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Manzalji K, Humaida S, Ramadan AA, Mudawi A, Ganwo I, Moghamis IS. Isolated myeloid sarcoma of the tibia: A case report. Int J Surg Case Rep 2024; 121:109956. [PMID: 38945014 DOI: 10.1016/j.ijscr.2024.109956] [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: 05/19/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/02/2024] Open
Abstract
INTRODUCTION Myeloid sarcoma (MS) is a rare extramedullary tumor composed of malignant myeloid cells that most commonly arise in patients previously diagnosed with myeloproliferative disease. However, they can still occur in isolation and without bone marrow disease. CASE PRESENTATION An 8-year-old girl who had a history of acute myeloid leukemia and was off treatment for four years presented to the clinic with a history of on and off left knee swelling and pain without any direct trauma to the knee over the last two years. Knee Magnetic resonance imaging (MRI) showed diffused joint effusion with proximal tibia focal edema. A diagnosis of juvenile rheumatoid arthritis was suspected, and the patient was started on treatment, but the problem did not resolve. Eventually, the patient underwent a repeat MRI and showed increased joint effusion with an increase in the focal edema. An open bone biopsy of the lesion was taken, and the histopathology showed sheets of primitive mononuclear cells positive for CD33 and CD117 and negative for CD34, myeloperoxidase, CD10, CD20, and CD68, indicating myeloid sarcoma. CLINICAL DISCUSSION Histological examination and immunohistochemistry are the most important in diagnosing myeloid sarcoma. Previously, before the introduction of chemotherapy and stem cell transplant, such cases of proximal tibia MS were treated with surgical resection of the bone. However, chemotherapy with the possibility of an allogeneic hematopoietic stem cell transplant (alloHSCT) has changed the view of survival in such cases. CONCLUSION Isolated proximal tibia myeloid sarcoma is a rare occurrence that can be misdiagnosed and lead to delayed treatment. Bone biopsy, Immunohistochemistry, and cytogenetic studies play a critical role in differentiating MS from other types of tumors.
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Affiliation(s)
- Karam Manzalji
- Primary Health Care Center, Family Medicine, Doha, Qatar
| | - Sara Humaida
- Primary Health Care Center, Family Medicine, Doha, Qatar
| | | | - Aiman Mudawi
- Hamad Medical Corporation, Orthopedics Surgery, Doha, Qatar
| | - Ibrahim Ganwo
- Hamad Medical Corporation, Department of Laboratory medicine & pathology, Doha, Qatar
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2
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Jebrini N, Sarahneh H, Jaber M, Natsheh M, Abu Ayyash A, Bannoura S, Razem R. Gastric myeloid sarcoma mimicking pseudoachalasia in non-leukemic context: a singular case report. Ann Med Surg (Lond) 2024; 86:2281-2285. [PMID: 38576939 PMCID: PMC10990304 DOI: 10.1097/ms9.0000000000001830] [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: 12/19/2023] [Accepted: 02/04/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction and importance Myeloid sarcoma (MS) is a rare tumour associated with acute myeloid leukaemia (AML) and occasionally occurs independently. It typically affects skin, bone, lymph nodes, and rarely the gastrointestinal tract, with gastric cases being extremely rare. Notably, no reported instances associate pseudoachalasia with gastric myeloid sarcoma. Case presentation A 20-year-old male presented with severe dysphagia, refractory vomiting, and weight loss. Diagnosed with type III achalasia via oesophageal tests, subsequent gastroscopy revealed a large gastric mass, later identified as gastric myeloid sarcoma through histopathology. Clinical discussion MS, characterized by immature blast cells, poses diagnostic challenges without typical leukaemia symptoms. Diagnosis involves immunohistochemistry, employing markers like CD33, CD34, and CD43. Optimal treatments, such as chemotherapy or stem cell transplantation, aim to delay leukaemia progression. Gastric primary de-novo myeloid sarcoma is exceedingly rare, emphasizing the need for tailored treatment strategies. Conclusion Gastric myeloid sarcoma is an exceptionally rare tumour, especially without concurrent acute myeloid leukaemia (AML), complicating its diagnosis. This case represents the first globally documented instance of gastric myeloid sarcoma causing pseudoachalasia. Documenting this unique clinical presentation is crucial for a better grasp of gastric myeloid sarcoma's diverse manifestations.
