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Gallardo MS, Joyrich R, Taub JW. Pediatric acute myeloid leukemia with breast chloromas. EJHAEM 2023; 4:488-490. [PMID: 37206254 PMCID: PMC10188463 DOI: 10.1002/jha2.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 05/21/2023]
Affiliation(s)
- Maria S. Gallardo
- Division of Pediatric Hematology/OncologyChildren's Hospital of MichiganDetroitMichiganUSA
| | - Richard Joyrich
- Department of Hematology‐OncologyKarmanos Cancer Institute, Wayne State UniversityDetroitMichiganUSA
| | - Jeffrey W. Taub
- Division of Pediatric Hematology/OncologyChildren's Hospital of MichiganDetroitMichiganUSA
- Discipline of PediatricsCentral Michigan University College of MedicineDetroitMichiganUSA
- Department of PediatricsWayne State University School of MedicineDetroitMichiganUSA
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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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Clinicopathological analysis of myeloid sarcoma with megakaryocytic differentiation. Pathology 2021; 54:442-448. [PMID: 34852914 DOI: 10.1016/j.pathol.2021.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/18/2021] [Accepted: 08/27/2021] [Indexed: 12/15/2022]
Abstract
Myeloid sarcoma (MS) is defined as a tumour mass consisting of myeloid blasts that occurs at an anatomical site other than bone marrow. MS with megakaryocytic differentiation (MSmgk) is extremely rare and its clinicopathological features have not been well described. We reviewed 11 cases in 11 patients of extramedullary mass-forming malignant tumours composed of immature non-lymphoid haematopoietic cells expressing CD41 with or without concurrent bone marrow lesions. The patients consisted of seven men and four women (1.75:1 male-to-female ratio). The mean and median ages at diagnosis were 50 and 62 years, respectively, ranging from 2 to 78 years. Extramedullary mass lesions were solitary in three cases (27%) and multiple in eight cases (73%). Tumour locations were lymph nodes (6 cases), subcutaneous tissue (3 cases), intramuscular (1 case), and bone (1 case). Seven of the 11 patients (64%) had a history of myelodysplastic syndrome (MDS) or myeloproliferative neoplasm (MPN). Three patients (27%) developed MS during remissions of acute myelogenous leukaemia, and one patient had a recurrence of MS at other sites. Follow-up data were available for four cases. Tumour cells were positive for CD41, CD33, CD34, MPO, and CD68 in 11 (100%), three (27%), seven (64%), four (36%), and seven (64%) cases, respectively. Cytogenetic analysis was successfully performed in two cases. Complex but inconsistent abnormalities were evident. When compared with cases of MS without megakaryocytic differentiation, the survival of MSmgk was significantly shorter (p=0.0033). Compared to MS without megakaryocytic differentiation, MSmgk is more likely to follow MDS/MPN, to involve multiple sites, and to be associated with poorer outcomes. More detailed studies, including genomic or gene expression analyses, could confirm the characteristics of MSmgk.
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Huang C, Fei S, Yao J, Chen P, Luo J, Wang Y, Li J, Wang W. Breast myeloid sarcoma presenting as a palpable breast lump after allogeneic stem cell transplantation for acute myelomonocytic leukemia: a rare case report. World J Surg Oncol 2021; 19:289. [PMID: 34579724 PMCID: PMC8477564 DOI: 10.1186/s12957-021-02399-9] [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: 07/06/2021] [Accepted: 09/14/2021] [Indexed: 12/17/2022] Open
Abstract
Background Myeloid sarcoma (MS) is a tumor secondary to myeloid leukemia that consists of immature granulocytes with or without mature granulocytes and is a rare extramedullary manifestation of acute myeloid leukemia (AML). Case presentation We report a case of a 34-year-old woman diagnosed with AML-M4 who achieved remission after chemotherapy and received allogeneic stem cell transplantation (allo-SCT) for consolidation. Her past medical history showed that she received bilateral breast implants 7 years ago. This patient underwent ultrasound examination of the breast and multiple bilateral breast nodules were revealed that were not considered by clinicians to be concerning. Several months later, the patient’s bilateral nodules rapidly progressed to large palpable masses. Ultrasound-guided biopsy revealed diffuse infiltration of undifferentiated tumor cells and immunohistochemistry (IHC) indicated that the tumor was positive for myeloperoxidase (MPO), cluster of differentiation (CD) 34, CD43, CD68, CD117, and Ki67. The pathological diagnosis was extramedullary recurrence of AML as MS of breast. After the diagnosis, the patient received systemic chemotherapy and drugs containing cytarabine, azacitidine, and methotrexate. However, 1 year after achieving partial remission, the patient died from intracranial invasion of leukemia, brain herniation, and respiratory failure. Conclusion It is necessary for the specialist to have a high suspicion index by careful inquiry of the patient’s medical history if a patient presents at the breast clinic with a breast tumor as the chief complaint. Combining information from the patient’s medical history with a tumor biopsy is critical for obtaining the correct diagnosis of the disease.
