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Pace M, Guadagno E, Russo D, Gencarelli A, Carlea A, Di Spiezio A, Bertuzzi C, Mascolo M, Grimaldi F, Insabato L. Myeloid Sarcoma of the Breast as Blast Phase of JAK2-Mutated (Val617Phe Exon 14p) Essential Thrombocythemia: A Case Report and a Systematic Literature Review. Pathobiology 2022; 90:123-130. [PMID: 35850113 DOI: 10.1159/000525163] [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: 07/17/2021] [Accepted: 05/12/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Myeloid sarcoma (MS) is a mass-forming proliferation of myeloid blasts. Frequently, it arises as blast phase of pre-existing myeloproliferative, myelodysplastic disorders or consequent to bone marrow transplant. Its molecular characterization has become an increasingly important requirement for the diagnostic definition of this solid leukemia. CASE PRESENTATION Our case report concerns an MS arising in the breast of a woman with a previous diagnosis of JAK2-mutated essential thrombocythemia (Val617Phe exon 14p) mimicking, on histology, a lobular carcinoma of the breast. The immunohistochemical study of the neoplasm provided the key that solved the diagnostic doubt and the immunohistochemical evaluation of NPM protein expression, which turn out to be negative, provided a clear indication on the molecular status and prognosis of the disease. A year later, the neoplasm relapsed in the pelvic area. DISCUSSION This diagnostic challenge led us to review the literature of the past 10 years concerning MS of the breast. To the best of our knowledge, this was the first case of MS of the breast occurring in a patient with a history of essential thrombocythemia and recurred in the pelvic region.
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Affiliation(s)
- Mirella Pace
- Department of Advanced Biomedical Sciences, Pathology Section- Federico II University Hospital of Naples, Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, Pathology Section- Federico II University Hospital of Naples, Naples, Italy
| | - Daniela Russo
- Department of Advanced Biomedical Sciences, Pathology Section- Federico II University Hospital of Naples, Naples, Italy
| | - Annarita Gencarelli
- Department of Advanced Biomedical Sciences, Pathology Section- Federico II University Hospital of Naples, Naples, Italy
| | - Annunziata Carlea
- Department of Neurosciences, Reproductive Sciences and Dentistry, Gynecology Unit-Federico II University Hospital of Naples, Naples, Italy
| | - Attilio Di Spiezio
- Department of Public Health, Gynecology Unit-Federico II University Hospital of Naples, Naples, Italy
| | - Clara Bertuzzi
- Department of Experimental, Diagnostic and Specialty Medicine, Hematopathology Unit, University of Bologna, Bologna, Italy
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, Pathology Section- Federico II University Hospital of Naples, Naples, Italy
| | - Francesco Grimaldi
- Department of Clinical Medicine and Surgery, Hematology Unit, Federico II University Hospital of Naples, Naples, Italy
| | - Luigi Insabato
- Department of Advanced Biomedical Sciences, Pathology Section- Federico II University Hospital of Naples, Naples, Italy,
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Nicosia L, Latronico A, Farina M, Bozzini AC, Baratella P, Galimberti VE, Fiori S, Montesano M, Cassano E. Myeloid sarcoma of the breast: a pathology that should not be forgotten. Ecancermedicalscience 2020; 14:1160. [PMID: 33574905 PMCID: PMC7864689 DOI: 10.3332/ecancer.2020.1160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Indexed: 11/24/2022] Open
Abstract
Myeloid sarcoma (MS) is a rare neoplasm, represented by a tumoural mass composed of myeloid blasts, occurring at any anatomical site other than the bone marrow. MS is considered the tissue-based equivalent of acute myeloid leukaemia (AML), requiring the same therapeutic specification, independently from the association with previous or coexisting myeloid neoplasms. Isolated breast involvement by MS is exceedingly rare, with only exceptional cases reported in the literature. This work aims to provide a pictorial essay of the main features of breast involvement by MS. Even though it is a rare condition, we should not forget this neoplasm, and its possibility of being disguised by the AML, as it requires prompt treatment.
