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Lavette LE, Niehaus AG, Clark CJ, Conway JD, Mishra G, Jahann DA. Pancreatic Myeloid Sarcoma Causing Obstructive Jaundice: A Case Report and Literature Review. Case Rep Gastrointest Med 2024; 2024:5513857. [PMID: 38500609 PMCID: PMC10948221 DOI: 10.1155/2024/5513857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 03/20/2024] Open
Abstract
Myeloid sarcoma (MS) is an extramedullary manifestation of acute myeloid leukemia (AML) and commonly occurs in sites such as the lymph nodes, skin, soft tissues, and bone. It more rarely manifests in the pancreas, with less than 20 cases reported in the literature since 1987. Despite its rarity, MS should be considered in the differential diagnosis of a soft tissue mass causing obstructive jaundice, especially if the patient has a known hematologic disease. Isolated cases of pancreatic MS have been known to progress to AML; therefore, it is crucial to differentiate MS from more common diagnoses, such as pancreatic cancer or pancreatitis. This is a case of a 70-year-old male with symptomatic obstructive jaundice secondary to pancreatic MS, ultimately requiring endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and management. Also included is a comprehensive review of previous case reports with similar clinical presentations, management, and treatment of pancreatic MS.
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Affiliation(s)
- Laura E. Lavette
- Department of Internal Medicine, University of Virginia Medical Center, 1215 Lee St., Charlottesville, Virginia 22903, USA
| | - Angela G. Niehaus
- Department of Pathology, Wake Forest Baptist Health, Medical Center Blvd., Winston-Salem, North Carolina 27157, USA
| | - Clancy J. Clark
- Department of Surgery, Wake Forest Baptist Health, Medical Center Blvd., Winston-Salem, North Carolina 27157, USA
| | - Jason D. Conway
- Department of Medicine, Section on Gastroenterology and Hepatology, Wake Forest Baptist Health, Medical Center Blvd., Winston-Salem, North Carolina 27157, USA
| | - Girish Mishra
- Department of Medicine, Section on Gastroenterology and Hepatology, Wake Forest Baptist Health, Medical Center Blvd., Winston-Salem, North Carolina 27157, USA
| | - Darius A. Jahann
- Department of Medicine, Section on Gastroenterology and Hepatology, Wake Forest Baptist Health, Medical Center Blvd., Winston-Salem, North Carolina 27157, USA
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Hu X, Li W, Tang J, Li D, Wang P. Multimodal imaging study of pancreatic myeloid sarcoma: a case report and literature review. Front Oncol 2023; 13:1259236. [PMID: 37829333 PMCID: PMC10565847 DOI: 10.3389/fonc.2023.1259236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/05/2023] [Indexed: 10/14/2023] Open
Abstract
Myeloid sarcoma (MS) is a rare extramedullary parenchymal tumor composed of immature myeloid cells, occurring mainly in the lymph nodes, skin, soft tissue, testicles, bones, peritoneum, and gastrointestinal tract, and rarely in the pancreas. Herein, we report the case of a 68-year-old female patient who visited our hospital for medical assistance due to acute abdominal pain. Abdominal computed tomography (CT) and magnetic resonance imaging showed a mass approximately 8 cm in diameter in the pancreatic tail, which was suspected to be a malignant tumor. To further assess the presence of distant metastases, the patient underwent fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/CT, which revealed an increased 18F-FDG uptake in the corresponding lesions. Subsequently, the patient underwent surgical treatment, and postoperative pathology and immunohistochemistry revealed that the mass was MS. Moreover, we reviewed the clinical features, imaging findings, and histopathology of pathologically confirmed pancreatic MS in the published literature.
