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Wang D, He K, Sroussi H, Treister N, Luskin M, Villa A, Woo SB, Shazib MA. Oral myeloid sarcoma as an uncommon manifestation of acute myeloid leukemia: A case series and review of the literature. J Am Dent Assoc 2021; 152:393-400.e8. [PMID: 33926625 DOI: 10.1016/j.adaj.2021.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/13/2020] [Accepted: 01/31/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OVERVIEW Oral myeloid sarcoma (MS) is an extramedullary tumor that can occur in the setting of acute myeloid leukemia, either as the first sign of an underlying disease or later in the course of disease. The authors' aim was to present the clinical features of oral MS and review the literature. CASE DESCRIPTION Case 1 was an 82-year-old woman with an asymptomatic erythematous swelling on the maxillary gingiva and no history of hematologic malignancy. Case 2, a 65-year-old man, and case 3, a 58-year-old woman, each had a history of acute myeloid leukemia and a painful ulcer on the palatal mucosa and an asymptomatic ulcer on the lower lip mucosa, respectively. Case 1 was treated with focal radiation then chemotherapy and achieved complete remission initially, but died of relapse 2 years after diagnosis. Case 2 received radiotherapy and immunotherapy and had a complete response. Case 3 received chemotherapy and achieved remission initially, but relapsed and is undergoing investigational targeted therapies. CONCLUSIONS AND PRACTICAL IMPLICATIONS Oral MS can manifest as gingival or mucosal swelling or ulceration and can indicate onset or relapse of associated hematologic malignancies, which often have a poor prognosis. Because patients with oral findings are likely to seek treatment from their dentists first, oral clinicians should maintain a broad differential diagnosis list when evaluating oral lesions, especially if treatment prescribed for a more common diagnosis fails to resolve the lesion.
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Hu YG, Deng XH, Lei W, Li XL. Clinical characteristics and management of primary granulocytic sarcoma of the oral cavity: A case report and literature review. Medicine (Baltimore) 2020; 99:e22820. [PMID: 33120806 PMCID: PMC7581149 DOI: 10.1097/md.0000000000022820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Granulocytic sarcoma (GS) is a commonly occurring tumor comprising immature myeloid cells, which are usually related to acute or chronic myelocytic leukemia. The tumor rarely precedes leukemia without bone marrow involvement and is called primary GS. Although primary GS can occur in any body part, the involvement of the oral cavity is uncommon. PATIENT CONCERNS A 49-year-old woman hospitalized at the Department of Plastic and Maxillofacial Surgery presented with a growing mass in her left maxillary hard palate dating two months back. No obvious physical findings were noted during general examination. She was diagnosed with an oral ulcer at a local clinic, and received antibiotics. However, the symptoms did not improve; the mass became bigger and painful. DIAGNOSIS An incisional biopsy of the oral mass was performed, the immunohistochemistry showed that the tumor cells tested positive for myeloperoxidase, CD4, BCL-2, KI-67. Bone marrow aspiration was negative for malignant cells, and the laboratory test results revealed only monocytosis. Standard bone marrow cytogenetic analysis showed a normal karyotype and leukemia-related fusion gene detection was normal. Therefore, the final diagnosis was intraoral primary GS. INTERVENTIONS The patient was treated with a chemotherapy regimen based on idarubicin and cytarabine arabinoside. OUTCOMES After 2 cycles of idarubicin and cytarabine arabinoside regimen chemotherapy, the patient achieved complete remission. The tumor was barely visible in the left maxillary hard palate. There has been no evidence of disease spread and progression after 1 year of follow-up. CONCLUSIONS Careful morphological and immunohistochemical analyses, correlating with clinical data are necessary to establish the diagnosis of oral primary GS. Early aggressive systemic chemotherapy can effectively relieve symptoms, significantly reducing primary GS conversion into acute myelocytic leukemia and prolonging overall survival.
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Affiliation(s)
- Yun-Gang Hu
- Department of Plastic and Maxillofacial Surgery, The People's Affiliated Hospital of Nanchang University
| | - Xiao-Hua Deng
- Department of Plastic and Maxillofacial Surgery, The People's Affiliated Hospital of Nanchang University
| | - Wei Lei
- Department of Plastic and Maxillofacial Surgery, The People's Affiliated Hospital of Nanchang University
| | - Xiao-Lin Li
- Key Laboratory of Maxillofacial Plastic and Reconstructive surgery, Jiangxi, People's Republic of China, 92 Aiguo road, Nanchang, Jiangxi, People's Republic of China
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Ishikawa S, Kato Y, Kabasawa T, Yoshioka C, Kitabatake K, Yamakawa M, Ishizawa K, Iino M. A case of myeloid sarcoma of the mandibular gingiva as extramedullary relapse of acute myeloid leukemia. Oral Maxillofac Surg 2020; 24:121-126. [PMID: 31788742 DOI: 10.1007/s10006-019-00812-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE Myeloid sarcoma (MS) is defined as a tumorous mass of myeloblasts or immature myeloid cells involving an extramedullary anatomic site. MS occurs in 3 to 8% of patients with acute myeloid leukemia. The overwhelming majority of MS occurs in the skin, bones, and gastrointestinal tract; intraoral MS (IMS) is extremely rare. METHODS We describe a case of MS of the mandibular gingiva in a patient with acute myeloid leukemia that was in remission. We also present a review of the English and Japanese literature with a special focus on the management and prognosis of intraoral MS. RESULTS The patient was discharged while in remission 8 months after the initial examination. CONCLUSION The prognosis of IMS is extremely poor in general, and a diagnostic delay can prevent adequate therapy by hematologists and oncologists. All dental clinicians must keep the possibility of IMS in mind and carefully examine all patients with AML.
