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Gallardo MS, Joyrich R, Taub JW. Pediatric acute myeloid leukemia with breast chloromas. EJHAEM 2023; 4:488-490. [PMID: 37206254 PMCID: PMC10188463 DOI: 10.1002/jha2.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 05/21/2023]
Affiliation(s)
- Maria S Gallardo
- Division of Pediatric Hematology/Oncology Children's Hospital of Michigan Detroit Michigan USA
| | - Richard Joyrich
- Department of Hematology-Oncology Karmanos Cancer Institute, Wayne State University Detroit Michigan USA
| | - Jeffrey W Taub
- Division of Pediatric Hematology/Oncology Children's Hospital of Michigan Detroit Michigan USA
- Discipline of Pediatrics Central Michigan University College of Medicine Detroit Michigan USA
- Department of Pediatrics Wayne State University School of Medicine Detroit Michigan USA
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2
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Jindal A, Kapatia G, Kaur M, Khera U, Shergill JS. Myeloid sarcoma: "A cytological surprise". Diagn Cytopathol 2022; 50:538-539. [PMID: 35960136 DOI: 10.1002/dc.25034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/26/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Akriti Jindal
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Bathinda, India
| | - Gargi Kapatia
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Bathinda, India
| | - Manjit Kaur
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Bathinda, India
| | - Utkarshni Khera
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Bathinda, India
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3
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Nicosia L, Latronico A, Farina M, Bozzini AC, Baratella P, Galimberti VE, Fiori S, Montesano M, Cassano E. Myeloid sarcoma of the breast: a pathology that should not be forgotten. Ecancermedicalscience 2020; 14:1160. [PMID: 33574905 PMCID: PMC7864689 DOI: 10.3332/ecancer.2020.1160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Indexed: 11/24/2022] Open
Abstract
Myeloid sarcoma (MS) is a rare neoplasm, represented by a tumoural mass composed of myeloid blasts, occurring at any anatomical site other than the bone marrow. MS is considered the tissue-based equivalent of acute myeloid leukaemia (AML), requiring the same therapeutic specification, independently from the association with previous or coexisting myeloid neoplasms. Isolated breast involvement by MS is exceedingly rare, with only exceptional cases reported in the literature. This work aims to provide a pictorial essay of the main features of breast involvement by MS. Even though it is a rare condition, we should not forget this neoplasm, and its possibility of being disguised by the AML, as it requires prompt treatment.
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Affiliation(s)
- Luca Nicosia
- Department of Breast Radiology, European Institute of Oncology, 20141 Milan, Italy
| | - Antuono Latronico
- Department of Breast Radiology, European Institute of Oncology, 20141 Milan, Italy
| | - Mariagiorgia Farina
- Department of Breast Radiology, European Institute of Oncology, 20141 Milan, Italy
| | - Anna Carla Bozzini
- Department of Breast Radiology, European Institute of Oncology, 20141 Milan, Italy
| | - Paola Baratella
- Division of Breast Surgery, IEO, European Institute of Oncology, 20141 Milan, Italy
| | | | - Stefano Fiori
- Division of Pathology and Laboratory Medicine, IEO, European Institute of Oncology, 20141 Milan, Italy
| | - Marta Montesano
- Department of Radiological Sciences, Oncology and Pathology, I.C.O.T. Hospital, 'Sapienza' University of Rome, 04100 Latina, Italy
| | - Enrico Cassano
- Department of Breast Radiology, European Institute of Oncology, 20141 Milan, Italy
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4
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Bakst R, Powers A, Yahalom J. Diagnostic and Therapeutic Considerations for Extramedullary Leukemia. Curr Oncol Rep 2020; 22:75. [PMID: 32577912 DOI: 10.1007/s11912-020-00919-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the current literature on the presentation, diagnosis, and treatment options available for extramedullary (EM) manifestations of leukemia including myeloid sarcoma (MS) and leukemia cutis (LC). RECENT FINDINGS Advanced imaging using 18FDG-PET/CT is an effective screening tool for EM manifestations of leukemia. The role of radiation therapy has been more clearly delineated in the treatment of both MS and LC. FDA-approved targeted agents have improved outcomes in patients with AML but have not demonstrated improvements specifically for EM; however, a checkpoint inhibitor, Ipilimumab, holds promise in impacting local control for the treatment of AML-related EM. EM manifestations of leukemia pose significant therapeutic challenges. Treatment of EM is predicated on multiple factors including the presence of concomitant bone marrow involvement, AML-risk classification, and timing of presentation at initial diagnosis or relapse following systemic therapy.
