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Shu X, Wu Q, Guo T, Yin H, Liu J. Acute Promyelocytic Leukemia Presenting With a Myeloid Sarcoma of the Spine: A Case Report and Literature Review. Front Oncol 2022; 12:851406. [PMID: 35311073 PMCID: PMC8931201 DOI: 10.3389/fonc.2022.851406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/07/2022] [Indexed: 12/26/2022] Open
Abstract
Myeloid sarcoma is a rare extramedullary tumor of immature myeloid cells. Certain known acute myeloid leukemia cytogenetic abnormalities, in particular t(8,21), has been associated with a higher incidence. Myeloid sarcoma, which rarely happens in acute promyelocytic leukemias, is more common in recurrent patients after the advent of all-trans retinoic acid (ATRA) and are rare in untreated acute promyelocytic leukemia. We described a case of, to our knowledge, de novo myeloid sarcoma of the spine confirmed as acute promyelocytic leukemia. Myeloid sarcoma is diagnosed by spinal tumor biopsy, and microscopic examination of a bone marrow smear and cytogenetic analysis led to a confirmed diagnosis of acute promyelocytic leukemia.
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Wang L, Cai DL, Lin N. Myeloid sarcoma of the colon as initial presentation in acute promyelocytic leukemia: A case report and review of the literature. World J Clin Cases 2021; 9:6017-6025. [PMID: 34368322 PMCID: PMC8316963 DOI: 10.12998/wjcc.v9.i21.6017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/07/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Myeloid sarcoma (MS) rarely occurs in acute promyelocytic leukemia (APL) at onset, but it can develop in relapse cases, especially after APL treated with all-trans retinoic acid (ATRA). Therefore little is known about the clinical features and suitable treatment for APL related MS due to the rarity of the disease, although this may be different from the treatment and prognosis of MS in the relapse stage. To our best knowledge, this is the second case report of APL initial presentation as colon MS.
CASE SUMMARY A 77-year-old woman complained of intermittent right lower abdominal pain, black stool, and difficult defecation for 2 mo. Physical examination showed diffuse tenderness during deep palpation and an anemic appearance. Laboratory findings showed positivity for fecal occult blood testing; white blood cell count: 3.84 × 109/L; hemoglobin: 105 g/L; platelet count: 174 × 109/L; and negativity for tumor markers. Abdominal enhanced computed tomography showed a space occupying lesion in the colon (1.9 cm). Fibrocolonoscopy revealed a polypoid and ulcerated mass measuring 2.5 cm. The tumor was removed. To our surprise, MS was confirmed by immunohistochemistry. PML/RARα fusion gene was detected in colon specimens by fluorescent in situ hybridization and real-time reverse transcription polymerase chain reaction, which was consistent with the bone marrow. She was diagnosed as having APL related MS. A smooth and unobstructed intestinal wall was found by fibrocolonoscopy, and continuous molecular remission was confirmed in both the bone marrow and colon after four courses of ATRA + arsenic trioxide (ATO). ATRA + ATO showed a favorable therapeutic response for both APL and MS.
CONCLUSION Early use of ATRA can benefit APL patients, regardless of whether MS is the first or recurrent manifestation.
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Affiliation(s)
- Lei Wang
- Department of Hematology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Da-Li Cai
- Department of Hematology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Na Lin
- Department of Hematology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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3
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Sánchez-Romero C, Kashikar S, Molina JPDÍ, Carlos R. Clinical pathology conference case #6: multiple tumors of the skull in a pediatric patient. Oral Surg Oral Med Oral Pathol Oral Radiol 2019. [DOI: 10.1016/j.oooo.2019.02.261] [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]
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Yamashita T, Nishijima A, Noguchi Y, Narukawa K, Oshikawa G, Takano H. Acute promyelocytic leukemia presenting as recurrent spinal myeloid sarcomas 3 years before developing leukemia: A case report with review of literature. Clin Case Rep 2019; 7:316-321. [PMID: 30847197 PMCID: PMC6389481 DOI: 10.1002/ccr3.1991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 11/04/2018] [Accepted: 12/09/2018] [Indexed: 12/17/2022] Open
Abstract
The de novo myeloid sarcoma (MS) type of acute promyelocytic leukemia (APL) is rare, and clinical features may differ from extramedullary diseases in advanced APL. Many cases occur as a spinal tumor, and some occur in the absence of bone-marrow diseases or coagulation abnormalities. Fluorescence in situ hybridization analysis of MS tissue is useful for accurate diagnosis, even in preserved tissue.
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Affiliation(s)
- Tomoko Yamashita
- Department of Internal MedicineToshiba General HospitalTokyoJapan
| | - Akihiko Nishijima
- Department of HematologyJapan Red Cross Musashino HospitalTokyoJapan
| | - Yuma Noguchi
- Department of HematologyJapan Red Cross Musashino HospitalTokyoJapan
| | - Kensuke Narukawa
- Department of HematologyJapan Red Cross Musashino HospitalTokyoJapan
| | - Gaku Oshikawa
- Department of HematologyJapan Red Cross Musashino HospitalTokyoJapan
| | - Hina Takano
- Division of Blood TransfusionJapan Red Cross Musashino HospitalTokyoJapan
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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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