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Gündoğdu F, Agaimy A, Aytaç S, Hazar V, Üner A, Kösemehmetoğlu K. Myeloid sarcoma with RBM15::MRTFA (MKL1) mimicking vascular neoplasm. Virchows Arch 2024:10.1007/s00428-024-03766-z. [PMID: 38374236 DOI: 10.1007/s00428-024-03766-z] [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: 12/18/2023] [Revised: 01/24/2024] [Accepted: 02/09/2024] [Indexed: 02/21/2024]
Abstract
Extramedullary involvement of acute myeloid leukemia (AML), aka myeloid sarcoma, is a rare phenomenon in acute megakaryoblastic leukemia with RBM15:: MRTFA(MKL1) fusion, which might mimic non-hematologic malignancies. A 7-month-old infant presented with leukocytosis, hepatosplenomegaly, multiple lymphadenopathies, and a solid mass in the right thigh. Initially, the patient was diagnosed with a malignant vascular tumor regarding the expression of vascular markers from the biopsy of the right thigh lesion that was performed after the inconclusive bone marrow biopsy. The second bone marrow biopsy, which was performed due to the partial response to sarcoma treatment, showed hypercellular bone marrow with CD34 and CD61-positive spindle cell infiltration and > 20% basophilic blasts with cytoplasmic blebs. RNA sequencing of soft tissue biopsy revealed the presence of RBM15::MRTFA(MKL1) fusion. Based on these findings, myeloid sarcoma/AML with RBM15::MRTFA(MKL1) fusion diagnosis was made. AML with RBM15::MRTFA(MKL1) fusion can initially present as extramedullary lesions and might cause misdiagnosis of non-hematologic malignancies.
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Affiliation(s)
- Fatma Gündoğdu
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Abbas Agaimy
- Department of Pathology, Erlangen University, Erlangen, Germany
| | - Selin Aytaç
- Department of Pediatric Hematology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Volkan Hazar
- Department of Pediatric Oncology, Akdeniz University, Antalya, Türkiye
| | - Ayşegül Üner
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Kemal Kösemehmetoğlu
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Türkiye.
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Gu Y, Zheng H, Mo S, Guo T, Chen L, Yang J, Xiang Y. De novo myeloid sarcoma mimicking gynecological tumors: a retrospective case series of eight patients. BMC Womens Health 2023; 23:141. [PMID: 36978050 PMCID: PMC10053749 DOI: 10.1186/s12905-023-02278-3] [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: 01/30/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE To describe myeloid sarcoma (MS) that mimic gynecological tumors and provide guidelines for improving the diagnosis and treatment of patients. METHODS This case series study retrospectively analyzed the clinicopathological characteristics and oncological outcomes of female patients who were histologically diagnosed with MS after initially presenting with reproductive-system tumors at the Peking Union Medical College Hospital between January 2000 and March 2022. RESULTS There were eight cases in which MS mimicked cervical cancer, ovarian cancer, or hysteromyoma. Six patients had isolated MS, and the other two had acute myeloid leukemia (AML)-M2. The average age was 39.00 ± 14.26. They each sought advice from a gynecological oncologist at the initial visit, complaining of irregular bleeding (3/8), low abdominal pain (3/8), dysmenorrhea (1/8), or an accidentally found mass (1/8). CT/MRI exams revealed that the average tumor size reached 5.65 ± 2.35 cm, with 50% of the tumors being larger than 8 cm. The final diagnoses were confirmed by biopsy (2/8) or postoperative pathology (6/8); the most frequent positive immunohistochemical markers were Ki-67 (60-90%), MPO (100%), LCA (62.5%), CD43 (62.5%), CD117 (62.5%), CD99 (50%), vimentin (37.5%), and lysozyme (25%). MLL/AF9 gene fusions and CEBPA, JAK2, NRAS, and FLT3-TKD mutations were found in the patients. Six (75%) of the patients showed a complete response after upfront treatment using chemotherapy + surgery and experienced no recurrence during follow-up. The overall survival (OS) rate was 72.9%, and the 5-year OS rate was 72.9% (95%CI: 0.4056-1.000). The median OS was 26 months (range: 3-82). CONCLUSION For patients with isolated MS, treatment by chemotherapy and surgery are radical procedure, and initial treatment using chemotherapy alone should be considered for MS with synchronous intramedullary AML. Poor response to chemotherapy, short interval to leukemia occurrence, and heavy tumor burden (> 10 cm) could indicate a poor prognosis for patients with MS.
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Affiliation(s)
- Yu Gu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Haoran Zheng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shengwei Mo
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tao Guo
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lihua Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Junjun Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Li DP, Liu CZ, Jeremy M, Li X, Wang JC, Nath Varma S, Gai TT, Tian WQ, Zou Q, Wei YM, Wang HY, Long CJ, Zhou Y. Myeloid sarcoma with ulnar nerve entrapment: A case report. World J Clin Cases 2022; 10:10227-10235. [PMID: 36246824 PMCID: PMC9561602 DOI: 10.12998/wjcc.v10.i28.10227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/25/2022] [Accepted: 08/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Myeloid sarcoma (MS) is relatively rare, occurring mainly in the skin and lymph nodes, and MS invasion of the ulnar nerve is particularly unusual. The main aim of this article is to present a case of MS invading the brachial plexus, causing ulnar nerve entrapment syndrome, and to further clinical understanding of the possibility of MS invasion of peripheral nerves.