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Affiliation(s)
- Xianwen Hu
- Affiliated Hospital of Zunyi Medical University, Department of Nuclear Medicine, Zunyi, China
| | - Wenxin Li
- Affiliated Hospital of Zunyi Medical University, Department of Nuclear Medicine, Zunyi, China
| | - Jinyan Tang
- Affiliated Hospital of Zunyi Medical University, Department of Nuclear Medicine, Zunyi, China
| | - Dandan Li
- Zunyi Hospital of Traditional Chinese Medicine, Department of Obstetrics, Zunyi, China
| | - Pan Wang
- Affiliated Hospital of Zunyi Medical University, Department of Nuclear Medicine, Zunyi, China
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3
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Wu K, Zhang X, Zhang B. Myeloid sarcoma of the pancreas: A case report and literature review. Medicine (Baltimore) 2021; 100:e24913. [PMID: 33787578 PMCID: PMC8021285 DOI: 10.1097/md.0000000000024913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/04/2021] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Myeloid sarcoma (MS) is an extramedullary mass, consisting of myeloid blasts with or without maturation, which efface the normal tissue architecture. It occurs mainly in lymph nodes, skin and soft tissue, testis, bone, peritoneum, and gastrointestinal tract, but rarely in the pancreas. Because their clinical courses, treatments, and prognoses are quite different, it is crucially important to distinguish between MS and pancreatic cancer. PATIENT CONCERNS We herein report a rare case of acute myeloid leukemia (AML) which presented with a pancreatic mass that mimicked pancreatic cancer.Diagnosis: The diagnosis of MS was established based on immunohistochemical (IHC) analysis and bone marrow examination which revealed neoplastic cells with CD34+/CD117+. INTERVENTIONS The patient was actively treated with chemotherapy. OUTCOMES After 4 cycles of chemotherapy, the lesion in pancreas was significantly reduced, and the patient is still receiving further chemotherapy. CONCLUSION When we encounter a patient suspected of pancreatic cancer with blood cell abnormalities and no significant increase in carbohydrate antigen 19-9 (CA19-9), we need to be aware of the possibility of pancreatic MS. Preoperative pathological biopsy and IHC are indispensable. Misdiagnosis is common if we rely solely on imaging.
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Affiliation(s)
| | - Xuzhao Zhang
- Department of Hematology, Second Affiliated Hospital, School of Medicine, Zhejiang University
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Rajaretnam N, Malcolm P, Aroori S. Granulocytic sarcoma: An uncommon cause of systemic inflammatory response syndrome. Clin Case Rep 2019; 7:469-473. [PMID: 30899474 PMCID: PMC6406164 DOI: 10.1002/ccr3.1779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/26/2018] [Accepted: 08/03/2018] [Indexed: 12/11/2022] Open
Abstract
Granulocytic sarcoma rarely arises from adrenal glands. Its necrosis can lead to systemic inflammatory response syndrome (SIRS), causing clinical difficulty in diagnosis without imaging and both biochemical and histological analysis. Compressive effects of the tumor may mask its source, and therefore, prompt resuscitation, symptom control, and investigation are vital in preventing clinical deterioration.
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Tokunaga K, Yamamura A, Ueno S, Kikukawa Y, Yamaguchi S, Hidaka M, Matsuno N, Kawaguchi T, Matsuoka M, Okuno Y. Isolated Pancreatic Myeloid Sarcoma Associated with t(8;21)/RUNX1-RUNX1T1 Rearrangement. Intern Med 2018; 57:563-568. [PMID: 29151502 PMCID: PMC5849554 DOI: 10.2169/internalmedicine.8912-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
No valid treatment for isolated myeloid sarcoma (IMS) has yet been established, and no thorough genetic examinations have been performed because of its low incidence and unique manner of development. We herein report a 34-year-old man with pancreatic IMS with t(8;21)/RUNX1-RUNX1T1 rearrangement. He was treated with high-dose cytarabine followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT). This is the first report of pancreatic IMS with t(8;21). Positron emission tomography/computed tomography and genetic study are useful for the diagnosis, and allo-HSCT achieved complete remission in this patient.