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Affiliation(s)
- Shigeo Ishikawa
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan.
| | - Yuichi Kato
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan
| | - Takanobu Kabasawa
- Department of Hematology, Department of Pathological Diagnosis, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan
| | - Chiho Yoshioka
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan
| | - Kenichiro Kitabatake
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan
| | - Mitsunori Yamakawa
- Department of Hematology, Department of Pathological Diagnosis, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan
| | - Kenichi Ishizawa
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan
| | - Mitsuyoshi Iino
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan
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Nunes LFM, Rocha AL, Magalhães GHR, de Melo FHC, Travassos DV, Mesquita RA, Silva TA. Intraoral granulocytic sarcoma as a manifestation of myelofibrosis: A case report and review of the literature. SPECIAL CARE IN DENTISTRY 2018; 38:409-420. [DOI: 10.1111/scd.12325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 12/25/2022]
Affiliation(s)
| | - Amanda Leal Rocha
- Department of Oral Surgery and Pathology; Faculty of Dentistry; Universidade Federal de Minas Gerais; Minas Gerais Brazil
| | - Gustavo Henrique Romani Magalhães
- Department of Hematology and Oncology; Ambulatory of Chronic Myeloproliferative Diseases; Universidade Federal de Minas Gerais; Minas Gerais Brazil
| | | | - Denise Vieira Travassos
- Department of Community and Preventive Dentistry; Faculty of Dentistry; Universidade Federal de Minas Gerais; Minas Gerais Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology; Faculty of Dentistry; Universidade Federal de Minas Gerais; Minas Gerais Brazil
| | - Tarcília Aparecida Silva
- Department of Oral Surgery and Pathology; Faculty of Dentistry; Universidade Federal de Minas Gerais; Minas Gerais Brazil
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Gaal A, Chisholm KM, Egbert M. How Rare Is an Oral Presentation of Myeloid Sarcoma in the Infant? J Oral Maxillofac Surg 2018; 76:561-568. [DOI: 10.1016/j.joms.2017.08.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/26/2017] [Accepted: 08/26/2017] [Indexed: 10/18/2022]
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Shen Y, Zhao L, Wu Y, Huang P. Multifocal occurrence of intraoral isolated MS in a patient without leukemic presentation: A case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:e42-e48. [DOI: 10.1016/j.oooo.2017.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/27/2017] [Accepted: 11/08/2017] [Indexed: 11/25/2022]
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Vishwanath M, Ilanthodi S, Bhandary R, Pai MR. Invasive Fungal Infection in Acute Myeloid Leukemia Associated with Myeloid Sarcoma of the Sinonasal Cavity: A Rare Case. Indian J Otolaryngol Head Neck Surg 2017; 69:266-268. [PMID: 28607903 DOI: 10.1007/s12070-017-1088-3] [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: 04/16/2016] [Accepted: 01/25/2017] [Indexed: 10/20/2022] Open
Abstract
Myeloid sarcoma is a rare malignant extramedullary neoplasm of myeloid precursor cells. The majority of these cases occur in patients with known leukemia or those who eventually develop the disease. It can occur in various sites but sinonasal cavity involvement along with invasive fungal infection is exceedingly rare.
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Affiliation(s)
- Meghashree Vishwanath
- Department of Pathology, A. J. Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, 575004 India
| | - Sandhya Ilanthodi
- Department of Pathology, A. J. Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, 575004 India
| | - Rukma Bhandary
- Department of E.N.T., A. J. Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, 575004 India
| | - Muktha R Pai
- Department of Pathology, A. J. Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, 575004 India
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Sharma A, Singh HP, Gupta AA, Garg P, Moon NJ, Chavan R. Granulocytic sarcoma in non-leukaemic child involving maxillary sinus with long term follow up: A rare case report. Ann Maxillofac Surg 2014; 4:90-5. [PMID: 24987607 PMCID: PMC4073472 DOI: 10.4103/2231-0746.133078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Granulocytic sarcoma (GS) is a rare extramedullary malignant tumor composed of immature myeloid cells. It is strongly associated with acute myeloid leukaemia, chronic myeloproliferative diseases. Occurrence of GS in the oral cavity is extremely uncommon. Present case reported an unusual occurrence of GS without leukemia involving maxillary sinus of a child. The patient underwent chemotherapy followed by radiotherapy with complete remission. A long-term follow-up of the patient was carried without any evidence of recurrence with special focus on diagnostic difficulties. The present case highlights the perplexity in diagnosing such lesions with emphasis on the need of careful interpretation of all clinical, radiographic, histopathological and immunohistochemical details as it is one of the most frequently misdiagnosed disorder.
