1
|
Verma S, Baveja P, Thakur N, Patnaik S, Tilak TVSVGK, Mutreja D. Young man with alleged snake bite and disseminated intravascular coagulation or a life-threatening but potentially curable malignancy: Clinicopathological correlation. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:124-128. [PMID: 38692589 DOI: 10.25259/nmji_137_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Affiliation(s)
- Shipra Verma
- Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Puneet Baveja
- Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Nachiketa Thakur
- Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Subhashish Patnaik
- Department of Anaethesiology, Armed Forces Medical College, Pune, Maharashtra, India
| | - T V S V G K Tilak
- Department of Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Deepti Mutreja
- Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
| |
Collapse
|
2
|
Harrer DC, Lüke F, Einspieler I, Menhart K, Hellwig D, Utpatel K, Herr W, Reichle A, Heudobler D. Case Report: Extramedullary Acute Promyelocytic Leukemia: An Unusual Case and Mini-Review of the Literature. Front Oncol 2022; 12:886436. [PMID: 35692786 PMCID: PMC9174987 DOI: 10.3389/fonc.2022.886436] [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: 02/28/2022] [Accepted: 04/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background Acute promyelocytic leukemia (APL) constitutes a serious hematological emergency necessitating rapid diagnosis and therapy to prevent lethal bleedings resulting from APL-induced thrombocytopenia and coagulopathy. Atypical manifestations of APL, such as extramedullary disease at first presentation, pose diagnostic challenges and delay the onset of appropriate therapy. Nevertheless, extramedullary manifestations of APL are mostly accompanied by blood count alterations pointing to an underlying hematological disease. In this report, we present the first case of APL bearing close resemblance to a metastasized laryngeal carcinoma with normal blood counts and absent coagulopathy. Case Presentation A 67-year-old man with a previous history of smoking was admitted to our hospital with progressive hoarseness of voice, odynophagia, dysphagia and exertional dyspnea. Laryngoscopy revealed a fixed right hemi larynx with an immobile right vocal fold. Imaging of the neck via magnetic-resonance imaging (MRI) and positron emission tomography–computed tomography (PET/CT) with F-18-fluordeoxyglucose (FDG) showed a large hypermetabolic tumor in the right piriform sinus and tracer uptake in adjacent lymph nodes, highly suspicious of metastasized laryngeal carcinoma. Surprisingly the histological examination revealed an extramedullary manifestation of acute promyelocytic leukemia. Remarkably, blood counts and coagulation parameters were normal. Moreover, no clinical signs of hemorrhage were found. PML-RARA fusion was detected in both laryngeal mass and bone marrow. After diagnosis of APL, ATRA-based chemotherapy was initiated resulting in complete remission of all APL manifestations. Conclusions This is the first case report of APL initially presenting as laryngeal chloroma. Additionally, we performed a comprehensive literature review of previously published extramedullary APL manifestations. In aggregate, a normal blood count at first presentation constitutes an extremely rare finding in patients initially presenting with extramedullary APL manifestations.
Collapse
Affiliation(s)
- Dennis Christoph Harrer
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Florian Lüke
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Ingo Einspieler
- Institute of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Karin Menhart
- Department of Nuclear Medicine, University Hospital of Regensburg, Regensburg, Germany
| | - Dirk Hellwig
- Department of Nuclear Medicine, University Hospital of Regensburg, Regensburg, Germany
| | - Kirsten Utpatel
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Albrecht Reichle
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Daniel Heudobler
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany.,Bavarian Cancer Research Center (BZKF), Regensburg, Germany
| |
Collapse
|
3
|
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.
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Chadburn A, Chen YH, Nayar R, Young A, Sumpter I, Lee C, Gill M, Gao J. Limited Tissue Samples: Hematopoietic Lesions - Three Case Examples of Judicious Use of Limited Material. Acta Cytol 2019; 64:71-80. [PMID: 31063996 DOI: 10.1159/000496570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 01/16/2023]
Abstract
In the era of smaller and smaller biopsies submitted to pathology departments for diagnosis and the advent of personalized medicine, it has become imperative to efficiently and effectively use patient material to reach individualized, actionable diagnoses. The use of fine needle aspirates and core biopsies as acceptable methods for obtaining sufficient material for hematopoietic neoplasms under nonemergent conditions is debatable. There are, however, scenarios where only limited material is obtainable due to anatomic site, size of the lesion or condition of the patient. In these types of settings, thoughtful approaches and unconventional means are often necessary to reach a diagnosis. In this article, we describe three such scenarios and the unique tactics taken in each to obtain a personalized actionable diagnosis.