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Affiliation(s)
- Luca Nicosia
- Department of Breast Radiology, European Institute of Oncology, 20141 Milan, Italy
| | - Antuono Latronico
- Department of Breast Radiology, European Institute of Oncology, 20141 Milan, Italy
| | - Mariagiorgia Farina
- Department of Breast Radiology, European Institute of Oncology, 20141 Milan, Italy
| | - Anna Carla Bozzini
- Department of Breast Radiology, European Institute of Oncology, 20141 Milan, Italy
| | - Paola Baratella
- Division of Breast Surgery, IEO, European Institute of Oncology, 20141 Milan, Italy
| | | | - Stefano Fiori
- Division of Pathology and Laboratory Medicine, IEO, European Institute of Oncology, 20141 Milan, Italy
| | - Marta Montesano
- Department of Radiological Sciences, Oncology and Pathology, I.C.O.T. Hospital, 'Sapienza' University of Rome, 04100 Latina, Italy
| | - Enrico Cassano
- Department of Breast Radiology, European Institute of Oncology, 20141 Milan, Italy
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Kim SJ, Kim WG. Sonographic Features of a Myeloid Sarcoma of the Breast as a Relapse of Acute Myeloid Leukemia After Stem-Cell Transplantation: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:612-619. [PMID: 31030205 PMCID: PMC6501734 DOI: 10.12659/ajcr.915453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patient: Female, 24 Final Diagnosis: Myeloid sarcoma of the breast Symptoms: Breast lump Medication: — Clinical Procedure: Core needle biopsy Specialty: Radiology
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Affiliation(s)
- Suk Jung Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Woo Gyeong Kim
- Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
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Zhai J, Kong X, Yang X, Gao J, Xuan L, Wang X, Wang J, Fang Y. An uncommon granulocytic sarcoma of the breast: a case report and literature review. Onco Targets Ther 2018; 11:3685-3690. [PMID: 29983576 PMCID: PMC6026916 DOI: 10.2147/ott.s149149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Granulocytic sarcoma (GS) is an uncommon extramedullary manifestation of acute myeloid leukemia. GS is often likely to be clinically misdiagnosed as another type of primary breast cancer due to its rarity. We report an uncommon case of breast GS in a patient and review the relevant literature.
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Affiliation(s)
- Jie Zhai
- Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Xue Yang
- Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Jidong Gao
- Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Lixue Xuan
- Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Xiang Wang
- Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, ;
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Huang XE, Li YJ, Zhou XD. Granulocytic sarcoma of the breast: A case report. Oncol Lett 2015; 10:2447-2449. [PMID: 26622868 DOI: 10.3892/ol.2015.3532] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 06/23/2015] [Indexed: 02/06/2023] Open
Abstract
Granulocytic sarcoma (GS) is an unusual type of tumor composed of immature cells outside the bone marrow. The disease exhibits a correlation with acute myeloid leukemia and other myeloproliferative disorders. Although it can invade a number of areas of the body, the involvement of the breast is uncommon. The present study reports the case of a 58-year-old female with a mildly tender lump in the left breast that had been apparent for one year. Available diagnostic techniques, including ultrasound, magnetic resonance imaging and mammography, were systematically used to determine a diagnosis of GS, and lumpectomy and systemic chemotherapy were performed. The patient was satisfied with the result of no local recurrence at the one year follow-up examination. The present study discusses the clinical and pathological characteristics of the present case of GC.
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Affiliation(s)
- Xiao-E Huang
- Department of Surgical Oncology, Yuyao People's Hospital of Zhejiang, Yuyao, Zhejiang 315400, P.R. China
| | - Yu-Jie Li
- Department of Surgical Oncology, Yuyao People's Hospital of Zhejiang, Yuyao, Zhejiang 315400, P.R. China
| | - Xiao-Dong Zhou
- Department of Surgical Oncology, Yuyao People's Hospital of Zhejiang, Yuyao, Zhejiang 315400, P.R. China
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Gonçalves J, Louro LV, Ribeiro I, Oliveira A, Castro C. Radiotherapy for granulocytic sarcoma of the breast-Case report and review of the literature. Rep Pract Oncol Radiother 2014; 19:343-6. [PMID: 25184060 DOI: 10.1016/j.rpor.2014.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 02/26/2014] [Indexed: 11/30/2022] Open
Abstract
Granulocytic sarcomas are rare tumors that can present in innumerous locations; thus there is very little clinical experience with these cases. Therefore there is no consensus on which is the best treatment for patients with this malignancy. The authors present a case of a female with a granulocytic sarcoma of the breast and review the literature for the role of radiotherapy in the management of this clinical entity.