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Affiliation(s)
- Nidal Jebrini
- Faculty of Medicine, Palestine Polytechnic University, Hebron, Palestine
- Al-Ahli Hospital, Doha, Qatar
| | - Husein Sarahneh
- Faculty of Medicine, Palestine Polytechnic University, Hebron, Palestine
| | - Mohanad Jaber
- Faculty of Medicine, Palestine Polytechnic University, Hebron, Palestine
- Al-Ahli Hospital, Doha, Qatar
- Forensic Pathology
| | | | | | | | - Raghad Razem
- Faculty of Medicine, Palestine Polytechnic University, Hebron, Palestine
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Miller S, Jeberaeel J, Saad A, Abd Almohsen N, Vaishampayan N. Pediatric Myeloid Sarcoma of the Testes Treated With Surgery and Adjuvant Radiation Therapy. Cureus 2024; 16:e57029. [PMID: 38681318 PMCID: PMC11047021 DOI: 10.7759/cureus.57029] [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] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Myeloid sarcoma (MS) is a rare extramedullary tumor of immature granulocytic cells and is most often associated with acute myeloid leukemia (AML). Myeloid sarcomas can occur anywhere in the body but are seldom present in the testicles, especially in the pediatric population. The treatment of MS, especially testicular myeloid sarcoma (TMS) is not well defined in the literature and the role of radiation therapy in the treatment of TMS is even less well defined. In this case report, we discuss the treatment for TMS in a pediatric patient, review the literature, and discuss the role of radiation therapy in the treatment.
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Affiliation(s)
- Steven Miller
- Department of Oncology, Wayne State University School of Medicine, Detroit, USA
| | - Julian Jeberaeel
- Department of Oncology, Wayne State University School of Medicine, Detroit, USA
| | - Anas Saad
- Department of Pathology, Wayne State University School of Medicine, Detroit, USA
| | - Nour Abd Almohsen
- Department of Pathology, Wayne State University School of Medicine, Detroit, USA
| | - Nitin Vaishampayan
- Department of Oncology, Wayne State University School of Medicine, Detroit, USA
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Lizardo-Thiebaud Maria J, Emilio AH, Jesus DDLM, Montante-Montes de Oca D. The immutable relevance of myeloid sarcomas: Clinicopathological study of fourteen cases. Pathol Res Pract 2024; 255:155176. [PMID: 38394809 DOI: 10.1016/j.prp.2024.155176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
An extramedullary myeloid tumor or chloroma is an infrequent manifestation of a myeloid neoplasm. It is considered an equivalent to an acute myeloid leukemia. It is confirmed through biopsy, where infiltrating neoplastic myeloid cells distort the parenchyma. A total of twenty-nine cases were diagnosed as MS between 198 and 2023. Upon re-evaluation, only fourteen cases fulfilled the criteria for MS. The most common differential diagnosis were lymphomas, leukemic infiltration, and extramedullary hematopoiesis. Few were isolated cases; the rest were in the context of progression of a myeloid neoplasm. The majority had a myelomonocytic morphology and immunophenotype. The most reliable markers were CD45, HLA-DR, CD68 and CD4. The study highlights the complexity and impact of an accurate diagnosis of a myeloid sarcoma.
