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Wilson HC, Hashemi S, Sabnis HS, Hong AL, Michelfelder EC. Inflammation or Infiltration? Infiltrative Cardiovascular Chloroma Presenting With Syncope and Heart Block. Circ Cardiovasc Imaging 2023; 16:e014532. [PMID: 36649458 DOI: 10.1161/circimaging.122.014532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Hunter C Wilson
- Emory University School of Medicine, Children's Heart Center, Children's Healthcare of Atlanta, GA (H.C.W., E.C.M.)
| | | | - Himalee S Sabnis
- Emory University School of Medicine, Aflac Center for Cancer and Blood Disorders, Children's Healthcare of Atlanta, GA (H.S.S., A.L.H.)
| | - Andrew L Hong
- Emory University School of Medicine, Aflac Center for Cancer and Blood Disorders, Children's Healthcare of Atlanta, GA (H.S.S., A.L.H.)
| | - Erik C Michelfelder
- Emory University School of Medicine, Children's Heart Center, Children's Healthcare of Atlanta, GA (H.C.W., E.C.M.)
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Jayaraman D, Bhurat R, Rathinasamy J, Shanmugam SG, Scott JX, Sivaraman RP, Sneha LM. A Journey Across Oceans With a Heavy Heart: Rare Presentation of a Pediatric Malignancy. JACC Case Rep 2021; 3:1221-1226. [PMID: 34401764 PMCID: PMC8353567 DOI: 10.1016/j.jaccas.2021.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/01/2021] [Accepted: 03/25/2021] [Indexed: 11/24/2022]
Abstract
Myeloid sarcoma, due to extramedullary deposition of myeloblasts, is one of the rare presentations in acute myeloid leukemia. We present an extremely rare case of a 5-year-old boy with cardiac myeloid sarcoma. Noninvasive mode of diagnosis, timely initiation of chemotherapy and meticulous supportive care are the keys to successful outcome. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Dhaarani Jayaraman
- Division of Pediatric Hemato-Oncology, Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Rishab Bhurat
- Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Jebaraj Rathinasamy
- Division of Paediatric Cardiology, Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Sri Gayathri Shanmugam
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Julius Xavier Scott
- Division of Pediatric Hemato-Oncology, Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Rajakumar Padur Sivaraman
- Division of Pediatric Intensive Care, Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Latha M Sneha
- Division of Pediatric Hemato-Oncology, Department of Pediatrics, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
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Gautam A, Jalali GK, Sahu KK, Deo P, Ailawadhi S. Cardiac Myeloid Sarcoma: Review of Literature. J Clin Diagn Res 2017; 11:XE01-XE04. [PMID: 28511492 DOI: 10.7860/jcdr/2017/23241.9499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/23/2017] [Indexed: 11/24/2022]
Abstract
Granulocytic Sarcomas (GS) also called as Myeloid Sarcomas (MS) or chloromas are the representatives of extramedullary infiltrates of immature myeloid cells including myeloblasts, promyelocytes and myelocytes. Primary cardiac malignancies per se are rare and infiltration of cardiac muscles by secondary malignant cells is also an uncommon finding. Out of these cardiac tumors, contribution of Cardiac Myeloid Sarcoma (CMS) is even more smaller thereby limiting our knowledge about this rare entity. Because of its very lower incidence, an exact guideline for diagnosis and management is still missing and usually haematologists around the world are treating CMS based on their clinical acumen. Aim of this review is to briefly discuss the presenting clinical feature, differential diagnosis, diagnostic workup and management based on published articles related to CMS till date.
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Affiliation(s)
- Archana Gautam
- Junior Resident, Department of Internal Medicine, UCMS, New Delhi, India
| | - Ghazal Kooshk Jalali
- Senior Resident, Department of Internal Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Kamal Kant Sahu
- Senior Resident, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Prateek Deo
- Junior Resident, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Sikander Ailawadhi
- Senior Associate Consultant, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida
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Yang WC, Yao M, Chen YH, Kuo SH. Complete response of myeloid sarcoma with cardiac involvement to radiotherapy. J Thorac Dis 2016; 8:1323-8. [PMID: 27293853 DOI: 10.21037/jtd.2016.04.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We present a rare case of intracardiac myeloid sarcoma (MS) of acute myeloid leukemia (AML) and who responds completely well to low-dose radiotherapy. This 19-year-old young man initially presented with AML and received standard chemotherapy followed by allogeneic hematopoietic stem cell transplantation (HSCT). However, he developed intracardiac isolated MS relapse with the presentation of exertional dyspnea and superior vena cava (SVC) syndrome 3 years later. He then received radiotherapy with 24 Gy at a 12 daily fractions using forward "field in field" intensity modulated radiotherapy technique. He dramatically had improved clinical symptoms, and complete remission was achieved one month after completing radiotherapy. Our result is in line with anecdotal case reports showed that radiotherapy with 15 Gy in 10 fractions or with 24 Gy in 12 fractions resulted in good response and less toxicity of 2 cases of MS with cardiac involvement. These results indicate that a modest radiotherapy dose, 24 Gy, achieves good local control of MS with cardiac involvement.