CASE SUMMARY We present the case of a 46-year-old man with a 13-year history of well-treated acute nonlymphocytic leukaemia who was admitted to the hospital after presenting with numbness and pain in his left little finger. The initial diagnosis was considered a simple case of nerve entrapment disease, with magnetic resonance imaging showing slightly abnormal left brachial plexus nerve alignment with local thickening, entrapment, and high signal on compression lipid images. Due to the severity of the ulnar nerve compression, we surgically investigated and cleared the entrapment and nerve tissue hyperplasia; however, subsequent pathological biopsy results revealed evidence of MS. The patient had significant relief from his neurological symptoms, with no postoperative complications, and was referred to the haemato-oncology department for further consultation about the primary disease. This is the first report of safe treatment of ulnar nerve entrapment from MS. It is intended to inform hand surgeons that nerve entrapment may be associated with extramedullary MS, as a rare presenting feature of the disease.
CONCLUSION MS invasion of the brachial plexus and surrounding tissues of the upper arm, resulting in ulnar nerve entrapment and degeneration with significant neurological pain and numbness in the little finger, is uncommon. Surgical treatment significantly relieved the patient’s nerve entrapment symptoms and prevented further neurological impairment. This case is reported to highlight the rare presenting features of MS.
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Affiliation(s)
- Da-Peng Li
- Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Hand and Foot Microsurgery, Yantai 264009, Shandong Province, China
| | - Chao-Zong Liu
- University College London, Royal National Orthopaedic Hospital, London HA7 4LP, United Kingdom
| | - Mortimer Jeremy
- University College London, Royal National Orthopaedic Hospital, London HA7 4LP, United Kingdom
| | - Xin Li
- Jilin Ginseng Academy, Changchun University of Chinese Medicine, Changchun 130000, Jilin Province, China
| | - Jin-Chao Wang
- Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Hand and Foot Microsurgery, Yantai 264009, Shandong Province, China
| | - Swastina Nath Varma
- University College London, Royal National Orthopaedic Hospital, London HA7 4LP, United Kingdom
| | - Ting-Ting Gai
- Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Hand and Foot Microsurgery, Yantai 264009, Shandong Province, China
| | - Wei-Qi Tian
- Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Hand and Foot Microsurgery, Yantai 264009, Shandong Province, China
| | - Qi Zou
- Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Hand and Foot Microsurgery, Yantai 264009, China
| | - Yan-Mian Wei
- Yantai Hospital of Shandong Wendeng Osteopathic & Traumatology, Hand and Foot Microsurgery, Yantai 264009, Shandong Province, China
| | - Hao-Yu Wang
- University College London, Royal National Orthopaedic Hospital, London HA7 4LP, United Kingdom
| | - Chang-Jiang Long
- Qinhai University, Medical Institute, Xining 810000, Qinhai Province, China
| | - Yu Zhou
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun 130000, Jilin Province, China
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Gutiérrez-Jimeno M, Panizo-Morgado E, Calvo-Imirizaldu M, Galán-Gómez V, Escudero-López A, Patiño-García A. Case Report: The Value of Genomic Analysis in a Case of Megakaryoblastic Leukemia With Atypical Initial Manifestation. Front Pediatr 2022; 10:875510. [PMID: 35844738 PMCID: PMC9277000 DOI: 10.3389/fped.2022.875510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/09/2022] [Indexed: 02/01/2023] Open
Abstract
We report the case of a 7-month-old female patient who developed acute megakaryoblastic leukemia 6 months after the appearance of skull bone lesions. Initial evaluation and diagnosis of this patient were challenging and only achieved thanks to genomic analysis by NGS (next generation sequencing). It is unusual for the initial manifestation of acute megakaryoblastic leukemia to be a skull bone lesion. Extramedullary acute myeloid leukemia (eAML), also known as myeloid sarcoma (MS), often occurs simultaneously with acute myeloid leukemia (AML), although it may precede AML. Genomic analysis based on a NGS panel (Oncomine Childhood Cancer Research Assay) detected a RBM15::MKL1 fusion, a consequence of a t (1;22)(p13;q13) translocation, establishing the diagnosis of acute megakaryoblastic leukemia and enabling disease follow-up by qPCR. A diagnosis of eAML is built up from various findings in radiological, histological, immunophenotypic and genomic studies; when the tumor appears de novo, diagnosis is more complicated. We emphasize the importance of a multidisciplinary team in the initial approach to rare tumors and the use of genomic studies to contribute to the knowledge of these neoplasms, risk stratification and treatment planning.
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Affiliation(s)
| | | | - Marta Calvo-Imirizaldu
- Division of Neuroradiology, Department of Radiology, University Clinic of Navarra, Pamplona, Spain
| | - Víctor Galán-Gómez
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, La Paz University Hospital, Madrid, Spain
| | - Adela Escudero-López
- Pediatric Molecular Hemato-Oncology Section, Department of Genetics, Institute of Medical and Molecular Genetics (INGEMM), La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - Ana Patiño-García
- Department of Pediatrics, University Clinic of Navarra, Pamplona, Spain.,Solid Tumor Program, CIMA, Center for Applied Medical Research and IdiSNA, Pamplona, Spain
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