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Affiliation(s)
- Richard Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, New York, NY, 10029, USA.
| | - Ann Powers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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5
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Wu HY, Liu L, Gu L, Luo YH. Clinical characteristics and management of primary granulocytic sarcoma of the breast: A case report. Medicine (Baltimore) 2019; 98:e16648. [PMID: 31464900 PMCID: PMC6736367 DOI: 10.1097/md.0000000000016648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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 Primary granulocytic sarcoma of the breast is a rare and poor-prognosis malignancy. Clinicians do not have sufficient knowledge of this disease and often misdirect it as other soft tissue sarcomas or inflammation. PATIENT CONCERNS A 42-year-old female presented with a self-discovered asymptomatic growing and palpable right breast mass that had been present for 4 months. DIAGNOSES The patient was diagnosed as primary myeloid sarcoma. INTERVENTIONS The patient received modified radical mastectomy in the right breast and sentinel lymph node biopsy. Pathological diagnosis is primary granulocytic sarcoma. Then the patient accepted acute myeloid leukemia-induction chemotherapy. OUTCOMES The follow-up of this patient has no evidence of disease progression or spread during 1 year. LESSONS Granulocytic sarcoma in the breast tissue is rare. But it still should be considered in the differential diagnosis of any tumor in the breast. The present study discusses comprehensively the clinical and pathological characteristics to improve the understanding of myeloid sarcoma.
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6
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Kim SJ, Kim WG. Sonographic Features of a Myeloid Sarcoma of the Breast as a Relapse of Acute Myeloid Leukemia After Stem-Cell Transplantation: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:612-619. [PMID: 31030205 PMCID: PMC6501734 DOI: 10.12659/ajcr.915453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patient: Female, 24 Final Diagnosis: Myeloid sarcoma of the breast Symptoms: Breast lump Medication: — Clinical Procedure: Core needle biopsy Specialty: Radiology
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Affiliation(s)
- Suk Jung Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Woo Gyeong Kim
- Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
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7
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Multiple Granulocytic Sarcomas: A Rare Presentation of Acute Myeloid Leukemia. Indian J Hematol Blood Transfus 2018; 35:186-188. [PMID: 30828173 DOI: 10.1007/s12288-018-1033-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 10/16/2018] [Indexed: 12/28/2022] Open
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8
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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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9
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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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10
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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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11
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Abstract
Myeloid sarcoma is a rare, solid extramedullary tumor originating from immature granulocytic cells or monocytes. Breast involvement without an aleukemic or myeloproliferative disorder is very infrequent. A 21-year-old female patient was admitted with bilateral palpable breast masses for four months. The patient had given birth approximately one year ago. The ultrasonographic examination revealed multiple, oval shaped—some of them with microlubulated margins—hypoechoic, solid masses of which, the largest mass measured 4.5 × 2.5 cm, evaluated as BI-RADS 4. The histopthological examination suggested hematolymphoid neoplasm. In the differential diagnosis of solid breast lesions, myeloid sarcoma should be kept in mind even without hematological findings. Early diagnosis of this tumor is important for the effectiveness of the medical treatment.
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12
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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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13
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Vachhani P, Bose P. Isolated gastric myeloid sarcoma: a case report and review of the literature. Case Rep Hematol 2014; 2014:541807. [PMID: 25105036 PMCID: PMC4106093 DOI: 10.1155/2014/541807] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/23/2014] [Indexed: 01/23/2023] Open
Abstract
Myeloid sarcoma represents the proliferation of myeloblasts of acute myeloid leukemia (AML) at extramedullary sites. While extramedullary involvement in AML is uncommon in itself, isolated myeloid sarcomas, that is, myeloid sarcomas without any bone marrow involvement, are extremely rare and pose a diagnostic and therapeutic challenge. Here, we present the case of a middle-aged woman with isolated myeloid sarcoma in the stomach-an organ seldom involved by this disease. Additionally, the literature on the epidemiology, diagnosis, pathology, prognosis, and therapeutic options in myeloid sarcomas has been reviewed.