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Affiliation(s)
- Wen-Chi Yang
- 1 Division of Radiation Oncology, Department of Oncology, 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 3 Cancer Research Center, 4 Graduate Institute of Oncology, National Taiwan University College of Medicine and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Ming Yao
- 1 Division of Radiation Oncology, Department of Oncology, 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 3 Cancer Research Center, 4 Graduate Institute of Oncology, National Taiwan University College of Medicine and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Yu-Hsuan Chen
- 1 Division of Radiation Oncology, Department of Oncology, 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 3 Cancer Research Center, 4 Graduate Institute of Oncology, National Taiwan University College of Medicine and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Sung-Hsin Kuo
- 1 Division of Radiation Oncology, Department of Oncology, 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 3 Cancer Research Center, 4 Graduate Institute of Oncology, National Taiwan University College of Medicine and National Taiwan University Cancer Center, Taipei, Taiwan
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[Radiotherapy of chloroma or granulocytic sarcoma: A literature review]. Cancer Radiother 2016; 20:60-5. [PMID: 26775223 DOI: 10.1016/j.canrad.2015.05.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/17/2015] [Accepted: 05/22/2015] [Indexed: 02/08/2023]
Abstract
Granulocytic sarcoma, or chloroma, is a rare clinical entity, usually associated with a blood disease, including acute myeloid leukemia. Management strategies are based on the combination of systemic therapy and local therapy (surgery or radiation). Data for radiotherapy dose are derived from retrospective studies and case reports. We conducted a literature review using the Pubmed search engine to clarify the terms and indications for radiotherapy of chloromas.
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CT and MRI evaluation of cardiac complications in patients with hematologic diseases: a pictorial review. Int J Cardiovasc Imaging 2015; 31 Suppl 2:159-67. [PMID: 25651878 DOI: 10.1007/s10554-015-0610-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/29/2015] [Indexed: 12/12/2022]
Abstract
Cardiac complications with hematologic diseases are not uncommon but it is difficult to diagnose, due to non-specific clinical symptoms. Prompt recognition of these potentially fatal complications by cardiac computed tomography (CT) or cardiac magnetic resonance imaging (MRI) may help to direct clinicians to specific treatments according to causes. Thrombosis is often related to central venous catheter use and is usually located at the catheter tip near the atrial wall. Differentiation of thrombosis from normal structure is possible with CT and, distinction of a thrombus from a tumor is possible on a delayed enhancement MRI with a long inversion time (500-600 ms). Granulocytic sarcoma of the heart is indicated by an infiltrative nature with involvement of whole layers of myocardium on CT and MRI. MRI with T2* mapping is useful in evaluating myocardial iron content in patients with hemochromatosis. Diffuse subendocardial enhancement is typically observed on delayed MRIs in patients with cardiac amyloidosis. T1 mapping is an emerging tool to diagnose amyloidosis. Myocardial abscess can occur due to an immunocompromised status. CT and MRI show loculated lesions with fluid density and concomitant rim-like contrast enhancement. Awareness of CT and MRI findings of cardiac complications of hematologic diseases can be helpful to physicians for clinical decision making and treatment.