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Affiliation(s)
- J Lizardo-Thiebaud Maria
- Department of Anatomic Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Delgado-de la Mora Jesus
- Department of Anatomic Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Daniel Montante-Montes de Oca
- Department of Anatomic Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Han X, Li Q, Wang EH, Liu N. Clear cell sarcoma of soft tissue with plasmacytoid morphology: A rare case report. Medicine (Baltimore) 2022; 101:e31631. [PMID: 36343072 PMCID: PMC9646632 DOI: 10.1097/md.0000000000031631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
RATIONALE Clear cell sarcoma of soft tissue (CCSST) is a rare malignant tumor that occurs in the extremities of young adults. CCSST has been documented to have atypical histopathological features, such as epidermotropism or myxoid differentiation, which may set pitfalls in the differential diagnosis. We report a case of CCSST with plasmacytoid morphology which has never been described. PATIENT CONCERNS A 15-year-old male, presented with a 5-cm mass in his left inguinal area. DIAGNOSIS Positron emission tomography-computed tomography examination showed nodules in the left groin and the lung, the latter was considered metastasis. A core needle biopsy with the diagnosis of CCSST with plasmacytoid morphology was made according to histology, immunostaining, and molecular analysis. INTERVENTIONS The patient received chemotherapy of doxorubicin and ifosfamide. OUTCOMES The patient failed to respond to the standard chemotherapy and deceased twelve months after diagnosis. LESSONS This special case of CCSST with plasmacytoid features demonstrated a morphological variation never been documented and may easily lead to misdiagnosis. For such cases, molecular analysis is essential to provide solid evidence for accurate diagnosis.
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Affiliation(s)
- Xu Han
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Qingchang Li
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - En-Hua Wang
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Nan Liu
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
- *Correspondence: Nan Liu, Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China (e-mail: )
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Pace M, Guadagno E, Russo D, Gencarelli A, Carlea A, Di Spiezio A, Bertuzzi C, Mascolo M, Grimaldi F, Insabato L. Myeloid Sarcoma of the Breast as Blast Phase of JAK2-Mutated (Val617Phe Exon 14p) Essential Thrombocythemia: A Case Report and a Systematic Literature Review. Pathobiology 2022; 90:123-130. [PMID: 35850113 DOI: 10.1159/000525163] [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: 07/17/2021] [Accepted: 05/12/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Myeloid sarcoma (MS) is a mass-forming proliferation of myeloid blasts. Frequently, it arises as blast phase of pre-existing myeloproliferative, myelodysplastic disorders or consequent to bone marrow transplant. Its molecular characterization has become an increasingly important requirement for the diagnostic definition of this solid leukemia. CASE PRESENTATION Our case report concerns an MS arising in the breast of a woman with a previous diagnosis of JAK2-mutated essential thrombocythemia (Val617Phe exon 14p) mimicking, on histology, a lobular carcinoma of the breast. The immunohistochemical study of the neoplasm provided the key that solved the diagnostic doubt and the immunohistochemical evaluation of NPM protein expression, which turn out to be negative, provided a clear indication on the molecular status and prognosis of the disease. A year later, the neoplasm relapsed in the pelvic area. DISCUSSION This diagnostic challenge led us to review the literature of the past 10 years concerning MS of the breast. To the best of our knowledge, this was the first case of MS of the breast occurring in a patient with a history of essential thrombocythemia and recurred in the pelvic region.