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Affiliation(s)
- Pankit Vachhani
- Department of Internal Medicine, Virginia Commonwealth University (VCU), P.O. Box 980663, 1001 E Broad Street, Old City Hall, Suite 405, Richmond, VA 23298, USA
| | - Prithviraj Bose
- Department of Internal Medicine, Virginia Commonwealth University (VCU), P.O. Box 980663, 1001 E Broad Street, Old City Hall, Suite 405, Richmond, VA 23298, USA
- Massey Cancer Center, Virginia Commonwealth University (VCU), P.O. Box 980070, 1201 E Marshall Street, MMEC 11-213, Richmond, VA 23298, USA
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14
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Vishnu P, Chuda RR, Hwang DG, Aboulafia DM. Isolated granulocytic sarcoma of the nasopharynx: a case report and review of the literature. Int Med Case Rep J 2013; 7:1-6. [PMID: 24368892 PMCID: PMC3869915 DOI: 10.2147/imcrj.s53612] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Granulocytic sarcoma (GS) is a rare extramedullary manifestation of acute myeloid leukemia (AML). It may also represent blastic transformation of myelodysplastic syndromes or myeloproliferative neoplasms. Although usually seen in the context of advanced and poorly controlled disease, it may also present as the first manifestation of illness, without concurrent bone marrow or blood involvement. In the medical literature, chloroma and GS are terms that have been used interchangeably with myeloid sarcoma. GS usually manifests as soft tissue or bony masses in several extracranial sites, such as bone, periosteum, and lymph nodes; involvement of the head and neck region is uncommon. We report a case of a woman with insidious onset of progressive nasal congestion and diminished hearing who was diagnosed with an isolated GS of the nasopharynx. With involved field radiotherapy, she achieved a complete remission of 12-months duration before being diagnosed with overt AML. She has remained disease-free for greater than 18 months following induction and consolidation chemotherapy. Through a MEDLINE®/PubMed® search we identified an additional 13 cases of nasopharyngeal GS. The median age was 37 years (range 1 to 81 years). The cases were equally distributed among the sexes. The most common presenting symptoms were conductive hearing loss and sinonasal congestion. Isolated GS was identified in six cases, and the median time from diagnosis of GS to AML was 12 months (range 3 to 48 months). The treatment varied, but responses were seen in all the patients who received chemotherapy with or without radiotherapy.
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Affiliation(s)
- Prakash Vishnu
- Floyd and Delores Jones Cancer Institute at Virginia Mason Medical Center, Seattle, WA, USA
| | - Ravindra Reddy Chuda
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Dick G Hwang
- Department of Pathology, Virginia Mason Medical Center, Seattle, WA, USA
| | - David M Aboulafia
- Floyd and Delores Jones Cancer Institute at Virginia Mason Medical Center, Seattle, WA, USA ; Division of Hematology, University of Washington, Seattle, WA, USA
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15
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Kim SJ, Hong WS, Jun SH, Jeong SH, Kang SY, Kim TH, Kang DK, Yim HE, Jung YS, Kim KS. Granulocytic sarcoma in breast after bone marrow transplantation. J Breast Cancer 2013; 16:112-6. [PMID: 23593091 PMCID: PMC3625757 DOI: 10.4048/jbc.2013.16.1.112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 11/02/2012] [Indexed: 12/22/2022] Open
Abstract
Granulocytic sarcoma is a localized extramedullary solid tumor composed of immature myeloid cell and is usually associated with acute myeloid leukemia or myelodysplastic syndrome. Although it can involve any site, commonly in lymph nodes, skin, bone and soft tissue, the involvement of breast is unusual. Especially, the involvement of the breast as a pattern of relapse after bone marrow transplantation is extremely rare. We have experienced 2 cases of granulocytic sarcoma after bone marrow transplantation. One case was a 39-year-old woman with right breast mass diagnosed with granulocytic sarcoma. She had received an unrelated bone marrow transplantation due to biphenotype acute leukemia 3 years before our presentation. Another case was a 48-year-old woman with acute myeloid leukemia, who was diagnosed with granulocytic sarcoma on both breasts 8 months after allogenic bone marrow transplantation. We also discuss the clinicopathologic features of granulocytic sarcoma in breast after bone marrow transplantation.