Collapse
Affiliation(s)
- Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA,
| | - Yi-Hua Chen
- Department of Pathology, Northwestern Medicine - Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ritu Nayar
- Department of Pathology, Northwestern Medicine - Feinberg School of Medicine, Chicago, Illinois, USA
| | - April Young
- Anatomic Pathology, Department of Pathology, Stanford Health Care, Stanford, California, USA
| | - Ingrid Sumpter
- HematoGenix Laboratory Services, Tinley Park, Illinois, USA
| | - Christopher Lee
- Department of Pathology, Northwestern Medicine - Feinberg School of Medicine, Chicago, Illinois, USA
| | - Manjot Gill
- Department of Ophthalmology, Northwestern Medicine - Feinberg School of Medicine, Chicago, Illinois, USA
| | - Juehau Gao
- Department of Pathology, Northwestern Medicine - Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Spinal promyelocytic sarcoma as the initial manifestation of acute promyelocytic leukaemia. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
8
|
Winters C, Chen AI, Moore S, Traer E, Dunlap J. Acute promyelocytic leukemia presenting with features of metastatic osseous disease. Leuk Res Rep 2018; 9:36-37. [PMID: 29892546 PMCID: PMC5993356 DOI: 10.1016/j.lrr.2018.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/26/2018] [Accepted: 02/09/2018] [Indexed: 12/01/2022] Open
Abstract
Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia defined by a balanced translocation between chromosomes 15 and 17 resulting in fusion of the promyelocytic leukemia gene (PML) on chromosome 15 with the retinoic acid receptor-alpha gene (RARα) on chromosome 17. APL often presents with pancytopenia and is associated with a life threatening coagulopathy making prompt diagnosis and initiation of therapy critical. We report an unusual case of APL in a 59 year old female without peripheral blood abnormalities or diffuse marrow involvement. Clinical and radiographic findings were initially interpreted as metastatic osseous disease but ultimately found to be APL.
Collapse
|
9
|
Villaseñor-Ledezma J, Amosa-Delgado M, Ruíz-Ginés JA, Álvarez-Salgado JA. Spinal promyelocytic sarcoma as the initial manifestation of acute promyelocytic leukaemia. Neurologia 2017; 33:558-560. [PMID: 28431836 DOI: 10.1016/j.nrl.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/29/2017] [Accepted: 02/04/2017] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - M Amosa-Delgado
- Servicio de Neurocirugía, Complejo Hospitalario de Toledo, Toledo, España
| | - J A Ruíz-Ginés
- Servicio de Neurocirugía, Complejo Hospitalario de Toledo, Toledo, España
| | | |
Collapse
|
10
|
Abla O, Kutny MA, Testi AM, Feusner JH, Creutzig U, Gregory J, Gibson B, Leverger G, Ribeiro RC, Smith O, Locatelli F, Kaspers G. Management of relapsed and refractory childhood acute promyelocytic leukaemia: recommendations from an international expert panel. Br J Haematol 2016; 175:588-601. [PMID: 27651168 DOI: 10.1111/bjh.14313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Oussama Abla
- Division of Hematology/Oncology, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Matthew A Kutny
- Department of Pediatrics, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anna Maria Testi
- Department of Cellular Biotechnologies and Haematology, Sapienza University of Rome, Rome, Italy
| | - James H Feusner
- Division of Hematology/Oncology, Children's Hospital and Research Center Oakland, Oakland, CA, USA
| | - Ursula Creutzig
- Paediatric Haematology/Oncology, Hannover Medical School, Hannover, Germany
| | - John Gregory
- Atlantic Health System, Goryeb Children's Hospital, Morristown, NJ, USA
| | - Brenda Gibson
- Department of Haematology and Oncology, Royal Hospital for Children, Glasgow, UK
| | - Guy Leverger
- Haematology/Oncology, Hôpital Armand Trousseau, Paris, France
| | - Raul C Ribeiro
- Department of Oncology, Division of Leukemia/Lymphoma, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Owen Smith
- Department of Haematology/Oncology, Our Lady's Children's Hospital, Dublin, Ireland
| | - Franco Locatelli
- Department of Paediatric Haematology and Oncology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.,University of Pavia, Pavia, Italy
| | - Gertjan Kaspers
- Paediatric Oncology, VU University Medical Centre, Amsterdam, The Netherlands.,Academy of Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| |
Collapse
|
11
|
