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Chen TH, Roelofs KA, Goh T, Pullarkat S, Goldberg RA, Rootman DB. Orbital Involvement in Acute Adult Leukemias: Case Series and Review of Literature. Ophthalmic Plast Reconstr Surg 2023; 39:e107-e111. [PMID: 37083726 DOI: 10.1097/iop.0000000000002369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Orbital involvement in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) is well-described in children but is uncommon in adults. This series reports 2 adult patients with orbital leukemic involvement and summarizes the existing literature. A 37-year-old male with recently diagnosed AML underwent induction therapy and subsequently developed a tan-pink colored sub-conjunctival lesion in the left eye. Incisional biopsy confirmed AML. A 35-year-old male with history of ALL presented with left-sided orbital mass. Fine needle aspiration biopsy confirmed ALL. Literature review of adult-onset orbital leukemia yielded 29 cases of AML and 3 cases of ALL. Orbital involvement of acute adult-onset leukemia tends to be unilateral, presents in the extraconal space and can occur at any point during systemic leukemic disease. Chemotherapy is the mainstay of treatment, often in combination with radiation and/or hematopoietic stem cell transplant.
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Affiliation(s)
- Teresa H Chen
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Tracie Goh
- Department of Pathology, University of California, Los Angeles, California, U.S.A
| | - Sheeja Pullarkat
- Department of Pathology, University of California, Los Angeles, California, U.S.A
| | - Robert A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
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El Salloukh NA, Hage DG, Bashshur AZ, Kheir WJ. Early Ophthalmological Manifestations of Acute Myeloid Leukemia: Current Perspectives. Clin Ophthalmol 2022; 16:2119-2127. [PMID: 35800672 PMCID: PMC9255417 DOI: 10.2147/opth.s342720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022] Open
Abstract
Acute myeloid leukemia (AML) is a hematological malignancy affecting different organ systems including the eye. The purpose of this review is to present and evaluate the medical literature regarding the early ophthalmological manifestations of acute myeloid leukemia. AML affects the ocular system through direct infiltration of tissues, secondary to hematological abnormalities, or in the form of chloroma or myeloid sarcoma in the brain or orbit consequently leading to a variety of manifestations depending on the ocular tissue involved. It is imperative for ophthalmologists to be aware of the early ophthalmological manifestations of AML which will allow for earlier diagnosis and treatment of this life-threatening disease.
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Affiliation(s)
| | - Dany G Hage
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Anna Z Bashshur
- Ophthalmology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wajiha Jurdi Kheir
- Ophthalmology Department, American University of Beirut Medical Center, Beirut, Lebanon
- Correspondence: Wajiha Jurdi Kheir, Department of Ophthalmology, American University of Beirut Medical Center, Cairo Street, Beirut, Lebanon, Tel +961-1-350000, Fax +961-1-370837, Email
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Vera-Aguilera J, Mukarram O, Nutalapati P, Mok M, Bulumulle A, Vera-Aguilera C. Bilateral orbital myeloid sarcoma preceding acute myeloid leukemia in an adult: a case report and review of the literature. J Med Case Rep 2016; 10:31. [PMID: 26846095 PMCID: PMC4743162 DOI: 10.1186/s13256-015-0778-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 11/30/2015] [Indexed: 11/20/2022] Open
Abstract
Background Acute myeloid leukemia is typically a disease of the older population and presents mostly in the fifth decade of life. Myeloid sarcoma is a rare initial presentation of acute myeloid leukemia. Previously it has only been documented in children and younger patients. Case Presentation We present an unusual case of retro-orbital myeloid sarcoma as an initial presentation of acute myeloid leukemia in a 43-year-old Caucasian man, with rearrangement of chromosome 11q23 involving the MLL gene. Conclusions We present an unusual case of retro-orbital myeloid sarcoma as an initial presentation of acute myeloid leukemia in a 43-year-old man, with rearrangement of chromosome 11q23 involving the MLL gene.