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Affiliation(s)
- Kenji Tokunaga
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Japan
| | - Ayako Yamamura
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Japan
| | - Shikiko Ueno
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Japan
| | - Yoshitaka Kikukawa
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Japan
| | - Shunichiro Yamaguchi
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Japan
| | - Michihiro Hidaka
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Japan
| | - Naofumi Matsuno
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Japan
| | - Tatsuya Kawaguchi
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Japan
| | - Masao Matsuoka
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Japan
| | - Yutaka Okuno
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Japan
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Ishii A, Kondo T, Oka T, Nakamoto Y, Takaori-Kondo A. Granulocytic sarcoma of the pancreas on 18F-FDG PET/CT: A case report. Medicine (Baltimore) 2016; 95:e5570. [PMID: 27930567 PMCID: PMC5266039 DOI: 10.1097/md.0000000000005570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE Granulocytic sarcoma (GS) is defined as leukemia infiltration in any organ other than the bone marrow. GS rarely occurs in the pancreas. Here, we present the first report of GS in the pancreas on F-fluorodexyglucose positron emission tomography/computed tomography (F-FDG PET/CT). PATIENT CONCERNS A 19-year-old male patient with acute myeloid leukemia received a human leukocyte antigen-haploidentical stem cell transplant as a second transplant while in second complete remission. INTERVENTIONS After a second stem cell transplant, obstructive pancreatitis accompanied by a mass in the pancreatic head was observed. FDG-PET/CT revealed abnormal activity in the head of the pancreas and the skin in the patient's left breast area. DIAGNOSES Pathological examination demonstrated relapsed acute myeloid leukemia in both the lesions. OUTCOMES This is the first report showing the F-FDG PET/CT findings of GS in the pancreas. LESSONS F-FDG PET/CT may help determine the stage of GS.
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Affiliation(s)
| | | | | | - Yuji Nakamoto
- Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Norsworthy KJ, Bhatnagar B, Singh ZN, Gojo I. Myeloid Sarcoma of the Hepatobiliary System: A Case Series and Review of the Literature. Acta Haematol 2016; 135:241-51. [PMID: 27007946 DOI: 10.1159/000444516] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/08/2016] [Indexed: 12/26/2022]
Abstract
Myeloid sarcoma (MS) is a rare extramedullary presentation of myeloid malignancies, most commonly seen in association with acute myeloid leukemia (AML). Although MS can develop in any organ, the involvement of the hepatobiliary system is rare. With clinical manifestations of jaundice, abdominal pain and other gastrointestinal symptoms, MS presenting at this location can be a challenge to diagnose, particularly in patients with no known history of hematologic malignancy. This may cause delay in proper management. Here we report 3 cases from a single institution and a review of the literature concerning the epidemiology, clinical presentation, treatment and outcomes in patients with MS of the liver, biliary tree and pancreas.
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Affiliation(s)
- Kelly J Norsworthy
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Md., USA
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Paydaş S, Ozdoğu H, Günaldı M, Haksöyler V, Açıkalın A, Ergin M. Extramedullary myeloid tumor involving the pancreas: a case report and review of the literature. Turk J Haematol 2014; 31:295-300. [PMID: 25330524 PMCID: PMC4287032 DOI: 10.4274/tjh.2012.0166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Extramedullary myeloid tumors (EMMTs) are the tumors of myeloid cells. These tumors may occur in all of the organs of the body, but some localizations are rare. Pancreatic involvement of EMMTs is a rare entity. Here we report a case of EMMT of the pancreas 4 years after allogeneic stem cell transplantation and we review the existing data about EMMTs involving the pancreas.
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Affiliation(s)
- Semra Paydaş
- Çukurova University Faculty of Medicine, Department of Medical Oncology, Adana, Turkey. E-ma-il:
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9
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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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10
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Rock J, Bloomston M, Lozanski G, Frankel WL. The spectrum of hematologic malignancies involving the pancreas: potential clinical mimics of pancreatic adenocarcinoma. Am J Clin Pathol 2012; 137:414-22. [PMID: 22338053 DOI: 10.1309/ajcpcxw7qug9efto] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Hematologic malignancies often involve the pancreas, causing potential diagnostic pitfalls and, rarely, potentially avoidable surgical resection. We review the spectrum of hematologic malignancies involving the pancreas and describe features useful in preoperative distinction from adenocarcinoma. Archived clinical, pathologic, and radiologic data (1965 to present) for hematologic malignancies involving the pancreas were reviewed and compared with the data for 157 surgically resected pancreatic adenocarcinomas. Of 42 cases, 27 (64%) were clinically "suspicious" for hematologic malignancies. Of the remaining 15 cases, 4 patients underwent resection for presumed pancreatic adenocarcinoma. Isolated pancreatic masses proved most difficult to identify clinically. Significant factors in distinguishing hematologic malignancies from adenocarcinoma included history of hematologic malignancy, young age, large tumor size, low CA19-9 level, B symptoms, and lack of jaundice or diabetes mellitus. Various hematologic malignancies involve the pancreas, most commonly diffuse large B-cell lymphoma. Pancreatic masses are usually correctly identified clinically. Preoperative and operative sampling is strongly recommended when hematologic malignancies cannot be excluded.