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Affiliation(s)
- Seung Jin Kim
- Special Study Module for Breast, Ajou University School of Medicine, Suwon, Korea
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16
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Granulocytic sarcoma of the male breast in acute myeloblastic leukemia with concurrent deletion of 5q and trisomy 8. Case Rep Hematol 2012; 2012:194312. [PMID: 22937319 PMCID: PMC3420427 DOI: 10.1155/2012/194312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 06/22/2012] [Indexed: 11/23/2022] Open
Abstract
We describe a unique case of Granulocytic Sarcoma (GS) in a male, who presented to us with a painless right breast mass without any prior history of Leukemia. GS is an extramedullary tumor of myeloproliferative precursors and may involve multiple sites of the body, but involvement of male breast is extremely rare. In the absence of clinical history or hematological abnormality, GS may be misdiagnosed, depending on the degree of myeloid differentiation present within the tumor. Often it is misdiagnosed as lymphoma. Diagnosis is made by finding eosinophilic myelocytes, myeloperoxidase, chloroacetate esterase staining, and lysozyme immunostain. Chemotherapy regimens similar to acute myeloid leukemia are recommended to treat GS. Recognition of this rare entity is important because early, aggressive chemotherapy can induce regression of the tumor and improve patient longevity.
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Toumeh A, Phinney R, Kobalka P, Mohamed I. Bilateral myeloid sarcoma of the breast and cerebrospinal fluid as a relapse of acute myeloid leukemia after stem-cell transplantation: a case report. J Clin Oncol 2012; 30:e199-201. [PMID: 22734027 DOI: 10.1200/jco.2011.40.2255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anis Toumeh
- Department of Medicine, Division of Medical Oncology, University of Toledo Medical Center, 3000 Arlington Ave, Toledo, OH 43614, USA.
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Abstract
BACKGROUND Breast leukemia is extremely rare. The published data on this manifestation include predominantly case reports and do not provide any statistical information. PURPOSE To identify clinical signs and radiological features of breast leukemia. MATERIAL AND METHODS PubMed and Medline databases between 1980 and 2010 were screened using 'breast leukemia' and 'leukemia of the breast' as keywords. Secondary references were also reviewed. By this search, a total of 139 patients were identified from the literature. RESULTS In most patients (n = 85, 61.2%) acute myeloid leukemia was diagnosed. Acute lymphatic leukemia occurred in 35 patients (25.2%). Isolated BL before bone marrow infiltration was seen in 24 patients (17.3%). Involvement of the breast during the course of leukemia was diagnosed in 25 cases (18%). Intramammary leukemic relapse after therapy/stem cell transplantation occurred in 59 patients (42.4%). In 71 cases (51.1%) the lesions were solitary and in 57 (41%) multiple. The number of lesions was not reported in 11 patients (7.9%). There was no significant difference between the number of lesions in ML and LL. Clinically, 73% of the patients presented with palpable breast masses. Most of them were painless. Mammography was performed in 39 patients, allowing the identification of the following three mammographic patterns: breast masses (28 patients, 72%), architectural distortion (5 patients, 13%), no abnormalities (6 patients, 15%). On ultrasound, most identified masses were homogeneously hypoechoic with microlobulated or indistinct margins. On MRI, on T2-weighted images breast lesions were hyperintense. After venous administration of contrast medium, BL showed marked inhomogeneous contrast enhancement. Treatment of BL is the same as for other localizations and is based on chemotherapy and/or radiotherapy. CONCLUSION In the present study the clinical and radiological features of BL are described. They are non-specific. However, BL should be considered in the differential diagnosis of breast disorders, especially in patients with leukemia.
