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Takeyasu S, Morita K, Saito S, Toho M, Oyama T, Obo T, Taoka K, Shimura A, Maki H, Shibata E, Watanabe Y, Suzuki F, Zhang L, Kobayashi H, Hinata M, Kurokawa M. Myeloid sarcoma and pathological fracture: a case report and review of literature. Int J Hematol 2023; 118:745-750. [PMID: 37707761 PMCID: PMC10673718 DOI: 10.1007/s12185-023-03656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023]
Abstract
Myeloid sarcoma is a rare clinical entity that presents as an isolated proliferation of leukemic cells, concurrently with or at relapse of acute myeloid leukemia (AML), myelodysplastic syndromes/neoplasms (MDS), chronic myeloid leukemia (CML), and myeloproliferative neoplasm (MPN). Myeloid sarcoma disrupts the normal architecture of its surrounding tissues. When it forms in long bones, it can cause their pathological fracture. We recently experienced a rare case of MDS presenting with myeloid sarcoma in the femur that eventually resulted in its pathological fracture. Detailed chromosomal analysis of the bone marrow cells suggested emergence of myeloid sarcoma during the fast-paced progression of MDS just after acquiring trisomy 22. A comprehensive review of previous cases of myeloid sarcoma-associated pathological fracture indicated possible involvement of structural rearrangements of chromosomes 9 and 22. Management of myeloid sarcoma should continue to improve, and clinicians should note that myeloid sarcoma with specific chromosomal alterations needs extra medical attention to prevent pathological fracture.
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Affiliation(s)
- Sho Takeyasu
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Ken Morita
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Seitaro Saito
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Masanori Toho
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Takashi Oyama
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Takafumi Obo
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Kazuki Taoka
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Arika Shimura
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Hiroaki Maki
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Eisuke Shibata
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Fumio Suzuki
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Liuzhe Zhang
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Kobayashi
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Munetoshi Hinata
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
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Nagasawa H, Okada K, Miyakoshi N, Tsuchie H, Nanjo H, Shimada Y. De Novo Granulocytic Sarcoma of the Humerus in an 82-Year-Old Woman: A Case Report. J Med Cases 2021; 11:249-252. [PMID: 34434405 PMCID: PMC8383681 DOI: 10.14740/jmc3526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/23/2020] [Indexed: 12/02/2022] Open
Abstract
Granulocytic sarcoma is a rare solid malignant tumor that occurs in patients with acute myeloid leukemia. As such, granulocytic sarcoma without leukemia occurring in long bones is quite rare. This case report describes an isolated granulocytic sarcoma of the right humerus in an 82-year-old woman in the absence of acute myeloid leukemia. The patient was admitted to our hospital with a pathological fracture of the right humerus. An incisional biopsy was performed, and the pathological diagnosis was granulocytic sarcoma. Radiotherapy (45 Gy) to the humerus resulted in a good clinical outcome with no evidence of myeloid leukemia at 9.5 years of follow-up. Radiotherapy was effective for pain relief and maintenance of good quality of life in this patient. Although laboratory evaluation has not revealed any abnormalities 9.5 years after radiotherapy, periodic observation is required.
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Affiliation(s)
- Hiroyuki Nagasawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Science, Akita, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroyuki Tsuchie
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Nanjo
- Department of Clinical Pathology, Akita University Hospital, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Song JH, Son SH, Lee JH, Chung SM, Jang HS, Choi BO. Defining the optimal dose of radiation in leukemic patients with extramedullary lesions. BMC Cancer 2011; 11:428. [PMID: 21975070 PMCID: PMC3196724 DOI: 10.1186/1471-2407-11-428] [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: 03/31/2011] [Accepted: 10/06/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Analysis of the clinical response of extramedullary lesions in leukemic patients treated with radiation therapy (RT) and defining the optimal dose of radiation. METHODS Forty-two extramedullary lesions found in 24 leukemic patients treated with RT were reviewed. The radiation was delivered usually 2 Gy/day, up to a median of 20 Gy (range: 18.0-40.8). The clinical response and symptom palliation effect were analyzed. The factors affecting the response were also included in the analysis. RESULTS After a median time of 7.9 weeks, the overall response rate was 76.2%. A complete response (CR) was achieved in 35.7%, a partial response in 40.5%. The symptom was relieved in 85.7% sites. The overall response rate was better in patients whose initial tumor size was smaller than 10 cm2 (p = 0.010) or who were treated with more than 25 Gy (p = 0.031). The overall CR rate was also higher in those who had smaller tumors (smaller than 6 cm or 30 cm2) (p = 0.015), or when the tumor was located in soft tissue (p = 0.029). CONCLUSIONS Extramedullary lesions in leukemic patients can be successfully treated with RT. The tumor response rate was excellent and symptom relief was achieved in almost all patients. There was a better response to treatment when the tumor was small or it was located in soft tissue. Although, there was no definite correlation between volume reduction and total dose, it seems that higher total dose more of than 25 Gy is needed for better response.
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Affiliation(s)
- Jin Ho Song
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Nonleukemic granulocytic sarcoma of knee: a case report. Case Rep Med 2011; 2010:235295. [PMID: 21209806 PMCID: PMC3014795 DOI: 10.1155/2010/235295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 11/18/2010] [Indexed: 11/29/2022] Open
Abstract
Granulocytic sarcoma (GS) is a rare extramedullary tumor composed of immature myeloid cells. It is usually associated with leukemia or other myeloproliferative disorders. It occurs very rarely without overt hematologic diseases. A 19-year-old man presented with left knee mass. Biopsy with pathological analysis showed lymphoma aspect. Immunostains yielded the diagnosis of GS with myeloperoxidase and CD43 positivity. There was no systemic manifestation of leukemia, and bone marrow biopsiy was negative for neoplastic infiltration. Chemotherapy by CHOP was efficient, and the patient remaind alive and healthy 40 months after the end of treatment. The case is discussed in the framework of the existing literature about the diagnosis, treatment, and prognosis of this very rare condition.
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