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11
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Messager M, Amielh D, Chevallier C, Mariette C. Isolated granulocytic sarcoma of the pancreas: a tricky diagnostic for primary pancreatic extramedullary acute myeloid leukemia. World J Surg Oncol 2012; 10:13. [PMID: 22248364 PMCID: PMC3283461 DOI: 10.1186/1477-7819-10-13] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 01/16/2012] [Indexed: 12/22/2022] Open
Abstract
We report two clinical cases of primary granulocytic sarcoma of the pancreas that were diagnosed on the surgical specimen. Atypical clinical and morphological presentations may have lead to pretherapeutic biopsies of the pancreatic mass in order to indicate primary chemotherapy. Literature review of this rare clinical presentation may help physicians to anticipate diagnostic and therapeutic strategies.
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Affiliation(s)
- Mathieu Messager
- Department of Digestive and Oncological Surgery, Centre Régional et Universitaire de Lille, Place de Verdun, 59037 Lille cedex, France
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12
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Kaiafa GD, Perifanis V, Diamantidis MD, Giouleme O, Voulgaridou V, Beretouli E, Kalogera-Fountzila A, Kaloutsi V. Aberrant expression of myeloid and B cell markers in an aggressive multiple-site myeloid sarcoma. Ann Hematol 2011; 91:1157-9. [PMID: 22134831 DOI: 10.1007/s00277-011-1378-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 11/20/2011] [Indexed: 12/28/2022]
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Li XP, Liu WF, Ji SR, Wu SH, Sun JJ, Fan YZ. Isolated pancreatic granulocytic sarcoma: A case report and review of the literature. World J Gastroenterol 2011; 17:540-2. [PMID: 21274386 PMCID: PMC3027023 DOI: 10.3748/wjg.v17.i4.540] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 11/25/2010] [Accepted: 12/01/2010] [Indexed: 02/06/2023] Open
Abstract
Granulocytic sarcoma (GS) is an extramedullary tumor mass consisting of immature myeloid cells. Isolated pancreatic granulocyte sarcoma is extremely rare. We report a very unusual pancreatic granulocytic sarcoma in a patient without acute myeloid leukemia. The patient presented with acute epigastric pain because of splenic infarction due to a mass consisting of myeloblasts in the pancreatic tail. The patients underwent splenectomy and distal pancreatectomy. Pathology and immunohistochemistry suggested a GS. Despite local surgery, an isolated tumor recurred 2 mo after operation and the patient died 3 mo after removal of the tumor. Only 7 reported cases of pancreatic GS were identified in the literature and the mass was located in the pancreatic head. This is the first report of GS in the pancreatic tail with splenic infarction.