Raphael J, Valent A, Hanna C, Auger N, Casiraghi O, Ribrag V, De Botton S, Saada V. Myeloid sarcoma of the nasopharynx mimicking an aggressive lymphoma. Head Neck Pathol 2013; 8:234-8. [PMID: 24101200 PMCID: PMC4022928 DOI: 10.1007/s12105-013-0495-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Myeloid sarcoma (MS) is a rare extra-medullary tumour of the myeloid lineage, which can be a difficult diagnosis to make. CASE PRESENTATION We report the case of a 73-year-old male with a right-sided nasopharyngeal mass revealed on CT scan and MRI. RESULTS An initial cytological and histological examination suggested a high-grade lymphoma. Nevertheless, the final diagnosis was a MS with an unusual involvement of the nasopharynx that was treated with a conventional induction leukemia therapy. Eight months later, the patient had persistent thrombocytopenia and a bone marrow aspiration showed the dysplasia of a high grade myelodysplastic syndrome and cytogenetics detected t(3;21). The patient was treated with a 5-Azacitidine (Vidaza) protocol until overt progression and disease evolution. CONCLUSION In conclusion few cases of MS involving the nasopharynx have been reported. Its diagnosis is often difficult and should be considered especially when a high index of suspicion is present and the immunophenotype of the malignant haematological cells is not clearly in favour of a lymphoma.
Collapse
Affiliation(s)
- Jacques Raphael
- grid.14925.3b0000000122849388Clinical Haematology Department, Institut Gustave Roussy (IGR), 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Alexander Valent
- grid.14925.3b0000000122849388Biology and Pathology Department, Institut Gustave Roussy (IGR), Villejuif, France
| | - Colette Hanna
- grid.14925.3b0000000122849388Clinical Haematology Department, Institut Gustave Roussy (IGR), 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Nathalie Auger
- grid.14925.3b0000000122849388Biology and Pathology Department, Institut Gustave Roussy (IGR), Villejuif, France
| | - Odile Casiraghi
- grid.14925.3b0000000122849388Biology and Pathology Department, Institut Gustave Roussy (IGR), Villejuif, France
| | - Vincent Ribrag
- grid.14925.3b0000000122849388Clinical Haematology Department, Institut Gustave Roussy (IGR), 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Stephane De Botton
- grid.14925.3b0000000122849388Clinical Haematology Department, Institut Gustave Roussy (IGR), 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Veronique Saada
- grid.14925.3b0000000122849388Biology and Pathology Department, Institut Gustave Roussy (IGR), Villejuif, France
| |
Collapse
|
12
|
Bittencourt H, Teixeira Junior AL, Glória ABF, Ribeiro AFLT, Fagundes EM. Acute promyelocytic leukemia presenting as an extradural mass. Rev Bras Hematol Hemoter 2013; 33:478-80. [PMID: 23049367 PMCID: PMC3459371 DOI: 10.5581/1516-8484.20110126] [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] [Received: 06/24/2011] [Accepted: 10/04/2011] [Indexed: 11/27/2022] Open
Abstract
Acute promyelocytic leukemia is potentially a highly curable type of leukemia that usually presents with pancytopenia, coagulopathies and bleeding. We describe a case of an unusual presentation of acute promyelocytic leukemia. A 53 year-old male was admitted complaining of pain and weakness in his legs. He presented at examination a spastic paraparesis with a sensitive level at the eighth thoracic medullar (T8) segment. Magnetic resonance imaging showed a posterolateral extradural mass from T6 through T8 segments with medullar compression. A complete blood count showed anemia, thrombocytopenia and the presence of promyelocytes and blasts. Marrow examination was compatible with the diagnosis of acute promyelocytic leukemia by cytogenetics and polymerase chain reaction for the PML-RARα gene. He was treated with all-trans-retinoic acid therapy plus daunorubicin and presented an all-trans-retinoic acid syndrome. Despite hematological remission, the patient presented neurologic deterioration and had to be treated with radiotherapy (total dose 3000 cGy) of the extradural lesion. The patient evolved with severe sepsis and died without any recovery from his neurologic deficit. Extramedullary infiltration is a very rare complication in acute promyelocytic leukemia. Most cases are related to relapse after initial treatment with all-trans-retinoic acid. The skin and the central nervous system are the most frequently involved sites. This is possibly the first case reported of this condition in which the patient had a symptomatic extradural mass.
