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Chang L, Gong C, Lu H, Liu Y, Kang L, Chen J, Wang L, Xu B. Percutaneous intravenous catheter forceps biopsy in right atrial mass: two case reports and literature review. BMC Cardiovasc Disord 2022; 22:63. [PMID: 35184743 PMCID: PMC8859873 DOI: 10.1186/s12872-022-02507-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/10/2022] [Indexed: 12/17/2022] Open
Abstract
Background Primary malignant tumors of the heart are rare. Although preoperative histological diagnosis is difficult, it has paramount value in therapeutic strategy development and prognostic estimation. Herein, we reported 2 cases of intracardiac tumors. Cases presentation Both patients presented to the hospital with heart-related symptoms. Echocardiography showed massive masses in the atrium and positron emission tomography–computed tomography (PET/CT) revealed hypermetabolism and invasiveness. One patient cannot take surgery due to extensive metastasis and poor condition. The other patient was primarily diagnosed with lymphoma, and surgery was not recommended. They successfully underwent intravenous atrial biopsy, and histological samples confirmed intimal sarcoma and diffuse large B cell lymphoma. Based on immunohistochemical and molecular assessments, targeted chemotherapy was administered, resulting in clinical and imaging remission at discharge. Conclusions Percutaneous intravenous catheter biopsy as a safe invasive test provides an accurate pathological diagnosis after imaging evaluation, and offers a therapeutic direction. Nonmalignant masses and some chemo-radiosensitive malignant tumors in the atrium could have good prognosis after targeted therapy.
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Gautam A, Jalali GK, Sahu KK, Deo P, Ailawadhi S. Cardiac Myeloid Sarcoma: Review of Literature. J Clin Diagn Res 2017; 11:XE01-XE04. [PMID: 28511492 DOI: 10.7860/jcdr/2017/23241.9499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/23/2017] [Indexed: 11/24/2022]
Abstract
Granulocytic Sarcomas (GS) also called as Myeloid Sarcomas (MS) or chloromas are the representatives of extramedullary infiltrates of immature myeloid cells including myeloblasts, promyelocytes and myelocytes. Primary cardiac malignancies per se are rare and infiltration of cardiac muscles by secondary malignant cells is also an uncommon finding. Out of these cardiac tumors, contribution of Cardiac Myeloid Sarcoma (CMS) is even more smaller thereby limiting our knowledge about this rare entity. Because of its very lower incidence, an exact guideline for diagnosis and management is still missing and usually haematologists around the world are treating CMS based on their clinical acumen. Aim of this review is to briefly discuss the presenting clinical feature, differential diagnosis, diagnostic workup and management based on published articles related to CMS till date.
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Affiliation(s)
- Archana Gautam
- Junior Resident, Department of Internal Medicine, UCMS, New Delhi, India
| | - Ghazal Kooshk Jalali
- Senior Resident, Department of Internal Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Kamal Kant Sahu
- Senior Resident, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Prateek Deo
- Junior Resident, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Sikander Ailawadhi
- Senior Associate Consultant, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida
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Yang WC, Yao M, Chen YH, Kuo SH. Complete response of myeloid sarcoma with cardiac involvement to radiotherapy. J Thorac Dis 2016; 8:1323-8. [PMID: 27293853 DOI: 10.21037/jtd.2016.04.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We present a rare case of intracardiac myeloid sarcoma (MS) of acute myeloid leukemia (AML) and who responds completely well to low-dose radiotherapy. This 19-year-old young man initially presented with AML and received standard chemotherapy followed by allogeneic hematopoietic stem cell transplantation (HSCT). However, he developed intracardiac isolated MS relapse with the presentation of exertional dyspnea and superior vena cava (SVC) syndrome 3 years later. He then received radiotherapy with 24 Gy at a 12 daily fractions using forward "field in field" intensity modulated radiotherapy technique. He dramatically had improved clinical symptoms, and complete remission was achieved one month after completing radiotherapy. Our result is in line with anecdotal case reports showed that radiotherapy with 15 Gy in 10 fractions or with 24 Gy in 12 fractions resulted in good response and less toxicity of 2 cases of MS with cardiac involvement. These results indicate that a modest radiotherapy dose, 24 Gy, achieves good local control of MS with cardiac involvement.