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Affiliation(s)
- Joana Gonçalves
- Radiotherapy Department, Instituto Português de Oncologia do Porto de Francisco Gentil, E.P.E, Portugal
| | - Luís Vasco Louro
- Radiotherapy Department, Instituto Português de Oncologia do Porto de Francisco Gentil, E.P.E, Portugal
| | - Ivone Ribeiro
- Radiotherapy Department, Instituto Português de Oncologia do Porto de Francisco Gentil, E.P.E, Portugal
| | - Angelo Oliveira
- Radiotherapy Department, Instituto Português de Oncologia do Porto de Francisco Gentil, E.P.E, Portugal
| | - Carla Castro
- Radiotherapy Department, Instituto Português de Oncologia do Porto de Francisco Gentil, E.P.E, Portugal
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Emre JC, Baysak A, Oz AT, Ece G, Arda B, Bacakoglu F. Vancomycin resistant enterococcus bacteremia in a patient with Pneumocystis jiroveci pneumonia, granulocystic sarcoma and acute respiratory distress syndrome. Pan Afr Med J 2014; 17:49. [PMID: 25018799 PMCID: PMC4085949 DOI: 10.11604/pamj.2014.17.49.3246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/24/2013] [Indexed: 11/11/2022] Open
Abstract
In this case report we aimed to present a patient with granulocytic sarcomaa, neutropenic fever, ARDS and Pneumocystis jirovecii pneumoniae that was hospitalized in our intensive care unit. The patient recovered and then developed vancomycin resistant enterococci (VRE) bacteremia due to port catheter during follow up. The patient had risk factors for VRE bacteremia and he was administered linezolide without removing the catheter. He was discharged with recovery.
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Affiliation(s)
| | - Aysegul Baysak
- Izmir University School of Medicine, Department of Chest Diseases, Izmir, Turkey
| | - Adnan Tolga Oz
- Izmir University School of Medicine, Department of Chest Diseases, Izmir, Turkey
| | - Gulfem Ece
- Izmir University School of Medicine, Department of Medical Microbiology, Izmir, Turkey
| | - Bilgin Arda
- Ege University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Feza Bacakoglu
- Ege University School of Medicine, Department of Chest Diseases, Izmir, Turkey
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Abstract
Breast leukemia is extremely rare. Only 7 other reports describe its magnetic resonance (MR) imaging findings. This report describes a case of breast leukemia presenting as isolated intramammary leukemic relapse in the breasts after complete remission of acute myeloid leukemia. Dynamic contrast-enhanced MR imaging showed diffuse heterogeneous non-mass-like enhancement in one breast and a diffuse irregular heterogeneously enhancing mass in the other. Previous reports of MR imaging findings in breast leukemia have included only mass-like lesions; hence, the finding reported here is uncommon.
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Affiliation(s)
- Suk Jung Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine
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Abstract
BACKGROUND Breast leukemia is extremely rare. The published data on this manifestation include predominantly case reports and do not provide any statistical information. PURPOSE To identify clinical signs and radiological features of breast leukemia. MATERIAL AND METHODS PubMed and Medline databases between 1980 and 2010 were screened using 'breast leukemia' and 'leukemia of the breast' as keywords. Secondary references were also reviewed. By this search, a total of 139 patients were identified from the literature. RESULTS In most patients (n = 85, 61.2%) acute myeloid leukemia was diagnosed. Acute lymphatic leukemia occurred in 35 patients (25.2%). Isolated BL before bone marrow infiltration was seen in 24 patients (17.3%). Involvement of the breast during the course of leukemia was diagnosed in 25 cases (18%). Intramammary leukemic relapse after therapy/stem cell transplantation occurred in 59 patients (42.4%). In 71 cases (51.1%) the lesions were solitary and in 57 (41%) multiple. The number of lesions was not reported in 11 patients (7.9%). There was no significant difference between the number of lesions in ML and LL. Clinically, 73% of the patients presented with palpable breast masses. Most of them were painless. Mammography was performed in 39 patients, allowing the identification of the following three mammographic patterns: breast masses (28 patients, 72%), architectural distortion (5 patients, 13%), no abnormalities (6 patients, 15%). On ultrasound, most identified masses were homogeneously hypoechoic with microlobulated or indistinct margins. On MRI, on T2-weighted images breast lesions were hyperintense. After venous administration of contrast medium, BL showed marked inhomogeneous contrast enhancement. Treatment of BL is the same as for other localizations and is based on chemotherapy and/or radiotherapy. CONCLUSION In the present study the clinical and radiological features of BL are described. They are non-specific. However, BL should be considered in the differential diagnosis of breast disorders, especially in patients with leukemia.
