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Zhang X, Wang T, Chen P, Chen Y, Wang Z, Xu T, Yu P, Liu P. Spinal myeloid sarcoma presenting as initial symptom in acute promyelocytic leukemia with a rare cryptic PLZF::RARα fusion gene: a case report and literature review. Front Oncol 2024; 14:1375737. [PMID: 38835381 PMCID: PMC11148225 DOI: 10.3389/fonc.2024.1375737] [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: 01/24/2024] [Accepted: 05/07/2024] [Indexed: 06/06/2024] Open
Abstract
Background Acute promyelocytic leukemia (APL) is rarely caused by the PLZF::RARα fusion gene. While APL patients with PLZF::RARα fusion commonly exhibit diverse hematologic symptoms, the presentation of myeloid sarcoma (MS) as an initial manifestation is infrequent. Case presentation A 61-year-old patient was referred to our hospital with 6-month history of low back pain and difficulty walking. Before this admission, spine magnetic resonance imaging (MRI) conducted at another hospital revealed multiple abnormal signals in the left iliac bone and vertebral bodies spanning the thoracic (T11-T12), lumbar (L1-L4), and sacral (S1/S3) regions. This led to a provisional diagnosis of bone tumors with an unknown cause. On admission, complete blood count (CBC) test and peripheral blood smear revealed a slightly increased counts of monocytes. Immunohistochemical staining of both spinal and bone marrow (BM) biopsy revealed positive expression for CD117, myeloperoxidase (MPO), and lysozyme. BM aspirate showed a significant elevation in the percentage of promyelocytes (21%), which were morphologically characterized by round nuclei and hypergranular cytoplasm. Multiparameter flow cytometry of BM aspirate revealed that blasts were positive for CD13, CD33, CD117, and MPO. Through the integrated application of chromosome analysis, fluorescence in situ hybridization (FISH), reverse transcriptase polymerase chain reaction (RT-PCR), and Sanger sequencing, it was determined that the patient possessed a normal karyotype and a rare cryptic PLZF::RARα fusion gene, confirming the diagnosis of APL. Conclusion In the present study, we report the clinical features and outcome of a rare APL patient characterized by a cryptic PLZF::RARα fusion and spinal myeloid sarcoma (MS) as the initial presenting symptom. Our study not only offers valuable insights into the heterogeneity of APL clinical manifestations but also emphasizes the crucial need to promptly consider the potential link between APL and MS for ensuring a timely diagnosis and personalized treatments.
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Affiliation(s)
- Xuejiao Zhang
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Hematology, Zhongshan Hospital (Minhang Meilong Branch), Fudan University and Shanghai Geriatric Medical Center, Shanghai, China
| | - Tao Wang
- Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group Co. Ltd., Hangzhou, Zhejiang, China
| | - Pu Chen
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yan Chen
- Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group Co. Ltd., Hangzhou, Zhejiang, China
| | - Zhimei Wang
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianhong Xu
- Department of Hematology, Zhongshan Hospital (Minhang Meilong Branch), Fudan University and Shanghai Geriatric Medical Center, Shanghai, China
| | - Pengfei Yu
- Department of Hematology, Zhongshan Hospital (Minhang Meilong Branch), Fudan University and Shanghai Geriatric Medical Center, Shanghai, China
| | - Peng Liu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Hematology, Zhongshan Hospital (Minhang Meilong Branch), Fudan University and Shanghai Geriatric Medical Center, Shanghai, China
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Abstract
The purpose of this article is to describe the imaging appearance, etiology, clinical features, and treatment of rare presentations of common bone and joint diseases known to mimic Hill-Sachs lesions. Knowledge of uncommonly encountered manifestations of ankylosing spondylitis, rheumatoid arthritis, septic joint, hyperparathyroidism, hydroxyapatite deposition disease, malignant bone tumors, and benign bone cysts which mimic traumatic Hill-Sachs lesions is important for radiologists to guide the clinical care of patients who present with shoulder symptoms.