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Affiliation(s)
- Jesus Vera-Aguilera
- Internal Medicine Department, Texas Tech University Health Sciences Center at the Permian Basin, 800 W. 4th Street, Odessa, TX, 79763, USA.
| | - Osama Mukarram
- Internal Medicine Department, Texas Tech University Health Sciences Center at the Permian Basin, 800 W. 4th Street, Odessa, TX, 79763, USA.
| | - Prathibha Nutalapati
- Internal Medicine Department, Texas Tech University Health Sciences Center at the Permian Basin, 800 W. 4th Street, Odessa, TX, 79763, USA.
| | - Mary Mok
- Internal Medicine Department, Texas Tech University Health Sciences Center at the Permian Basin, 800 W. 4th Street, Odessa, TX, 79763, USA.
| | - Anushi Bulumulle
- Internal Medicine Department, Texas Tech University Health Sciences Center at the Permian Basin, 800 W. 4th Street, Odessa, TX, 79763, USA.
| | - Carlos Vera-Aguilera
- Departamento de Biología Celular y Tisular, Facultad de Medicina, Universidad Nacional Autónoma de México, México City, México.
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Orbital myeloid sarcoma in an adult with acute myeloid leukemia, FAB M1, and 12p-deletion. Ophthalmic Plast Reconstr Surg 2013; 29:e73-5. [PMID: 23314098 DOI: 10.1097/iop.0b013e318272d497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 49-year-old woman with acute myeloid leukemia, FAB M1 subtype, and 12p deletion, presented with progressive right proptosis and diplopia for 1 week. Orbital CT revealed a homogenously enhancing, orbital mass engulfing the inferior rectus muscle. Histopathology revealed myeloid sarcoma for which she underwent external beam radiotherapy. Subsequently, there was no sign of local recurrence, but she succumbed to leukemia involving the central nervous system. This is the first case, to the authors' knowledge, of an orbital sarcoma of FAB M1 myeloblasts bearing a 12p deletion.
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Ohanian M, Faderl S, Ravandi F, Pemmaraju N, Garcia-Manero G, Cortes J, Estrov Z. Is acute myeloid leukemia a liquid tumor? Int J Cancer 2013; 133:534-43. [PMID: 23280377 DOI: 10.1002/ijc.28012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 12/04/2012] [Accepted: 12/18/2012] [Indexed: 12/16/2022]
Abstract
Extramedullary manifestations of acute myeloid leukemia (AML) were described as early as the 19th century. However, the incidence, clinical significance and pathobiology of extramedullary AML remain ill defined. We reviewed case reports, retrospective case series, pilot studies and imaging studies of extramedullary leukemia (EML) to determine its frequency, characteristics, clinical presentation and significance. EML precedes or accompanies development of AML and occurs during or following treatment, even during remission. Although imaging studies are rarely conducted and the true incidence of EML has yet to be verified, authors have reported several estimates based on retrospective and autopsy studies. The incidence of EML in patients with AML of all ages is estimated to be about 9% and EML in children with AML was detected in 40% of patients at diagnosis. The combination of positron emission tomography and computed tomography were the most sensitive and reliable techniques of detecting and monitoring EML. Based on our literature review, the frequency of EML is likely underreported. The well-documented nature of EML in patients with AML suggests that AML can manifest as a solid tumor. The extent to which EML accompanies AML and whether EML is derived from bone marrow are unknown. Furthermore, questions remain regarding the role of the microenvironment, which may or may not facilitate the survival and proliferation of EML, and the implications of these interactions with regard to minimal residual disease, tumor cell quiescence and relapse. Therefore, prospective studies of detection and characterization of EML in patients with AML are warranted.
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Affiliation(s)
- Maro Ohanian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Ohanian M, Borthakur G, Quintas-Cardama A, Mathisen M, Cortés JE, Estrov Z, Pemmaraju N. Ocular granulocytic sarcoma: a case report and literature review of ocular extramedullary acute myeloid leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2012; 13:93-6. [PMID: 23017332 DOI: 10.1016/j.clml.2012.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 06/22/2012] [Accepted: 07/26/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Maro Ohanian
- Department of Leukemia, MD Anderson Cancer Center, Houston TX, USA
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Lee SG, Park TS, Cheong JW, Yang WI, Song J, Lee KA, Kim J, Park Y, Choi JR. Preceding orbital granulocytic sarcoma in an adult patient with acute myelogenous leukemia with t(8;21): a case study and review of the literature. ACTA ACUST UNITED AC 2008; 185:51-4. [DOI: 10.1016/j.cancergencyto.2008.04.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 04/13/2008] [Accepted: 04/21/2008] [Indexed: 11/25/2022]
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Maka E, Lukáts O, Tóth J, Fekete S. Orbital tumour as initial manifestation of acute myeloid leukemia: granulocytic sarcoma: case report. Pathol Oncol Res 2008; 14:209-11. [PMID: 18431695 DOI: 10.1007/s12253-008-9028-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Accepted: 03/05/2008] [Indexed: 12/13/2022]
Abstract
We report orbital involvement as an initial manifestation of acute myeloid leukemia in a 57-year-old woman. The patient presented with painful proptosis and limited ocular motility. Orbital computed tomography revealed bilateral homogeneous masses. Orbital biopsy was performed on the right side; and histopathology disclosed a myelocytic tumour. Despite treatment using irradiation and chemotherapy, the patient died eleven months after presentation. There appear to be only a few previous reports of acute myeloid leukemia cases presenting with orbital involvement, and most cases occurred in children. This very rare condition has a poor survival prognosis, even with radiation treatment and chemotherapy.