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Affiliation(s)
| | - Andreas Wienke
- Department of Medical Epidemiology, Biometry and Informatics, Martin-Luther-University of Halle-Wittenberg, Halle, Germany
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Baek JH, Lee JC, Lee JH, Kim JH, Kim MJ. Granulocytic Sarcoma Involving the Pectoralis Muscle in a Patient with Chronic Myelogenous Leukemia. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.4.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jong Hyun Baek
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University
| | - Jung Cheul Lee
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University
| | - Jang Hoon Lee
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University
| | - Jung Hee Kim
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University
| | - Mi Jin Kim
- Department of Pathology, College of Medicine, Yeungnam University
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Abstract
The breast continues to be reported as a site of resistant leukemia despite current curative protocols. To characterize disease behavior and potential for lengthy survival after breast relapse, a study was undertaken of 153 cases reported between 1969 and 2005. Authors were contacted for follow-up. There were 105 AML and 48 ALL cases identified. Ninety percent of female patients were younger than 50 and leukemia was temporally related to pregnancy in 13. Eight cases were males. Remissions were typically of short duration, principally due to further extramedullary relapses, in 3 main sites in both AML and ALL: contralateral breast, gynecologic organs, and CNS. However, there are cases of disease-free survival up to 26+ years after intensive treatment. Leukemia growing in the breast may follow a distinctive pattern, and prompt initiation of intensive multi-cycle treatment, assuming occult site involvement, with consideration of CSF prophylaxis, should increase the potential for disease eradication.
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Sung CO, Ko YH, Park CK, Jang KT, Heo JS. Isolated biliary granulocytic sarcoma followed by acute myelogeneous leukemia with multilineage dysplasia: a case report and literature review. J Korean Med Sci 2006; 21:550-4. [PMID: 16778404 PMCID: PMC2729966 DOI: 10.3346/jkms.2006.21.3.550] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Granulocytic sarcoma is a rare extramedullary tumor composed of myeloid progenitor cells. Primary involvement of the biliary tract without evidence of leukemia is exceedingly rare. Here, we report an isolated biliary granulocytic sarcoma in a 30-yr-old man who presented with jaundice, fever, and chill without any evidence of leukemia. However, five months after the diagnosis, he developed acute myelogenous leukemia with multilineage dysplasia and chromosomal abnormality. A rare possibility of biliary granulocytic sarcoma should be considered as a differential diagnosis in patients with obstructive jaundice. A histologic evaluation by aggressive diagnostic intervention is important and may improve prognosis.
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Affiliation(s)
- Chang Ohk Sung
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol Keun Park
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kee Taek Jang
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Heo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hsueh HC, Chou YH, Tiu CM, Hsu CY, Su CH. Primary Granulocytic Sarcoma Presenting as Bilateral Breast Masses. J Med Ultrasound 2006. [DOI: 10.1016/s0929-6441(09)60085-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
Abstract
Context.—Myeloid sarcoma is a neoplasm of myeloid cells that can arise before, concurrent with, or following acute myeloid leukemia. Rarely, it can also occur as an isolated mass.
Objective.—To describe the clinicopathologic features of 6 patients with myeloid sarcoma involving the breast.
Design.—Clinical information for all 6 patients was obtained from the medical record. Routine hematoxylin-eosin–stained slides; naphthol AS-D chloroacetate stain; and immunohistochemical stains for myeloid, B-cell, and T-cell antigens were prepared.
Results.—There were 6 women with a median age of 52 years (range, 31–73 years). Two patients presented with isolated tumors of the breast, with no history or subsequent development of acute myeloid leukemia. In 3 patients, the breast tumors represented relapse of acute myeloid leukemia. One patient who presented initially with myeloid sarcoma involving the breast, skin, and spleen was lost to follow-up. Histologically, these tumors were classified as well differentiated (n = 3), poorly differentiated (n = 2), and blastic (n = 1). Naphthol AS-D chloroacetate esterase was positive in all 3 cases assessed. Immunohistochemistry showed that myeloperoxidase (n = 5) and CD43 (n = 3) were positive, and CD3 (n = 5) and CD20 (n = 5) were negative in all cases assessed. Lysozyme was positive in 4 (80%) of 5; CD117 was positive in 2 (67%) of 3; and single cases were positive for CD45 (1/3), TdT (1/2), CD79a, and the PAX5 gene product.
Conclusions.—Myeloid sarcoma involving the breast is uncommon. In the literature, as in this study, these tumors most often represent relapse or the initial presentation of acute myeloid leukemia. However, 2 of the cases we report presented with isolated masses, without a history or subsequent development of acute myeloid leukemia at last follow-up. Immunohistochemical studies are extremely helpful for recognizing isolated myeloid sarcoma.
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Affiliation(s)
- Jose R Valbuena
- Department of Hematopathology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA
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