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Affiliation(s)
| | - Andreas Wienke
- Department of Medical Epidemiology, Biometry and Informatics, Martin-Luther-University of Halle-Wittenberg, Halle, Germany
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Abstract
Extramedullary (EM) manifestations of acute leukemia include a wide variety of clinically significant phenomena that often pose therapeutic dilemmas. Myeloid sarcoma (MS) and leukemia cutis (LC) represent 2 well-known EM manifestations with a range of clinical presentations. MS (also known as granulocytic sarcoma or chloroma) is a rare EM tumor of immature myeloid cells. LC specifically refers to the infiltration of the epidermis, dermis, or subcutis by neoplastic leukocytes (leukemia cells), resulting in clinically identifiable cutaneous lesions. The molecular mechanisms underlying EM involvement are not well defined, but recent immunophenotyping, cytogenetic, and molecular analysis are beginning to provide some understanding. Certain cytogenetic abnormalities are associated with increased risk of EM involvement, potentially through altering tissue-homing pathways. The prognostic significance of EM involvement is not fully understood. Therefore, it has been difficult to define the optimal treatment of patients with MS or LC. The timing of EM development at presentation versus relapse, involvement of the marrow, and AML risk classification help to determine our approach to treatment of EM disease.
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20
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Ginat DT, Puri S. FDG PET/CT manifestations of hematopoietic malignancies of the breast. Acad Radiol 2010; 17:1026-30. [PMID: 20547460 DOI: 10.1016/j.acra.2010.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 03/28/2010] [Accepted: 03/29/2010] [Indexed: 10/19/2022]
Abstract
Hematopoietic malignancies that can be encountered in the breast include lymphoma, leukemia, and multiple myeloma/plasmacytoma. These are readily imaged via [18]F-fluorodeoxyglucose position emission tomography (PET)/computed tomography (CT) and can manifest as unilateral, bilateral, single, multiple, round/oval masses, or diffuse. These malignancies can occasionally mimic primary breast cancers. Conversely, benign conditions, such as the lactating breast can resemble hematopoietic malignancies of the breast. Although uncommon, familiarity with hematopoietic malignancies of the breast is important for proper interpretation of PET/CT. In this pictorial review, the PET/CT imaging features of patients with hematopoietic malignancies of the breast will be described, including pathology-proven cases of acute myelogenous leukemia, diffuse B-cell lymphoma, follicular lymphoma, acute myeloid leukemia with neutropenic granulocytic) sarcoma, and plasmacytoma. In addition, potential pitfalls will be discussed.
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Granulocytic sarcoma of the breast without development of bone marrow involvement: a case report. Diagn Pathol 2009; 4:2. [PMID: 19126209 PMCID: PMC2632612 DOI: 10.1186/1746-1596-4-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 01/06/2009] [Indexed: 11/22/2022] Open
Abstract
A 29-year-old woman presented with a breast tumor with a primary diagnosis of MALT lymphoma. A repeat biopsy revealed a hematological neoplasm with diffuse, Indian file, and targetoid patterns. The cells were intermediate size with eosinophilic granules; the immunophenotyping showed monocytic differentiation, and no lymphoepithelial lesion was observed. The diagnosis was granulocytic sarcoma. Three different bone marrow biopsies were negative for neoplastic infiltration. After treatment, she developed secondary pancytopenia which contributed to her death 16 months after primary diagnosis. Granulocytic sarcoma of the breast is uncommon. A complete panel of immunohistochemistry is necessary to perform this diagnosis.
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Feng X, Ying J, Cameron Yin C, Li L, Shi S, Zhang H, Sun Y. The diagnosis and differential diagnosis of granulocytic sarcoma. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s10330-008-0103-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Abstract
Thirty-two cases of granulocytic sarcoma (GS) are reported in this paper. Age range was from 16 - 70 years. GS was accompanied by AML in 13 cases, ALL (My+) in one case, CML in 11 cases and MDS in two cases. GS was diagnosed simultaneously with leukemia in five cases and preceded the leukemia in eight. Lymph node and soft tissue were the most commonly detected localizations. Seven cases had first been diagnosed as NHL. Histopathologically blastic, immature and mature variants were found in 11, nine and 11 cases respectively and overall survival was shortest in the blastic type. Myeloperoxidase and lysozyme were found to be positive in 30 and 24 cases respectively. Therapy was radiation in five cases and surgery in three. Systemic chemotherapy was given to the cases. The clinical outcome of the patients after the diagnosis of GS was poor. GS is a unique entity; prognosis is poor but it is important to detect the signaling pathways associated with migration of myeloid cells to the extra-medullary tissues. The critical factors for detecting this interesting tumor are to be aware of this disease, cooperation between clinician and pathologist and the application of special stains to detect the myeloid origin.