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14
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Leiomyosarcoma arising in the pancreatic duct: a case report and review of the current literature. Case Rep Med 2010; 2010:252364. [PMID: 20589089 PMCID: PMC2892659 DOI: 10.1155/2010/252364] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 04/12/2010] [Indexed: 12/13/2022] Open
Abstract
Context. Leiomyosarcomas are rare malignant smooth muscle tumors that may arise in any organ or tissue that contains smooth muscle, commonly within the gastrointestinal tract. They are most often found in the stomach, large and small intestines, and retroperitoneum. Primary pancreatic leiomyosarcoma is extremely rare, and to the best of our knowledge only 30 cases have been reported in the world literature since 1951. Our case represents the first to have a clear origin from the main pancreatic duct. Case Report. This case was diagnosed in a large, tertiary care center in Tampa, Florida. Pertinent information was obtained from chart review and interdepartmental collaboration. A mass in the tail of the pancreas was identified with large pleomorphic and spindle-shaped cells. Immunohistochemistry for vimentin, smooth muscle actin, and desmin was positive. All remaining immunohistochemical markers performed were negative. The tumor clearly originated from the pancreatic duct wall, filled and expanded the duct lumen, and was covered with a layer of benign biliary epithelium. Conclusion. Leiomyosarcoma of the pancreas is an extremely rare malignancy with few reported cases in the literature. The prognosis is poor, and treatment consists of alleviating symptoms and pain management. To our knowledge, this represents the first reported case demonstrating clear origin of a leiomyosarcoma from the pancreatic duct.
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Abstract
Thirty-two cases of granulocytic sarcoma (GS) are reported in this paper. Age range was from 16 - 70 years. GS was accompanied by AML in 13 cases, ALL (My+) in one case, CML in 11 cases and MDS in two cases. GS was diagnosed simultaneously with leukemia in five cases and preceded the leukemia in eight. Lymph node and soft tissue were the most commonly detected localizations. Seven cases had first been diagnosed as NHL. Histopathologically blastic, immature and mature variants were found in 11, nine and 11 cases respectively and overall survival was shortest in the blastic type. Myeloperoxidase and lysozyme were found to be positive in 30 and 24 cases respectively. Therapy was radiation in five cases and surgery in three. Systemic chemotherapy was given to the cases. The clinical outcome of the patients after the diagnosis of GS was poor. GS is a unique entity; prognosis is poor but it is important to detect the signaling pathways associated with migration of myeloid cells to the extra-medullary tissues. The critical factors for detecting this interesting tumor are to be aware of this disease, cooperation between clinician and pathologist and the application of special stains to detect the myeloid origin.
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Affiliation(s)
- Semra Paydas
- Department of Oncology, Cukurova University Faculty of Medicine, Adana, Turkey.
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Abstract
We report the findings of a 10-year-old boy who presented to a pediatric emergency department with symptoms of spinal cord compression. Radiological imaging demonstrated multiple soft tissue masses in the head and spine. The surgical pathology showed that the masses were comprised of myeloid leukemia cells. These findings were consistent with those observed on bone marrow aspiration. The characteristics and management of extramedullary leukemia are discussed.
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Affiliation(s)
- James A Meltzer
- Department of Pediatrics, Section of Hematology/Oncology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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17
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Nappi O, Boscaino A, Wick MR. Extramedullary hematopoietic proliferations, extraosseous plasmacytomas, and ectopic splenic implants (splenosis). Semin Diagn Pathol 2004; 20:338-56. [PMID: 14694984 DOI: 10.1053/j.semdp.2003.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hematopoietic proliferations are well known to present ectopically outside the bone marrow, either in benign or malignant form. As such, they present a distinct problem with respect to morphologic interpretation because of their uncommonality in extramedullary sites and their capacity to simulate other lesions histologically. This review considers extramedullary myeloid tumors ("granulocytic sarcoma," "erythroblastic sarcoma," "megakaryocytic sarcoma"), tumefactive extramedullary hematopoiesis, and the peculiar condition known as "splenosis," with consideration of their clinical, microscopic, and cytohistochemical chararacteristics.