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Affiliation(s)
- Mirella Pace
- Department of Advanced Biomedical Sciences, Pathology Section- Federico II University Hospital of Naples, Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, Pathology Section- Federico II University Hospital of Naples, Naples, Italy
| | - Daniela Russo
- Department of Advanced Biomedical Sciences, Pathology Section- Federico II University Hospital of Naples, Naples, Italy
| | - Annarita Gencarelli
- Department of Advanced Biomedical Sciences, Pathology Section- Federico II University Hospital of Naples, Naples, Italy
| | - Annunziata Carlea
- Department of Neurosciences, Reproductive Sciences and Dentistry, Gynecology Unit-Federico II University Hospital of Naples, Naples, Italy
| | - Attilio Di Spiezio
- Department of Public Health, Gynecology Unit-Federico II University Hospital of Naples, Naples, Italy
| | - Clara Bertuzzi
- Department of Experimental, Diagnostic and Specialty Medicine, Hematopathology Unit, University of Bologna, Bologna, Italy
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, Pathology Section- Federico II University Hospital of Naples, Naples, Italy
| | - Francesco Grimaldi
- Department of Clinical Medicine and Surgery, Hematology Unit, Federico II University Hospital of Naples, Naples, Italy
| | - Luigi Insabato
- Department of Advanced Biomedical Sciences, Pathology Section- Federico II University Hospital of Naples, Naples, Italy,
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Vargas AC, Turner J, Burchett I, Ho LL, Zumbo R, Gill AJ, Maclean FM. Myeloid sarcoma and extramedullary hematopoiesis expand the spectrum of ERG-positive proliferations; an ancillary tool in the diagnosis. Hum Pathol 2022; 124:1-13. [DOI: 10.1016/j.humpath.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/20/2022] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
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Ye F, Zhang H, Zhang W, Dong J, Deng W, Yang L. Clinical characteristics, pathology features and outcomes of pediatric myeloid sarcoma: A retrospective case series. Front Pediatr 2022; 10:927894. [PMID: 36545668 PMCID: PMC9760868 DOI: 10.3389/fped.2022.927894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Myeloid sarcoma (MS) is a rare extramedullary mass with myeloid expression, which is easy to be missed and misdiagnosed, especially in the pediatric population. We analyze the clinicopathological characteristics, immunophenotypic, cytogenetic, and molecular studies, therapeutic approaches, and outcomes, to optimize the management of such patients. METHODS A retrospective, single-center, case series study of eleven children diagnosed with MS by pathology was performed. RESULTS The male-to-female ratio was 8:3, and the median age at diagnosis was 7 years. The most commonly involved sites were the skin and orbital region, followed by lymph nodes, central nervous system, and testis. Seven cases (64%) with Class I-MS and four cases (36%) presented as Class II-MS. Immunohistochemically, MPO and CD117 were the most commonly expressed markers, followed by CD33, CD43, CD34, CD68, and lysozyme. Chromosomal abnormalities were detected in 4 patients. Two patients had the presence of deleterious mutations (FLT3, ASXL, KIT, and DHX15) on molecular detection. Ten patients were treated with chemotherapy based on AML regimens. The median follow-up time was 33.5 months in eleven patients. Two patients relapsed, one died, and one lost to follow-up. The 2-year overall survival (OS) rate estimated by Kaplan-Meier curves was 90.9% ± 8.7%, and the event-free survival (EFS) rate was 64.9% ± 16.7%. CONCLUSIONS MS diagnosis is usually challenging. Adequate tumor biopsy and expanded immunohistochemistry are necessary for the correct diagnosis of MS. Early and regular systemic chemotherapy promises long-term survival.
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Affiliation(s)
- Fanghua Ye
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, China
| | - Hui Zhang
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, China
| | - Wen Zhang
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, China
| | - Jiajia Dong
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, China
| | - Wenjun Deng
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, China
| | - Liangchun Yang
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, China
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Rioja P, Macetas J, Luna-Abanto J, Tirado-Hurtado I, Enriquez DJ. Gastric myeloid sarcoma: A case report. World J Clin Oncol 2021; 12:960-965. [PMID: 34733617 PMCID: PMC8546661 DOI: 10.5306/wjco.v12.i10.960] [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: 04/21/2021] [Revised: 07/26/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Myeloid sarcoma (MS) is a rare hematologic malignancy defined as an extramedullary tumor of immature granulocytic cells. It can occur as primary or de novo and be associated with myelodysplasia or myeloproliferative neoplasms. The most frequent locations are the skin, lymph nodes and bones. The case of a patient with a diagnosis of primary granulocytic de novo gastric MS is reported.
CASE SUMMARY A 19-year-old female patient with MS, whose abdominal computed tomography showed a bulky tumor of 16.5 cm in the gastric chamber with infiltration in the retroperitoneal, pancreatic and bile duct region; the histological study showed gastric mucosa diffusely infiltrated by mononucleated cells and the immunohistochemistry expressed myeloperoxidase. After receiving induction chemotherapy based on the 3 + 7 regimen (daunorubicin/cytarabine), the patient developed severe hematological toxicity and neutropenic typhlitis which required a prolonged medical treatment. She presented a rapid disease progression. Although she received supportive treatment, the patient died.