Collapse
Affiliation(s)
- Henrique Bittencourt
- Hematology and Oncology Service, Centro Hospitalar Universitário Sainte-Justine, Universidade de Montreal, Montreal, AC, Canada
| | | | | | | | | |
Collapse
|
13
|
Zou XL, Zeng K, Xie LP, Wang L, Chen M, Liu T, Niu T. Acute promyelocytic leukemia with Flt3-TKD and WT1 mutations relapsing in a testicle and followed by systemic relapse. Acta Haematol 2013; 130:223-9. [PMID: 23816818 DOI: 10.1159/000351054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/17/2013] [Indexed: 12/22/2022]
Abstract
Extramedullary relapse is a rare phenomenon in patients with acute promyelocytic leukemia (APL), especially that derived from urogenital systems like the testicles. In this report, we describe an APL patient who had received standard induction/maintenance therapy resulting in durable remission for 4.5 years, when he presented with a unilateral testicular mass confirmed as myeloid sarcoma; this was followed by systemic relapse of APL. Retrospective analysis of the involved blood and bone marrow samples at the time of the initial diagnosis revealed a rare point mutation of FLT3-TKD and a novel mutation of WT1. These mutations were detected recurrently throughout the course of the disease. After reinduction therapy with arsenic trioxide and all-trans retinoic acid combined with daunorubicin, complete hematological remission was achieved for the ensuing salvage allogeneic hematopoietic stem cell transplant.
Collapse
Affiliation(s)
- Xing-li Zou
- Department of Hematology and Research Laboratory of Hematology, West China Hospital, Sichuan University, Chengdu, PR China
| | | | | | | | | | | | | |
Collapse
|
14
|
Liang C, Chan KH, Yoon PJ, Lovell MA. Clinicopathological characteristics of extramedullary acute megakaryoblastic leukemia (AMKL): report of a case with initial mastoid presentation and review of literature to compare extramedullary AMKL and non-AMKL cases. Pediatr Dev Pathol 2012; 15:385-92. [PMID: 22667334 DOI: 10.2350/11-12-1124-cr.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Extramedullary acute megakaryoblastic leukemia (AMKL) is a rare neoplasm with a varied clinical presentation. AMKL with initial mastoid presentation has never been reported. The extreme rarity of mastoid AMKL, together with the tendency of extramedullary AMKL to mimic other small blue cell tumors, can create a diagnostic challenge. We report a case of AMKL that initially presented as a mastoid lesion and provide a comprehensive review and analysis that compares the characteristics of extramedullary AMKL and nonmegakaryoblastic acute myeloid leukemia (AML) in reported pediatric cases over the past 30 years. We found that patients with extramedullary AMKL were not only younger than patients without megakaryocytic differentiation but were also limited to those ≤ 2 years of age. In addition, girls predominated in both AMKL and AML MLL(+) groups compared with other types of AML (P = 0.0366 and P = 0.0082). Furthermore, we found that extramedullary AMKL was more likely to involve bone than AML MLL(+) (P < 0.0001) or other types of AML (P = 0.0002). These findings suggest that extramedullary AMKL should be considered in the differential diagnosis of SBCT in children, especially in patients with mastoid or other bony lesions, those ≤ 2 years of age, and female patients.
Collapse
Affiliation(s)
- Conan Liang
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA
| | | | | | | |
Collapse
|
15
|
Williams T, Aljitawi OS, Moussa R, McHugh S, Dusing R, Abraha J, Yarlagadda SG. First case of donor transmitted non-leukemic promyelocytic sarcoma. Leuk Lymphoma 2012; 53:2530-4. [DOI: 10.3109/10428194.2012.695360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
16
|
Extramedullary disease in acute promyelocytic leukemia: two-in-one disease. Mediterr J Hematol Infect Dis 2011; 3:e2011066. [PMID: 22220263 PMCID: PMC3248343 DOI: 10.4084/mjhid.2011.066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 11/27/2011] [Indexed: 11/08/2022] Open
Abstract
In acute promyelocytic leukemia (APL), extramedullary disease (EMD) is particularly rare and shows special clinical and biological features. It is estimated that about 3-5% of APL patients will suffer extramedullary relapse. The most common site of EMD in APL is the central nervous system (CNS). At present, there are still many issues of EMD in APL needing further clarification, including pathogenesis, risk factors, prognosis and treatment. A better understanding of the biological mechanisms underlying EMD is important to be able to devise more effective CNS prophylaxis and induction-consolidation therapeutic strategies.