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Affiliation(s)
- Oscar Nappi
- Division of Anatomic Pathology, Histopathology, & Diagnostic Cytopathology, Department of Laboratory Medicine & Pathology, A. Cardarelli Hospital, Naples, Italy
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Rossetti JM, Lister J, Shadduck RK, Bloom E, Geyer SJ, Caushaj PF, Homann J, Papasavas P, Cedar M. Localized lymphoid relapse in the pancreas following allogeneic hematopoietic stem cell transplant for chronic myelogenous leukemia. Leuk Lymphoma 2003; 44:1071-4. [PMID: 12854913 DOI: 10.1080/1042819031000068089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The incidence of isolated extramedullary disease (EMD) following allogeneic hematopoietic stem cell transplant (allo-HSCT) for chronic myelogenous leukemia (CML) is not fully known. One review found the incidence of isolated myeloid EMD, or granulocytic sarcoma (GS), in an allo-HSCT treated CML/myelodysplastic subgroup to be just 0.22%. The incidence of lymphoid EMD in similar patients is extremely rare with only two cases reported in the literature. While the etiology of EMD in the post-transplant setting is not entirely clear, there may be inefficacy of immune surveillance function outside of the bone marrow cavity. Isolated CML GS following allo-HSCT carries a median interval to bone marrow relapse between 7 and 10 months and a median survival of 12 months. Less is known about lymphoid EMD. The treatment in these cases is ill defined with modalities ranging from involved field radiation to second allo-HSCT. We present a case of isolated pancreatic lymphoid EMD diagnosed 15 months after allo-HSCT for CML. Our patient was also treated with withdrawal of his immunosuppressive regimen. Unfortunately, at just over 4 months following pancreatic resection, he developed systemic relapse and died. While EMD can occur anywhere in the body, CML associated pancreatic EMD is not previously reported.
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Affiliation(s)
- J M Rossetti
- Western Pennsylvania Cancer Institute, The Western Pennsylvania Hospital, 4800 Friendship Avenue, Suite 2303, Pittsburgh, PA 15224, USA.
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Breccia M, D'Andrea M, Mengarelli A, Morano SG, D'Elia GM, Alimena G. Granulocytic sarcoma of the pancreas successfully treated with intensive chemotherapy and stem cell transplantation. Eur J Haematol 2003; 70:190-2. [PMID: 12605665 DOI: 10.1034/j.1600-0609.2003.00021.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A case of preleukemic granulocytic sarcoma of pancreas is presented. Pancreas is a well described site of secondary metastasis of solid tumors, but occasionally it has been reported as the primary site of leukemia. Like other cases reported in the literature, the present case was initially misdiagnosed as malignant lymphoma. We highlight the importance of an accurate immunohistochemical diagnosis and of an early and intensive acute myeloid leukemia-like treatment for these cases representing an uncommon and aggressive form of acute leukemia.
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Affiliation(s)
- Massimo Breccia
- Dipartimento di Biotecnologie Cellulari ed Ematologia, University La Sapienza, Via Benevento 6, Rome, Italy
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Ravandi F, Cortes J, Estrov Z, Thomas D, Giles FJ, Huh YO, Pierce S, O'Brien S, Faderl S, Kantarjian HM. CD56 expression predicts occurrence of CNS disease in acute lymphoblastic leukemia. Leuk Res 2002; 26:643-9. [PMID: 12008081 DOI: 10.1016/s0145-2126(01)00188-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We examined the pre-treatment bone marrow samples from 200 consecutive adult patients with acute lymphoblastic leukemia (ALL) treated on various protocols at the University of Texas, M.D. Anderson Cancer Center between 1986 and 1998. Standard MFC techniques were used to determine CD56 expression on the leukemia blasts cells. The expression of CD56 was correlated with clinical characteristics at diagnosis, response to therapy, survival and disease-free survival. Blast expression of CD56 (> or = 20% of leukemic blasts) was seen in 16 (8%) of patients, with a median expression of 67% (range 20-99%). CD56 expression was associated with a higher incidence of central nervous system (CNS) disease at diagnosis (19% versus 4%; P=0.016). Incidence of CNS disease at any time was higher in patients with CD56+ disease (31% versus 14%; P=0.057). Among the 109 patients uniformly treated with the hyperCVAD regimen, CD56 expression was associated with a statistically significant higher incidence of CNS disease (33% versus 9%; P=0.026). CD56 expression in ALL is uncommon but may predict a higher risk for CNS disease. If these results are confirmed, CD56 expression could be used in combination with other high-risk features (e.g. lactate dehydrogenase (LDH), S-phase fraction, mature B-cell phenotype) to design a risk-oriented approach to CNS prophylaxis.
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Affiliation(s)
- Farhad Ravandi
- Department of Hematology/Oncology, University of Illinois, Chicago, IL, USA
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