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Affiliation(s)
- Chengmin Huang
- Department of Surgery, Changxing People's Hospital, No. 66, Taihu Road, Changxing, Huzhou, 313100, China
| | - Shengqi Fei
- Department of Surgery, Changxing People's Hospital, No. 66, Taihu Road, Changxing, Huzhou, 313100, China
| | - Jiang Yao
- Department of Surgery, Changxing People's Hospital, No. 66, Taihu Road, Changxing, Huzhou, 313100, China
| | - Panpan Chen
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Jiaqing Luo
- Department of Surgery, Changxing People's Hospital, No. 66, Taihu Road, Changxing, Huzhou, 313100, China
| | - Yaqi Wang
- Department of Surgery, Changxing People's Hospital, No. 66, Taihu Road, Changxing, Huzhou, 313100, China
| | - Jie Li
- Department of Surgery, Changxing People's Hospital, No. 66, Taihu Road, Changxing, Huzhou, 313100, China
| | - Weilan Wang
- Department of Surgery, Changxing People's Hospital, No. 66, Taihu Road, Changxing, Huzhou, 313100, China.
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Chaudhary H, Aboushi H, Minkowitz J, Edwards JA, Beltre D, Parmar P, Breitman I, Luhrs C, McFarlane SI. Liver Granulocytic Sarcoma With Megakaryocytic Differentiation: A Rare Extra Medullary Involvement That Warrants Liver Biopsy for Prompt Diagnosis. Cureus 2021; 13:e16366. [PMID: 34306897 PMCID: PMC8279911 DOI: 10.7759/cureus.16366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 11/05/2022] Open
Abstract
Granulocytic sarcoma (GS) is an extramedullary manifestation of acute myeloid leukemia (AML), myelodysplastic syndrome (MDS) or myeloproliferative neoplasms. The diagnosis depends on morphology, immunohistochemistry and flow cytometry. An unusual location of this tumor may mask its primary source, therefore, a strategy involving immediate symptom control, and investigation is crucial in preventing clinical deterioration. We present a case of a 53-year-old man who initially presented with tumor lysis syndrome and transaminitis, with a subsequent CT Scan that revealed multiple liver lesions. This case describes a rare clinical entity of granulocytic sarcoma as multiple hypoattenuating liver lesions mimicking metastatic disease in its radiographic appearance. Since the imaging features of hepatic masses are nonspecific, and considering the aggressive nature of AML with concomitant tumor lysis syndrome, a confirmatory prompt biopsy should routinely be considered.
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Affiliation(s)
- Hira Chaudhary
- Department of Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Haytham Aboushi
- Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA
| | - Jeremy Minkowitz
- Department of Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Jodi-Ann Edwards
- Department of Surgery, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Daniel Beltre
- College of Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Priyanka Parmar
- College of Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Igal Breitman
- Department of Surgery, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Carol Luhrs
- Department of Hematology and Oncology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Samy I McFarlane
- Department of Internal Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
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Cannatella J, Ganapathi K, Horvai A. Hematolymphoid Neoplasms Rarely Mimic Undifferentiated Pleomorphic Sarcoma of Soft Tissue. Arch Pathol Lab Med 2021; 144:1547-1552. [PMID: 32167380 DOI: 10.5858/arpa.2019-0580-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Undifferentiated pleomorphic sarcoma (UPS) of soft tissue is defined as a sarcoma with no recognizable line of differentiation. During the past few decades, advances in ancillary studies and review of prior UPS diagnoses have narrowed the category of UPS by excluding more-specific malignancies. However, few of those studies have specifically targeted pleomorphic hematolymphoid neoplasms. OBJECTIVE.— To determine what fraction of UPS cases are misclassified pleomorphic hematolymphoid neoplasms, such as anaplastic large cell lymphoma, diffuse large B-cell lymphoma, histiocytic sarcoma (HS), myeloid sarcoma, and follicular dendritic cell sarcoma. DESIGN.— Sixty-one UPS cases were screened by tissue microarray and an immunostain panel with subsequent analysis on whole block sections for suspicious cases. RESULTS.— Five of 61 tumors (8%) were suggestive of HS based on the screening panel and were further evaluated with additional immunostains (PU.1, CD45, CD163) using whole sections. The 5 candidate HS cases were only focally positive for at most one stain with most staining in smaller, less-pleomorphic cells. Ultimately, no UPS met criteria for anaplastic large cell lymphoma, diffuse large B-cell lymphoma, myeloid sarcoma, follicular dendritic cell sarcoma, or HS. CONCLUSIONS.— Our results suggest that a UPS of somatic soft tissue is unlikely to represent a misclassified hematopoietic malignancy. Exclusion of HS is most challenging, but immunostaining for PU.1, a nuclear transcription factor, may be easier to interpret in this context.
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Affiliation(s)
- John Cannatella
- From the Department of Pathology (Cannatella, Horvai), University of California, San Francisco, San Francisco.,Cannatella is now with the Department of Pathology, University of Arkansas for Medical Sciences, Little Rock
| | - Karthik Ganapathi
- Department of Laboratory Medicine (Ganapathi), University of California, San Francisco, San Francisco
| | - Andrew Horvai
- From the Department of Pathology (Cannatella, Horvai), University of California, San Francisco, San Francisco
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