CONCLUSION Gastric primary de novo MS is a rare and aggressive course neoplasm, fostering knowledge is very important to decide its management and to promote more approaches focused on understanding this pathology and its particularities in our population.
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Affiliation(s)
- Patricia Rioja
- Department of Oncology Medicine, Instituto Nacional de Enfermedades Neoplásicas, Lima 15000, Peru
| | - Jackeline Macetas
- Department of Oncology Medicine, Instituto Nacional de Enfermedades Neoplásicas, Lima 15000, Peru
| | - Jorge Luna-Abanto
- Department of Surgical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima 15000, Peru
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Liu Y, GuLiBaHa M, Yue YB, Li MW, Cao SB, Yan M. An isolated childhood myeloid sarcoma with germline MSH6 mutation-a case report. Transl Pediatr 2021; 10:2136-2143. [PMID: 34584885 PMCID: PMC8429872 DOI: 10.21037/tp-21-326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
Myeloid sarcoma (MS) is a type of malignant tumor that originates in the bone marrow. This study reports on the treatment of an 11-year-old Uygur girl with a 15-day history of fever and paroxysmal cough, accompanied by right hip pain. During treatment, fatigue and anemia developed, physical strength decreased, and a few petechiae were seen in the lower extremities. Multiple enlarged lymph nodes were palpable in the neck, with slight congestion in the pharynx. Routine blood screening showed three major myeloid lineage abnormalities. Pathological examination revealed the presence of CD10 (-), CD99 (+), CD20 (+), CD3 (-), CD117 (weak+), CD34 (unclear location), TdT (-), Pax5 (-), Ki-67 (50%+), MPO (-), and CD43 (+). The patient was eventually diagnosed with isolated MS. After chemotherapy, no small particles were observed in bone marrow morphology. Complete remission was confirmed by flow cytometric detection of minimal residual disease. Genomic DNA was subjected to targeted sequencing of 236 gene panels to detect somatic mutations and the MSH6 c.3953_3954insAA p.R1318fs germline mutation. Unfortunately, the patient was subsequently lost to follow-up. To our knowledge, an MSH6 germline mutation had not previously been reported in children with MS, and we speculated that an MSH6 germline mutation led to genomic instability, triggering a somatic mutation in multiple genes and ultimately led to the development of MS in this patient. It is suggested that rare base abnormalities may be involved in the development of isolated myeloid sarcomas (IMS).
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Affiliation(s)
- Yu Liu
- Pediatric Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - MaiMaiTi GuLiBaHa
- Pediatric Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ying-Bin Yue
- Pediatric Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ming-Wei Li
- Pediatric Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Shan-Bo Cao
- Lab of Gene, Acornmed Biotechnology Co., Ltd. Beijing Economic and Technological Development Zone, Beijing, China
| | - Mei Yan
- Pediatric Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Sözen M, Vural Ç, Selek A, Kiraz U, Cantürk Z, Çetinarslan B, Gezer E, Köksalan D. Infiltration of thyroid papillary cancer tissue with myeloid leukemic cells: a case report. World J Surg Oncol 2021; 19:225. [PMID: 34325712 PMCID: PMC8323301 DOI: 10.1186/s12957-021-02341-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/20/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Extramedullary leukemia, also known as myeloid sarcoma, is a rare form of acute myeloid leukemia and often accompanies bone marrow involvement. Myeloid infiltration of the thyroid gland is extremely rare. Here, a unique case in which thyroid cancer tissue was infiltrated with myeloid cells is presented. CASE PRESENTATION We present a case of thyroid papillary cancer infiltrated by blastic cells and bilateral breast and axillary myeloid sarcoma in a 30-year-old Caucasian female patient with a history of osteosarcoma and MDS-RAEB2. The patient firstly received 6 cycles of chemotherapy for osteosarcoma, and