Collapse
|
17
|
Abstract
Myeloid sarcoma is a rare disease that can present as an isolated extramedullary leukemic tumor, concurrently with or at relapse of acute myeloid leukemia. Owing to the rarity of this disorder, most of the literature comprises small retrospective studies and case reports. The aim of this review is to summarize the current published data regarding the clinical presentation, morphological, cytogenetic and molecular features, prognosis and treatment of myeloid sarcoma.
Collapse
Affiliation(s)
- Batia Avni
- Division of Hematology, Chaim Sheba Medical Center Tel Hashomer, Israel and Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | - Maya Koren-Michowitz
- Division of Hematology, Chaim Sheba Medical Center Tel Hashomer, Israel and Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles CA, USA
| |
Collapse
|
18
|
Morrison AR, Smith MA, Bennett EC. Pediatric head and neck extramedullary hematopoietic disease: case series and review of the literature. Ann Otol Rhinol Laryngol 2011; 120:57-62. [PMID: 21370681 DOI: 10.1177/000348941112000108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We review 3 pediatric cases of extramedullary hematopoietic disease occurring in the orbit, ethmoid sinuses, and parotid gland, and present a review of the literature. Each of the 3 patients was taken to the operating room, and the biopsy specimens obtained were successful in establishing the diagnosis in every case. Head and neck manifestations of extramedullary hematopoietic disease are rare, indeed. However, these cases demonstrate that it is important for otolaryngologists, pediatricians, primary-care physicians, radiologists, and pathologists to maintain a high index of suspicion for extramedullary presentations of hematopoietic disease in the head and neck. A coordinated multidisciplinary approach, including the appropriate surgical approach for biopsy, will facilitate determination of the diagnosis and treatment plan.
Collapse
Affiliation(s)
- Aaron R Morrison
- Department of Surgery, Division of Otolaryngology, University of New Mexico Hospitals, Albuquerque, New Mexico 87131, USA
| | | | | |
Collapse
|
19
|
Thomas X, Chelghoum Y. Promyelocytic sarcoma of the sternum: a case report and review of the literature. THE KOREAN JOURNAL OF HEMATOLOGY 2011; 46:52-6. [PMID: 21461306 PMCID: PMC3065629 DOI: 10.5045/kjh.2011.46.1.52] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 01/31/2011] [Accepted: 01/31/2011] [Indexed: 11/17/2022]
Abstract
This study reports a case of promyelocytic sarcoma that developed as a solitary sternal mass without any clinical evidence of acute promyelocytic leukemia. The case presented the diagnostic difficulties common to all aleukemic granulocytic sarcomas, and diagnosis was made possible by local identification of the PML/RARα fusion gene by fluorescent in situ hybridization. The patient was treated by surgery followed by chemotherapy plus all-trans retinoic acid therapy and local radiotherapy.
Collapse
Affiliation(s)
- Xavier Thomas
- Department of Hematology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | |
Collapse
|
20
|
Papageorgiou SG, Foukas P, Economopoulou C, Tsirigotis P, Sakorafas G, Georgakopoulos N, Kefala M, Pappa V, Economopoulos T, Panayiotides I, Papageorgiou E, Dervenoulas J. Acute apenditis in patient with acute promyelocytic leukemia. Leuk Res 2010; 35:e4-5. [PMID: 20855112 DOI: 10.1016/j.leukres.2010.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 07/27/2010] [Accepted: 08/22/2010] [Indexed: 11/29/2022]
MESH Headings
- Acute Disease
- Adult
- Appendicitis/complications
- Chromosomes, Human, Pair 15
- Chromosomes, Human, Pair 17
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Promyelocytic, Acute/complications
- Leukemia, Promyelocytic, Acute/genetics
- Male
- Reverse Transcriptase Polymerase Chain Reaction
- Translocation, Genetic
Collapse
|
21
|
Ochs RC, Gormley RH, Luger S, Bagg A. Isolated bowel relapse in acute promyelocytic leukemia: an unusual site of extramedullary recurrence. J Clin Oncol 2010; 28:e550-3. [PMID: 20713873 DOI: 10.1200/jco.2010.29.7424] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Rachel C Ochs
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | |
Collapse
|
22
|
Unusual presentation of myeloid sarcoma in a case of acute promyelocytic leukemia with a cryptic PML–RARA rearrangement involving multiple sites including the atrium. ACTA ACUST UNITED AC 2010; 200:47-53. [DOI: 10.1016/j.cancergencyto.2010.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Revised: 03/03/2010] [Accepted: 03/25/2010] [Indexed: 11/17/2022]
|
23
|
Promyelocytic sarcoma of the spine: a case report and review of the literature. Adv Hematol 2010; 2010:137608. [PMID: 20339529 PMCID: PMC2843861 DOI: 10.1155/2010/137608] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 01/15/2010] [Indexed: 12/17/2022] Open
Abstract
Myeloid sarcoma (MS, previously named granulocytic sarcoma or chloroma) is a rare extramedullary tumour of immature myeloid cells. It can be present before, concurrently with, or after the diagnosis of acute myeloid leukemia. MS is extremely uncommon in acute promyelocytic leukemia (APL). In the case described here, MS was the sole site of APL relapse and the cause of spinal cord compression. The patient presented with neurologic symptoms due to a paravertebral mass of MS after 7 years of complete remission. He was treated with excision of the mass followed by local radiotherapy. Systemic treatment was also given with combined arsenic trioxide and all-trans retinoic acid and the patient was able to achieve a second prolonged clinical and molecular remission.