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MESH Headings
- Acute Disease
- Diagnosis, Differential
- Exophthalmos/etiology
- Fatal Outcome
- Female
- Humans
- Immunohistochemistry
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/therapy
- Middle Aged
- Orbital Neoplasms/diagnosis
- Orbital Neoplasms/therapy
- Prognosis
- Sarcoma, Myeloid/diagnosis
- Sarcoma, Myeloid/therapy
- Tomography, X-Ray Computed
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Affiliation(s)
- Erika Maka
- Department of Ophthalmology, Faculty of Medicine, Semmelweis University, Tömo utca 25-29, 1083, Budapest, Hungary.
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Jaing TH, Wang HS, Tseng CK, Hsueh C, Wang CJ, Tsai YJ. Simultaneous development of bilateral retrobulbar and intradural spinal masses following donor lymphocyte infusions for acute lymphoblastic leukemia relapsing after bone marrow transplantation. J Pediatr Hematol Oncol 2004; 26:447-50. [PMID: 15218421 DOI: 10.1097/00043426-200407000-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors describe a 6-year-old boy with acute lymphoblastic leukemia in relapse after bone marrow transplantation. Complete remission was obtained after reinduction chemotherapy followed by donor lymphocyte infusions. Ten months later, right-sided proptosis and exotropia developed, with back pain and leg paralysis. Computed tomography revealed bilateral orbital masses. Magnetic resonance imaging demonstrated abnormal signal intensity in the T4-6 vertebral bodies and an intradural mass on the left posterior side of the spinal canal. Although bone marrow aspiration was negative, orbital mass biopsies revealed CD10-positive lymphoblasts. Chimerism analysis of bone marrow and peripheral blood showed full donor alleles. Local radiotherapy and chemotherapy resulted in neurologic improvement.
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Affiliation(s)
- Tang-Her Jaing
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
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Blanchard S, Labalette P, Jourdel D, Dédès V, Leleu X, Dillie AF, Fenaux P, Rouland JF. Sarcome granulocytique orbitaire révélant l’acutisation d’un syndrome myélodysplasique. J Fr Ophtalmol 2004; 27:184-7. [PMID: 15029050 DOI: 10.1016/s0181-5512(04)96117-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Granulocytic sarcoma is a rare orbital complication of acute leukemia. It concerns primarily children under 10 years of age suffering from primitive acute myeloid leukemia. As this type of symptom can sometimes affect the elderly during the acute phase of myelodysplastic syndrome, it raises a problem with diagnosis and consequently with therapeutic treatments. We report the case of a 77-year-old female patient who had acute inflammatory proptosis during regressive right ethmoiditis. The diagnosis was reached by computed tomography showing an extraconical intraorbital tumor sprouting from the sinus, and by clinical examination and confirmed by the hematological investigation. Acute proptosis developing in an acute myeloblastic leukemia context heavily swayed diagnosis towards orbital granulocytic sarcoma. Chemotherapy by cytarabine and hydroxycarbamide associated with intravenous corticoid therapy resulted in complete disappearance of the proptosis within 10 days. This case report is a reminder of this peculiar sign of tumoral syndrome in acute myeloid leukemia. We also discuss different diagnostic methods and various therapeutic approaches, and analyze the disease course and patient follow-up.
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Affiliation(s)
- S Blanchard
- Service d'Ophtalmologie, Hôpital Claude Huriez, Lille.
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