allogeneic hematopoietic stem cell transplantation was performed after anthracycline-based chemotherapy due to MDS-RAEB2. The patient remained in remission on follow-up in terms of both osteosarcoma and MDS-RAEB2. Malignant features (Bethesda VI) were observed in the fine needle aspiration biopsy performed from a newly developed firm, fixed thyroid nodule approximately 4-5 cm in length in the left thyroid lobe. Because of the Bethesda VI thyroid nodule, the patient underwent total thyroidectomy. In the pathological evaluation, CD34-, CD117-, MPO-, and HLA-DR-positive blastic cells which infiltrated into follicular variant papillary thyroid carcinoma were detected. In the evaluation performed due to blastic cell infiltration, multiple lesions showing increased 18-fluorodeoxyglucose activity in bilateral breast and axillae were detected. Myeloid sarcoma was found as a result of tru-cut biopsy from these lesions. A fungal cystic lesion was detected in the frontal region of the patient who developed altered consciousness after the second cycle of treatment of myeloid sarcoma. During her follow-up in the intensive care unit, she died of cranial septic embolism and acute infarction. CONCLUSIONS Here, we present a very interesting case that is the first. A staged approach to diagnosis with methods including immunohistochemical staining, radiological imaging methods, and cytogenetic and molecular analyses can help make the definitive diagnosis.
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Affiliation(s)
- Mehmet Sözen
- Department of Endocrinology and Metabolism, Kocaeli University Faculty of Medicine, İzmit, Kocaeli, Turkey.
| | - Çiğdem Vural
- Department of Pathology, Kocaeli University Faculty of Medicine, İzmit, Kocaeli, Turkey
| | - Alev Selek
- Department of Endocrinology and Metabolism, Kocaeli University Faculty of Medicine, İzmit, Kocaeli, Turkey
| | - Umay Kiraz
- Department of Pathology, Kocaeli University Faculty of Medicine, İzmit, Kocaeli, Turkey
| | - Zeynep Cantürk
- Department of Endocrinology and Metabolism, Kocaeli University Faculty of Medicine, İzmit, Kocaeli, Turkey
| | - Berrin Çetinarslan
- Department of Endocrinology and Metabolism, Kocaeli University Faculty of Medicine, İzmit, Kocaeli, Turkey
| | - Emre Gezer
- Department of Endocrinology and Metabolism, Kocaeli University Faculty of Medicine, İzmit, Kocaeli, Turkey
| | - Damla Köksalan
- Department of Endocrinology and Metabolism, Kocaeli University Faculty of Medicine, İzmit, Kocaeli, Turkey
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Myeloid Sarcoma of the Testis in Children: Clinicopathologic and Immunohistochemical Characteristics With KMT2A (MLL) Gene Rearrangement Correlation. Appl Immunohistochem Mol Morphol 2021; 28:501-507. [PMID: 31241561 DOI: 10.1097/pai.0000000000000783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Myeloid sarcoma (MS) is defined as an extramedullary mass-forming lesion composed of immature myeloid cells. It is a rare but well-known manifestation of acute myeloid leukemia. Pediatrics testicular MS may pose a possible diagnostic challenge, an issue that is underscored in the few testicular pediatric MS cases reported in the literature. Herein, we report a series of 5 cases of pediatric testicular MS that are evaluated at the morphologic and immunohistochemical levels with correlation with the KMT2A (MLL) rearrangement status. Three patients presented with no prior history of acute myeloid leukemia. All 5 cases showed monoblastic morphology; positive for CD33, CD43, CD68, CD163, CD4 (dim), and lysozyme; and negative for CD10, CD34, CD117, and myeloperoxidase. KMT2A (MLL) rearrangement was detected in 4 of the 5 cases. In the literature, 8 more cases of pediatric testicular lymphoma were reported. Most of them showed monocytic differentiation and KMT2A (MLL) rearrangement was reported in 3 of the cases. In conclusions, testicular MS in pediatric patients shows monoblastic differentiation which may be attributed to the KMT2A (MLL) rearrangement. We also highlight the importance of using an extended immunohistochemistry panel in the diagnosis of MS.