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Chen WY, Wang CW, Chang CH, Liu HH, Lan KH, Tang JL, Tien HF, Kuo SH, Cheng AL. Clinicopathologic features and responses to radiotherapy of myeloid sarcoma. Radiat Oncol 2013; 8:245. [PMID: 24148102 PMCID: PMC4016483 DOI: 10.1186/1748-717x-8-245] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 10/15/2013] [Indexed: 02/02/2023] Open
Abstract
Background To evaluate clinicopathological features, radiotherapeutic parameters, and their associations with responses to radiotherapy (RT) in patients with myeloid sarcoma (MS). Methods We reviewed 20 patients receiving RT for MS lesions (in 43 RT courses) and analyzed the patients’ clinicopathologic features and radiotherapeutic parameters, and their associations with complete responses (CR) to RT using Fisher’s exact test and univariate logistic regression analysis. Generalized Estimating Equation was used to analyze all 43 irradiated lesions and account for the correlations in RT responses among lesions from the same patient. Results We found that the underlying hematological diseases of the evaluated patients were acute myeloid leukemia (AML) in 14 patients (70%), chronic myeloid leukemia in 4 patients (20%), myelodysplastic syndrome with AML transformation in one patient (5%), and de novo MS in one patient (5%). Most patients (55%) received RT for MS at the time of relapse following bone marrow transplantation (BMT). The most common cytogenetic abnormality was t(8;21)(q22;q22). The median RT dose of 20 Gy (range 6–35 Gy), administered in 1.5-3.5 Gy fractions, provided a 63% CR rate. RT dose, sex, cytogenetics, and bone marrow status at the time of RT had no significant effect on CR. Younger age (<50 y, P = 0.06), BMT prior to RT (P = 0.05), and underlying AML (P = 0.05) were marginally associated with higher CR to RT. Conclusions Our results indicate that a modest RT dose (20-30 Gy) achieves good local control of MS. Age, previous BMT, and underlying hematologic disease can affect RT response.
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Affiliation(s)
| | | | | | | | | | | | | | - Sung-Hsin Kuo
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Leone O, Veinot JP, Angelini A, Baandrup UT, Basso C, Berry G, Bruneval P, Burke M, Butany J, Calabrese F, d'Amati G, Edwards WD, Fallon JT, Fishbein MC, Gallagher PJ, Halushka MK, McManus B, Pucci A, Rodriguez ER, Saffitz JE, Sheppard MN, Steenbergen C, Stone JR, Tan C, Thiene G, van der Wal AC, Winters GL. 2011 consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology. Cardiovasc Pathol 2011; 21:245-74. [PMID: 22137237 DOI: 10.1016/j.carpath.2011.10.001] [Citation(s) in RCA: 351] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 09/28/2011] [Accepted: 10/07/2011] [Indexed: 01/04/2023] Open
Abstract
The Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology have produced this position paper concerning the current role of endomyocardial biopsy (EMB) for the diagnosis of cardiac diseases and its contribution to patient management, focusing on pathological issues, with these aims: • Determining appropriate EMB use in the context of current diagnostic strategies for cardiac diseases and providing recommendations for its rational utilization • Providing standard criteria and guidance for appropriate tissue triage and pathological analysis • Promoting a team approach to EMB use, integrating the competences of pathologists, clinicians, and imagers.
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Affiliation(s)
- Ornella Leone
- U.O. di Anatomia ed Istologia Patologica, Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy.
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Song JH, Son SH, Lee JH, Chung SM, Jang HS, Choi BO. Defining the optimal dose of radiation in leukemic patients with extramedullary lesions. BMC Cancer 2011; 11:428. [PMID: 21975070 PMCID: PMC3196724 DOI: 10.1186/1471-2407-11-428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 10/06/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Analysis of the clinical response of extramedullary lesions in leukemic patients treated with radiation therapy (RT) and defining the optimal dose of radiation. METHODS Forty-two extramedullary lesions found in 24 leukemic patients treated with RT were reviewed. The radiation was delivered usually 2 Gy/day, up to a median of 20 Gy (range: 18.0-40.8). The clinical response and symptom palliation effect were analyzed. The factors affecting the response were also included in the analysis. RESULTS After a median time of 7.9 weeks, the overall response rate was 76.2%. A complete response (CR) was achieved in 35.7%, a partial response in 40.5%. The symptom was relieved in 85.7% sites. The overall response rate was better in patients whose initial tumor size was smaller than 10 cm2 (p = 0.010) or who were treated with more than 25 Gy (p = 0.031). The overall CR rate was also higher in those who had smaller tumors (smaller than 6 cm or 30 cm2) (p = 0.015), or when the tumor was located in soft tissue (p = 0.029). CONCLUSIONS Extramedullary lesions in leukemic patients can be successfully treated with RT. The tumor response rate was excellent and symptom relief was achieved in almost all patients. There was a better response to treatment when the tumor was small or it was located in soft tissue. Although, there was no definite correlation between volume reduction and total dose, it seems that higher total dose more of than 25 Gy is needed for better response.
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Affiliation(s)
- Jin Ho Song
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
Myeloid sarcomas are rare extramedullary tumors composed of immature myeloid cells. Most cases are seen in childhood acute myelogenous leukemia (AML). They can develop at many sites, but cardiac involvement is a rare finding. We report the case of a 24-year-old woman who, after being in remission from AML for 10 years, developed an isolated cardiac myeloid sarcoma.
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