disease.
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Affiliation(s)
- Yuan Yu
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, People's Republic of China
| | - Xuemei Qin
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, People's Republic of China
| | - Shuxin Yan
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, People's Republic of China
| | - Wenxia Wang
- Department of Gynecology, Qilu Hospital, Shandong University, Jinan, People's Republic of China
| | - Yanlin Sun
- Department of Pathology, Qilu Hospital, Shandong University, Jinan, People's Republic of China
| | - Maohong Zhang
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, People's Republic of China
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97
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Huang XE, Li YJ, Zhou XD. Granulocytic sarcoma of the breast: A case report. Oncol Lett 2015; 10:2447-2449. [PMID: 26622868 DOI: 10.3892/ol.2015.3532] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 06/23/2015] [Indexed: 02/06/2023] Open
Abstract
Granulocytic sarcoma (GS) is an unusual type of tumor composed of immature cells outside the bone marrow. The disease exhibits a correlation with acute myeloid leukemia and other myeloproliferative disorders. Although it can invade a number of areas of the body, the involvement of the breast is uncommon. The present study reports the case of a 58-year-old female with a mildly tender lump in the left breast that had been apparent for one year. Available diagnostic techniques, including ultrasound, magnetic resonance imaging and mammography, were systematically used to determine a diagnosis of GS, and lumpectomy and systemic chemotherapy were performed. The patient was satisfied with the result of no local recurrence at the one year follow-up examination. The present study discusses the clinical and pathological characteristics of the present case of GC.
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Affiliation(s)
- Xiao-E Huang
- Department of Surgical Oncology, Yuyao People's Hospital of Zhejiang, Yuyao, Zhejiang 315400, P.R. China
| | - Yu-Jie Li
- Department of Surgical Oncology, Yuyao People's Hospital of Zhejiang, Yuyao, Zhejiang 315400, P.R. China
| | - Xiao-Dong Zhou
- Department of Surgical Oncology, Yuyao People's Hospital of Zhejiang, Yuyao, Zhejiang 315400, P.R. China
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98
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Sandrasegaran K, Tomasian A, Elsayes KM, Nageswaran H, Shaaban A, Shanbhogue A, Menias CO. Hematologic malignancies of the pancreas. ACTA ACUST UNITED AC 2015; 40:411-23. [PMID: 25120155 DOI: 10.1007/s00261-014-0217-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hematologic malignancies are relatively uncommon neoplasms of abdominal soft tissue. This article discusses the clinical and imaging features of pancreatic lymphoma, pancreatic extraosseous multiple myeloma, granulocytic sarcoma (chloroma), posttransplant lymphoproliferative disorder, and Castleman disease. The combination of imaging findings and the appropriate clinical presentation should allow the radiologist to raise a provisional diagnosis of hematologic malignancy.
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Affiliation(s)
- Kumar Sandrasegaran
- Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN, 46202, USA,
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99
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Tan YB. Myeloid Sarcoma Masquerading as Granulation Tissue: A Diagnostic Pitfall. Int J Surg Pathol 2015; 23:553-6. [PMID: 26063639 DOI: 10.1177/1066896915588931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Myeloid sarcoma is an uncommon neoplasm, comprising an extramedullary tumorous proliferation of immature myeloid cells. Its rarity and tendency for diverse clinical presentation contribute to difficulty in timely diagnosis. This report describes a case of a painful back lump in an elderly Chinese male, which was initially diagnosed as a carbuncle. Histology on the saucerization specimen was reported as inflamed granulation tissue. Failure of expected wound healing prompted surgical debridement; microscopic examination on the subsequent specimen revealed an immature myeloid population with an increased MIB-1 proliferative index, highlighted by myeloperoxidase, lysozyme, CD117, and CD43 immunoreactivity, in keeping with myeloid sarcoma. Despite aggressive management, the patient eventually died. This report draws attention to potential pitfalls in the pathological diagnosis of this uncommon tumor and briefly summarizes its salient features.
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100
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Hagen PA, Singh C, Hart M, Blaes AH. Differential Diagnosis of Isolated Myeloid Sarcoma: A Case Report and Review of the Literature. Hematol Rep 2015; 7:5709. [PMID: 26330997 PMCID: PMC4508548 DOI: 10.4081/hr.2015.5709] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/09/2015] [Accepted: 04/16/2015] [Indexed: 12/31/2022] Open
Abstract
Myeloid sarcoma (MS) is a rare disease entity identified as a variety of manifestations defined by the occurrence of extramedullary myeloid cell masses with or without bone marrow involvement. This case describes an unusual presentation of isolated MS in a 60-year-old otherwise healthy male, who initially presented to his primary care physician with vague abdominal pain. After extensive workup including three omental biopsies, umbilical core biopsy, and inguinal lymph node biopsy, he was ultimately diagnosed with isolated MS with extensive extramedullary tumor burden. Despite advanced extramedullary disease, peripheral cell counts were normal and bilateral bone marrow biopsies unremarkable with normal cellular lineages, morphology, and cytogenetics. The patient underwent induction chemotherapy and is now greater than 100 days post myeloablative unrelated donor marrow transplantation with no evidence of disease recurrence and 100% donor status with full chimerism. This case demonstrates that making a prompt diagnosis with rapid initiation of treatment in myeloid sarcoma can be challenging due to its varied clinical presentation, cytomorphology, cytochemistry, and cytogenetic overlap with other lymphoid malignancies. Once a diagnosis of MS has been made, moving quickly to induction therapy is important. Several studies have shown that improved overall survival is attained when MS is treated as acute myeloid leukemia and increased survival is noted for patients undergoing bone marrow transplantation. Further prospective studies are needed to elucidate the many remaining questions in regards to the natural history, prognosis, and optimal treatment strategies for this deadly disease.
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Affiliation(s)
- Patrick A Hagen
- Division of Hematology/Oncology/Transplantation, Department of Medicine , MN, USA
| | | | - Melissa Hart
- Division of Pathology, University of Minneapolis , MN, USA
| | - Anne H Blaes
- Division of Hematology/Oncology/Transplantation, Department of Medicine , MN, USA
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