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Affiliation(s)
- Wen-Chi Yang
- 1 Division of Radiation Oncology, Department of Oncology, 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 3 Cancer Research Center, 4 Graduate Institute of Oncology, National Taiwan University College of Medicine and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Ming Yao
- 1 Division of Radiation Oncology, Department of Oncology, 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 3 Cancer Research Center, 4 Graduate Institute of Oncology, National Taiwan University College of Medicine and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Yu-Hsuan Chen
- 1 Division of Radiation Oncology, Department of Oncology, 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 3 Cancer Research Center, 4 Graduate Institute of Oncology, National Taiwan University College of Medicine and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Sung-Hsin Kuo
- 1 Division of Radiation Oncology, Department of Oncology, 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 3 Cancer Research Center, 4 Graduate Institute of Oncology, National Taiwan University College of Medicine and National Taiwan University Cancer Center, Taipei, Taiwan
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[Radiotherapy of chloroma or granulocytic sarcoma: A literature review]. Cancer Radiother 2016; 20:60-5. [PMID: 26775223 DOI: 10.1016/j.canrad.2015.05.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/17/2015] [Accepted: 05/22/2015] [Indexed: 02/08/2023]
Abstract
Granulocytic sarcoma, or chloroma, is a rare clinical entity, usually associated with a blood disease, including acute myeloid leukemia. Management strategies are based on the combination of systemic therapy and local therapy (surgery or radiation). Data for radiotherapy dose are derived from retrospective studies and case reports. We conducted a literature review using the Pubmed search engine to clarify the terms and indications for radiotherapy of chloromas.
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Chen WY, Wang CW, Chang CH, Liu HH, Lan KH, Tang JL, Tien HF, Kuo SH, Cheng AL. Clinicopathologic features and responses to radiotherapy of myeloid sarcoma. Radiat Oncol 2013; 8:245. [PMID: 24148102 PMCID: PMC4016483 DOI: 10.1186/1748-717x-8-245] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 10/15/2013] [Indexed: 02/02/2023] Open
Abstract
Background To evaluate clinicopathological features, radiotherapeutic parameters, and their associations with responses to radiotherapy (RT) in patients with myeloid sarcoma (MS). Methods We reviewed 20 patients receiving RT for MS lesions (in 43 RT courses) and analyzed the patients’ clinicopathologic features and radiotherapeutic parameters, and their associations with complete responses (CR) to RT using Fisher’s exact test and univariate logistic regression analysis. Generalized Estimating Equation was used to analyze all 43 irradiated lesions and account for the correlations in RT responses among lesions from the same patient. Results We found that the underlying hematological diseases of the evaluated patients were acute myeloid leukemia (AML) in 14 patients (70%), chronic myeloid leukemia in 4 patients (20%), myelodysplastic syndrome with AML transformation in one patient (5%), and de novo MS in one patient (5%). Most patients (55%) received RT for MS at the time of relapse following bone marrow transplantation (BMT). The most common cytogenetic abnormality was t(8;21)(q22;q22). The median RT dose of 20 Gy (range 6–35 Gy), administered in 1.5-3.5 Gy fractions, provided a 63% CR rate. RT dose, sex, cytogenetics, and bone marrow status at the time of RT had no significant effect on CR. Younger age (<50 y, P = 0.06), BMT prior to RT (P = 0.05), and underlying AML (P = 0.05) were marginally associated with higher CR to RT. Conclusions Our results indicate that a modest RT dose (20-30 Gy) achieves good local control of MS. Age, previous BMT, and underlying hematologic disease can affect RT response.
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Affiliation(s)
| | | | | | | | | | | | | | - Sung-Hsin Kuo
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Allogeneic hematopoietic stem cell transplantation for adult AML patients with granulocytic sarcoma. Leukemia 2012; 26:2469-73. [PMID: 22699453 DOI: 10.1038/leu.2012.156] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We recently reported that adult acute myeloid leukemia (AML) patients with granulocytic sarcoma (GS) possessed unique clinical features and poor prognosis. However, the optimal therapeutic strategy for this entity has not been established. Therefore, the aim of this study was to assess the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for the management of AML with GS. We retrospectively analyzed 503 consecutive adult AML patients (median age, 44 years; range, 15-73 years) who received allo-HSCT. A total of 44 patients (8.7%) had GS before transplantation. Patients with GS achieved comparable survival to those without GS (5-year overall survival (OS), 47% vs 44%, respectively, P=0.621). In patients with GS, excellent outcomes were seen in those that underwent allo-HSCT while in complete remission, whereas nine out of ten patients with GS at the time of transplant experienced a relapse within 6 months after allo-HSCT. Local irradiation for GS prior to allo-HSCT and acute and chronic graft-versus-host disease did not affect survival significantly. Multivariate analysis identified age, disease status and the use of myeloablative conditioning as independent prognostic factors for OS. These data suggest that better control of GS prior to allo-HSCT is crucial to improve the outcome of transplantation for those with GS.