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Affiliation(s)
- Aman Sharma
- Departments of Oral and Maxillofacial Pathology and Microbiology, Swami Devi Dyal Hospital and Dental College, Panchkula, Haryana, India
| | | | | | - Parveen Garg
- Department of Oral and Maxillofacial Surgery, Krishna Dental College, Mohan Nagar, Uttar Pradesh, India
| | - Ninad Joshirao Moon
- Departments of Periodontics, RKDF Dental College and Research Centre, Bhopal, Madhya Pradesh, India
| | - Rahul Chavan
- Shri Guru Gobind Singh Educational and Welfare Society, Lal Bagh Road, Burhanpaur, Madhya Pradesh, India
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Ponnam SR, Srivastava G, Jampani N, Kamath VV. A fatal case of rapid gingival enlargement: Case report with brief review. J Oral Maxillofac Pathol 2014; 18:121-6. [PMID: 24959052 PMCID: PMC4065429 DOI: 10.4103/0973-029x.131938] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Myeloid sarcoma (MS) is a rare extramedullary tumor composed of primitive granulocytic cells. These lesions are commonly associated with other hematologic disorders such as myeloid leukemia and other myeloproliferative neoplasms. Although extremely rare in the oral cavity, this lesion was reported in gingiva, palate, buccal mucosa and extraction sockets. MS is an aggressive lesion associated with poor prognosis. Early identification and prompt treatment holds the key for increasing the disease-free period in these patients. In this context, we report a rare and aggressive case of MS, which ran a fatal course in a 45-year-old female patient.
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Affiliation(s)
- Srinivas Rao Ponnam
- Department of Oral Pathology, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - Gautam Srivastava
- Department of Oral Medicine and Radiology, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - Narendradev Jampani
- Department of Periodontics, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - V V Kamath
- Department of Oral Pathology, Dr. Syamala Reddy Dental College and Hospital, Bangalore, Karnataka, India
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10
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Pau M, Beham-Schmid C, Zemann W, Kahr H, Kärcher H. Intraoral Granulocytic Sarcoma: A Case Report and Review of the Literature. J Oral Maxillofac Surg 2010; 68:2569-74. [DOI: 10.1016/j.joms.2009.09.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Revised: 06/29/2009] [Accepted: 09/15/2009] [Indexed: 01/06/2023]
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12
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Gorman M, Ahmed KA, Pallera A, Samant S. Granulocytic Sarcoma of the Nasal Cavity: A Case Report. EAR, NOSE & THROAT JOURNAL 2009. [DOI: 10.1177/014556130908801107] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Granulocytic sarcoma of the nasal cavity is exceedingly rare. We describe the case of a 55-year-old man who presented with an intranasal mass that was later diagnosed as a granulocytic sarcoma. The mass was treated with rapid initiation of chemotherapy, which produced a substantial decrease in tumor bulk. Granulocytic sarcoma is often mistaken for lymphoma or other poorly differentiated malignancies, and the correct diagnosis requires a high index of clinical suspicion.
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Affiliation(s)
- Mary Gorman
- From the Department of Otolaryngology, University of Tennessee Health Science Center, Memphis
| | - Khwaja Asif Ahmed
- From the Department of Otolaryngology, University of Tennessee Health Science Center, Memphis
| | - Arnel Pallera
- From the Department of Otolaryngology, University of Tennessee Health Science Center, Memphis
| | - Sandeep Samant
- From the Department of Otolaryngology, University of Tennessee Health Science Center, Memphis
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14
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Xie Z, Zhang F, Song E, Ge W, Zhu F, Hu J. Intraoral granulocytic sarcoma presenting as multiple maxillary and mandibular masses: a case report and literature review. ACTA ACUST UNITED AC 2007; 103:e44-8. [PMID: 17428693 DOI: 10.1016/j.tripleo.2006.12.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2006] [Revised: 11/12/2006] [Accepted: 12/21/2006] [Indexed: 10/23/2022]
Abstract
Granulocytic sarcoma (GS) is an unusual localized tumor composed of immature granulocytic precursor cells that occurs in extramedullary sites. However, GS involving the oral cavity is rare. We report a case of intraoral GS with an unusual clinical presentation, including a history of chronic myelogenous leukemia in remission, multiple maxillary and mandibular gingival masses mimicking acute inflammation that developed over a short period, complete remission after 1 week of treatment with imatinib mesylate (Gleevec), and no bone marrow or peripheral blood involvement over a 6-month follow-up period. To our knowledge, this is the first report of treatment of intraoral GS with Gleevec resulting in a complete remission.
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Affiliation(s)
- Zhijian Xie
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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