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Affiliation(s)
- Semra Paydas
- Department of Oncology, Cukurova University Faculty of Medicine, Adana, Turkey.
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24
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Hsueh HC, Chou YH, Tiu CM, Hsu CY, Su CH. Primary Granulocytic Sarcoma Presenting as Bilateral Breast Masses. J Med Ultrasound 2006. [DOI: 10.1016/s0929-6441(09)60085-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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25
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Ewing CA, Miller MJ, Chhieng D, Lin O. Nonepithelial malignancies mimicking primary carcinoma of the breast. Diagn Cytopathol 2005; 31:352-7. [PMID: 15468118 DOI: 10.1002/dc.20147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although primary carcinomas account for the majority of breast malignancies, nonepithelial malignancies form a subset that must be differentiated accurately for treatment purposes. The purpose of this study was to identify cytological characteristics that differentiate between these two entities. Twenty-six fine-needle aspiration (FNA) specimens with histological correlation were reviewed (five lymphomas, two myelomas, six sarcomas, seven melanomas, and six carcinomas). On review, nonepithelial tumors presented as single cells with scant or ill-defined cytoplasm with rare cluster formations present. In contrast, carcinomas were arranged predominantly in clusters and contained more-defined, abundant, and sometimes vacuolated cytoplasm. Moreover, a major aid to diagnosis was an accurate clinical history. We conclude that nonepithelial malignancies of the breast are best differentiated from epithelial malignancies by a combination of cytological features and clinical information. These findings emphasize the importance of the triple test, in which integration of cytological findings and clinical information play a key role.
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Affiliation(s)
- C Alexander Ewing
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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26
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Abstract
Abstract
Context.—Myeloid sarcoma is a neoplasm of myeloid cells that can arise before, concurrent with, or following acute myeloid leukemia. Rarely, it can also occur as an isolated mass.
Objective.—To describe the clinicopathologic features of 6 patients with myeloid sarcoma involving the breast.
Design.—Clinical information for all 6 patients was obtained from the medical record. Routine hematoxylin-eosin–stained slides; naphthol AS-D chloroacetate stain; and immunohistochemical stains for myeloid, B-cell, and T-cell antigens were prepared.
Results.—There were 6 women with a median age of 52 years (range, 31–73 years). Two patients presented with isolated tumors of the breast, with no history or subsequent development of acute myeloid leukemia. In 3 patients, the breast tumors represented relapse of acute myeloid leukemia. One patient who presented initially with myeloid sarcoma involving the breast, skin, and spleen was lost to follow-up. Histologically, these tumors were classified as well differentiated (n = 3), poorly differentiated (n = 2), and blastic (n = 1). Naphthol AS-D chloroacetate esterase was positive in all 3 cases assessed. Immunohistochemistry showed that myeloperoxidase (n = 5) and CD43 (n = 3) were positive, and CD3 (n = 5) and CD20 (n = 5) were negative in all cases assessed. Lysozyme was positive in 4 (80%) of 5; CD117 was positive in 2 (67%) of 3; and single cases were positive for CD45 (1/3), TdT (1/2), CD79a, and the PAX5 gene product.
Conclusions.—Myeloid sarcoma involving the breast is uncommon. In the literature, as in this study, these tumors most often represent relapse or the initial presentation of acute myeloid leukemia. However, 2 of the cases we report presented with isolated masses, without a history or subsequent development of acute myeloid leukemia at last follow-up. Immunohistochemical studies are extremely helpful for recognizing isolated myeloid sarcoma.