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Affiliation(s)
- Allison Herring
- Department of Diagnostic Radiology and Nuclear Medicine, 21668University of Maryland Medical Center, Baltimore, MD, USA
| | - Derik L Davis
- Department of Diagnostic Radiology and Nuclear Medicine, 21668University of Maryland School of Medicine, Baltimore, MD, USA
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Oravcova I, Mikuskova E, Leitnerova M, Gyarfas J, Mlcakova A, Szepe P, Plank L, Demitrovicova L, Mikudova V, Cingelova S, Mego M, Drgona L. A unique clinical presentation of de novo acute promyelocytic leukemia as a myeloid sarcoma of the breast. Int J Hematol 2018; 108:550-553. [PMID: 29931624 DOI: 10.1007/s12185-018-2479-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/04/2018] [Accepted: 06/14/2018] [Indexed: 11/26/2022]
Abstract
Myeloid sarcoma is a rare presentation of acute leukemia as a solid tumor at various extramedullary sites. It may present concurrently, before or after the onset of systemic bone marrow leukemia. Unusual clinical localization may lead to misdiagnosis, or delayed diagnosis and treatment. We describe the first case, to our knowledge, of de novo myeloid sarcoma of the breast confirmed as acute promyelocytic leukemia. Immunohistochemical analysis, flow cytometry, fluorescent in situ hybridization analysis and molecular analysis using RQ-PCR of tissue samples should be routine in determining the correct diagnosis in this setting.
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MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy
- Bone Marrow/pathology
- Breast Neoplasms/diagnosis
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Diagnosis, Differential
- Female
- Flow Cytometry
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Leukemia, Promyelocytic, Acute/diagnosis
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/metabolism
- Magnetic Resonance Imaging
- Mammography
- Sarcoma, Myeloid/diagnosis
- Sarcoma, Myeloid/genetics
- Sarcoma, Myeloid/metabolism
- Treatment Outcome
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Affiliation(s)
- Iveta Oravcova
- Department of Oncohematology II, National Cancer Institute, Klenová 1, 83310, Bratislava, Slovakia.
- Oncohematology Clinic, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia.
| | - Eva Mikuskova
- Department of Oncohematology II, National Cancer Institute, Klenová 1, 83310, Bratislava, Slovakia
| | - Michaela Leitnerova
- Department of Medical Genetics, National Cancer Institute, Bratislava, Slovakia
| | - Jan Gyarfas
- Department of Laboratory Hematology, National Cancer Institute, Bratislava, Slovakia
| | - Andrea Mlcakova
- Department of Laboratory Hematology, National Cancer Institute, Bratislava, Slovakia
| | - Peter Szepe
- Department of Pathology, Jessenius Faculty of Medicine, The Comenius University, Martin, Slovakia
| | - Lukas Plank
- Department of Pathology, Jessenius Faculty of Medicine, The Comenius University, Martin, Slovakia
| | - Ludmila Demitrovicova
- Department of Oncohematology II, National Cancer Institute, Klenová 1, 83310, Bratislava, Slovakia
| | - Vanda Mikudova
- Department of Oncohematology II, National Cancer Institute, Klenová 1, 83310, Bratislava, Slovakia
| | - Silvia Cingelova
- Department of Oncohematology II, National Cancer Institute, Klenová 1, 83310, Bratislava, Slovakia
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Lubos Drgona
- Oncohematology Clinic, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
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Sawhney S, Holtzman NG, Davis DL, Kaizer H, Giffi V, Emadi A, Koka R. Promyelocytic sarcoma of the right humerus: an unusual clinical presentation with unique diagnostic and treatment considerations. Clin Case Rep 2017; 5:1874-1877. [PMID: 29152290 PMCID: PMC5676285 DOI: 10.1002/ccr3.1212] [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: 07/05/2017] [Revised: 08/15/2017] [Accepted: 08/18/2017] [Indexed: 01/05/2023] Open
Abstract
Promyelocytic leukemia is a known medical emergency and requires rapid diagnosis and expedient therapy with differentiating agents. We present an unusual case in which the diagnosis is based on a fine needle aspirate of a humeral mass. Despite lack of systemic involvement, the sarcoma responded to traditional differentiation agents.
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Affiliation(s)
- Sameer Sawhney
- Department of Pathology University of Maryland School of Medicine Baltimore Maryland.,University of Maryland Greenebaum Comprehensive Cancer Center Baltimore Maryland
| | - Noa G Holtzman
- University of Maryland Greenebaum Comprehensive Cancer Center Baltimore Maryland.,Department of Medicine University of Maryland School of Medicine Baltimore Maryland
| | - Derik L Davis
- Department of Diagnostic Radiology & Nuclear Medicine University of Maryland School of Medicine Baltimore Maryland.,University of Maryland School of Medicine Baltimore Maryland
| | - Hannah Kaizer
- University of Maryland School of Medicine Baltimore Maryland
| | | | - Ashkan Emadi
- University of Maryland Greenebaum Comprehensive Cancer Center Baltimore Maryland.,Department of Medicine University of Maryland School of Medicine Baltimore Maryland
| | - Rima Koka
- Department of Pathology University of Maryland School of Medicine Baltimore Maryland.,University of Maryland School of Medicine Baltimore Maryland
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