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Lamour C, Bergeron A. Non-infectious pulmonary complications of myelodysplastic syndromes and chronic myeloproliferative disorders. Rev Mal Respir 2011; 28:e18-27. [PMID: 21742229 DOI: 10.1016/j.rmr.2009.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2008] [Accepted: 04/07/2009] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Non-infectious pulmonary complications of myelodysplastic syndromes and chronic myeloproliferative disorders are not rare but remain little known to respiratory physicians who may be confronted with various clinical pictures corresponding to different pathophysiological causes. BACKGROUND The few data in the literature only relate to isolated cases or small series. The non-infectious pulmonary complications of myelodysplastic syndromes and chronic myeloproliferative disorders can be classified into several clinical entities: tumour syndrome, pulmonary fibrosis or diffuse infiltrating pneumonia, autoimmune reactions including vasculitis, Sweet syndrome, organizing pneumonia, pulmonary alveolar proteinosis, pleural effusion and pulmonary arterial hypertension. The diagnosis is provided by the histology and management of these complications depends on the underlying pathology. VIEWPOINTS AND CONCLUSION Myelodysplastic syndromes and myeloproliferative disorders are entities which are becoming better characterized and understood. Better knowledge of the pathophysiological mechanisms involved in these complications should improve their diagnosis and their management, which still remains complex.
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Affiliation(s)
- C Lamour
- Service de pneumologie, CHU de Poitiers, Poitiers cedex, France.
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Serefhanoglu S, Goker H, Aksu S, Buyukasik Y, Sayinalp N, Haznedaroglu IC, Ozcebe OI. Spinal myeloid sarcoma in two non-leukemic patients. Intern Med 2010; 49:2493-7. [PMID: 21088356 DOI: 10.2169/internalmedicine.49.3878] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Myeloid sarcoma, formerly termed granulocytic sarcoma or chloroma, consists of neoplastic granulocytic precursors and myeloblasts. Isolated chloromas (granulocytic sarcomas) are rare tumors. Spinal complications of chloromas, such as cord compression secondary to epidural tumor or cauda equine syndrome have been described but are rare. We herein report two cases with spinal granulocytic sarcomas in non-leukemic patients. The case of a previously healthy 22-year-old man diagnosed with multiple spinal granulocytic sarcomas with no evidence of bone marrow or other hematological involvement is described. And, a 43-year-old woman diagnosed cervical spinal granulocytic sarcoma with no evidence of bone marrow or other hematological involvement is described. The tumor was totally removed by microsurgery. The histopathological examination was consistent with granulocytic sarcoma. Granulocytic sarcoma should be considered in the differential diagnosis of an epidural mass in patients with or without acute leukemia, because early diagnosis followed by appropriate combined chemotherapy and radiation may obviate surgical intervention and eventually prevent leukemic transformation.
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Affiliation(s)
- Songul Serefhanoglu
- Department of Internal Medicine, Division of Hematology, Hacettepe University Medical School, Ankara, Turkey.
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Lamour C, Bergeron A. Complications pulmonaires non infectieuses des maladies myéloprolifératives et des syndromes myélodysplasiques. Rev Mal Respir 2009; 26:655-65. [DOI: 10.1016/s0761-8425(09)74695-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Spinal epidural granulocytic sarcoma in non-leukemic patient. Int J Hematol 2009; 89:95-97. [PMID: 19109732 DOI: 10.1007/s12185-008-0227-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 10/29/2008] [Accepted: 11/10/2008] [Indexed: 02/03/2023]
Abstract
A previously healthy 24-year-old male presented with a 3-month history of progressive backache and weakness in both legs. Magnetic resonance imaging of the spine showed a large soft tissue mass infiltrating paraspinal musculature of lumbosacral area, sacral laminas, last lumbar and all sacral vertebra, protruding into the spinal canal, and with propagation into pelvis. Baseline laboratory data were normal. Decompressive laminectomy and tumor removal were performed resulting in neurological improvement. Histological examination identified granulocytic sarcoma (GS). Bone marrow biopsy showed normal findings. The patient underwent adjuvant chemotherapy and radiotherapy, resulting in the elimination of residual lesion, followed by autologous transplant. Immediate diagnosis and adequate systematic treatment are essential to achieve optimal results in patients with isolated GS. The patient is alive and free of the disease 14 months from the diagnosis.
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