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Affiliation(s)
- Jose R Valbuena
- Department of Hematopathology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA
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27
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Hill PA, Ellis DW, Zito RA. An unusual breast tumour occurring six years after a similar tumour in the contralateral breast. Pathology 2004; 36:367-9. [PMID: 15370142 DOI: 10.1080/00313020410001721528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Nappi O, Boscaino A, Wick MR. Extramedullary hematopoietic proliferations, extraosseous plasmacytomas, and ectopic splenic implants (splenosis). Semin Diagn Pathol 2004; 20:338-56. [PMID: 14694984 DOI: 10.1053/j.semdp.2003.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hematopoietic proliferations are well known to present ectopically outside the bone marrow, either in benign or malignant form. As such, they present a distinct problem with respect to morphologic interpretation because of their uncommonality in extramedullary sites and their capacity to simulate other lesions histologically. This review considers extramedullary myeloid tumors ("granulocytic sarcoma," "erythroblastic sarcoma," "megakaryocytic sarcoma"), tumefactive extramedullary hematopoiesis, and the peculiar condition known as "splenosis," with consideration of their clinical, microscopic, and cytohistochemical chararacteristics.
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Affiliation(s)
- Oscar Nappi
- Division of Anatomic Pathology, Histopathology, & Diagnostic Cytopathology, Department of Laboratory Medicine & Pathology, A. Cardarelli Hospital, Naples, Italy
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29
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Dutta Roy S, Stafford JS, Scally J, Selvachandran SN. Granulocytic sarcoma of the breast antedating acute myelogenous leukemia. Breast 2004; 13:242-6. [PMID: 15177430 DOI: 10.1016/j.breast.2003.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We report a rare case of granulocytic sarcoma of the breast presenting as an isolated breast lump antedating bone marrow manifestation of acute myelogenous leukaemia.
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Affiliation(s)
- S Dutta Roy
- Department of Surgery, Leighton Hospital, Crewe, Cheshire CW1 4QJ, UK.
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30
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Raja V, Bryant B, Bessman DJ, Alperin JB. Soft tissue sarcomas. Case 1. Granulocytic sarcoma: presentation with nodal and skin involvement. J Clin Oncol 2004; 22:2026-7. [PMID: 15143096 DOI: 10.1200/jco.2004.06.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vinay Raja
- University of Texas Medical Branch, Galveston, USA
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31
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Chen VMY, McIlroy K, Loui JPY, Fay K, Ward C. Extramedullary presentation of acute leukaemia: a case of myeloid/natural killer cell precursor leukaemia. Pathology 2003; 35:325-9. [PMID: 12959763 DOI: 10.1080/0031302031000150489] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM Myeloid/natural killer (NK) cell leukaemia is characterised by coexpression of myeloid with natural killer cell antigens, a high incidence of extramedullary disease and an aggressive clinical course. METHODS We report a case of a 28-year-old woman with myeloid/NK cell precursor acute leukaemia. Clinical presentation was correlated with leukaemic blast morphology, immunophenotype, cytogenetic analysis, molecular studies for clonal rearrangements and histological review. RESULTS The patient had noted skin lesions and a breast infiltrate 4 months prior to the diagnosis. Bone marrow biopsy at the time of presentation revealed characteristic morphological features with a dense infiltrate of bizarre, pleomorphic blast cells with marked nuclear invagination and reniform shapes. Immunophenotypic analysis of the blasts displayed coexpression of myeloid and natural killer cell antigens with a relatively immature phenotype: CD34-,HLADR+, CD33+, CD56+, CD16-, CD57-, MPO-. Cyto- genetic analysis revealed a complex karyotype: del(6)(q21);-12 and add(19)(p13). Histological review of the previous breast biopsy was consistent with granulocytic sarcoma of the breast with a phenotype corresponding to the circulating blasts (positive cytoplasmic staining for myeloid markers, CD68 and CD31, and the NK cell marker CD56, with negative staining for MPO). Skin biopsy confirmed leukaemia cutis. CONCLUSION Although nodal extramedullary disease is common in the myeloid/NK cell leukaemias, this is the first description of myeloid/NK cell leukemia primarily involving breast and skin. We speculate that CD56 may predispose to extramedullary localisation of tumour.
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Affiliation(s)
- Vivien M Y Chen
- Northern Blood Research Centre, Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, Australia
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