Collapse
|
24
|
Johnston DL, Mandel K. Central nervous system relapse of acute promyelocytic leukemia. Pediatr Blood Cancer 2010; 54:336-7; author reply 338. [PMID: 19847884 DOI: 10.1002/pbc.22317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
25
|
Digiorgio CM, Altmeyer MD, Wang AR, Boh EE. JAAD grand rounds. A 49-year-old man with an asymptomatic cutaneous eruption. J Am Acad Dermatol 2009; 61:913-5. [PMID: 19836658 DOI: 10.1016/j.jaad.2008.12.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 12/16/2008] [Accepted: 12/21/2008] [Indexed: 11/30/2022]
|
26
|
Vega-Ruiz A, Faderl S, Estrov Z, Pierce S, Cortes J, Kantarjian H, Ravandi F. Incidence of extramedullary disease in patients with acute promyelocytic leukemia: a single-institution experience. Int J Hematol 2009; 89:489-496. [PMID: 19340529 DOI: 10.1007/s12185-009-0291-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 03/06/2009] [Accepted: 03/10/2009] [Indexed: 02/02/2023]
Abstract
Using current treatment regimens, over 90% of patients with acute promyelocytic leukemia will achieve complete remission (CR). However, approximately 30% of these patients will relapse, including a small proportion who will develop extramedullary disease (EMD). In this study, we investigated the incidence of EMD in 263 patients with APL who were treated at our institution from January 1990 to May 2008. With a median follow-up of 31 months (range 2 days-203 months), 8 (3%) patients developed EMD. The most commonly affected site was the central nervous system (n = 7). Before developing EMD, one patient had achieved CR with a chemotherapy-only regimen, six patients had achieved CR with all-trans-retinoic acid (ATRA)-based regimens, and one patient had achieved CR with an ATRA plus arsenic trioxide (ATO)-based regimen. The EMD conferred a poor prognosis; five patients died within 4 months of developing EMD. The molecular status did not predict EMD; four patients had a negative PCR for the PML-RARA transcripts prior to relapse with EMD. In conclusion, the incidence of EMD is low. We were unable to identify any specific factors that could predict the development of EMD.
Collapse
Affiliation(s)
- Arturo Vega-Ruiz
- Department of Leukemia, Unit 428, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Stefan Faderl
- Department of Leukemia, Unit 428, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Zeev Estrov
- Department of Leukemia, Unit 428, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Sherry Pierce
- Department of Leukemia, Unit 428, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Jorge Cortes
- Department of Leukemia, Unit 428, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Hagop Kantarjian
- Department of Leukemia, Unit 428, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Farhad Ravandi
- Department of Leukemia, Unit 428, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| |
Collapse
|
27
|
Wang X, Liu H, Wu Z, Xu X, Chen X, Zhai Z, Sun Z. A case of acute promyelocytic leukemia presenting with a nonleukemic granulocytic sarcoma of the ovary, with subsequent development of acute myeloid leukemia associated with t(8;21). Leuk Res 2008; 33:580-2. [PMID: 18804280 DOI: 10.1016/j.leukres.2008.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 08/10/2008] [Accepted: 08/12/2008] [Indexed: 11/24/2022]
|