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13
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Auerbach A, Schmieg JJ, Aguilera NS. Pediatric Lymphoid and Histiocytic Lesions in the Head and Neck. Head Neck Pathol 2021; 15:41-58. [PMID: 33723759 PMCID: PMC7959275 DOI: 10.1007/s12105-020-01257-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/19/2020] [Indexed: 12/31/2022]
Abstract
Lymphoid and histiocytic lesions of the head and neck in pediatric patients is a fascinating topic as most of these lesions are benign, but that the neoplastic cases are essential to diagnose accurately for appropriate treatment. It is thought that 90% of children will have palpable lymph nodes between the ages of 4 to 8; most, but not all, are non-malignant and some resolve spontaneously without treatment. This paper will look at many of the benign and malignant lesions of both lymphocytic and histiocytic origin that present in the head and neck of children focusing on their diagnostic criteria. There is a very pertinent discussion of nonmalignant lymphoid proliferations, as infections and other reactive conditions dominate the pathology of pediatric lymphohistiocytic head and neck lesions. Discussion of those lymphomas which arise more frequently in the head and neck focuses on those seen in children and young adults such as classic Hodgkin lymphoma and Burkitt lymphoma, as well as new more controversial entities such as pediatric-type follicular lymphoma. Histiocytic lesions, both benign and malignant, are described and may be challenging to diagnose.
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Affiliation(s)
- A Auerbach
- The Joint Pathology Center, Silver Spring, MD, USA.
| | - J J Schmieg
- The Joint Pathology Center, Silver Spring, MD, USA
| | - N S Aguilera
- University of Virginia Health System, Charlottesville, VA, USA
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14
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Granulocytic sarcoma: Extramedullary manifestation of chronic myeloproliferative neoplasm in a young African woman. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2020.200462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Bai CR, Li X, Wang JS, Li JJ, Liu N, Fei Q, Li D, Yang Y. Diagnosis and surgical treatment of primary isolated aggressive lumbar myeloid sarcoma: a rare case report and review of the literatures. BMC Musculoskelet Disord 2021; 22:220. [PMID: 33627110 PMCID: PMC7905608 DOI: 10.1186/s12891-021-04066-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 02/09/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Myeloid sarcoma is a rare, extramedullary, solid tumor derived from immature myeloid cell precursors. It is most frequently accompanied by acute myelogenous leukemia, though infrequently found in non-acute myelogenous leukemia patients. The tumor may involve any part of the body, but the lumbar spine is seldom involved. The present case study aims to understand the diagnosis and surgical treatment of a rare primary isolated myeloid sarcoma of the lumbar spine causing aggressive spinal cord compression in a non-acute myelogenous leukemia patient. CASE PRESENTATION A 29-year-old man complained of an aggressive radiating pain to the lower extremities and moderate dysuria with a Visual Analogue Scale score that gradually increased from 3 to 8. Lumbar enhanced magnetic resonance imaging and computed tomography revealed a lumbar canal lesion at lumbar spine L2 to L4 with spinal cord compression. A whole body bone scan with fused single photon emission computed tomography/computed tomography demonstrated abnormal 99mTc-methylene diphosphonate accumulation in the L3 lamina and spinous process. No evidence of infection or hematology disease was observed in laboratory tests. Due to rapid progression of the symptoms and lack of a clear diagnosis, decompression surgery was performed immediately. During the operation, an approximately 6.0 × 2.5 × 1.2 cm monolithic, fusiform, soft mass in the epidural space and associated lesion tissues were completely resected. The radiating pain was relieved immediately and the dysuria disappeared within 1 week. Intraoperative pathological frozen section analysis revealed a hematopoietic malignant tumor and postoperative immunohistochemistry examination confirmed the diagnosis of myeloid sarcoma. CONCLUSIONS The primary isolated aggressive lumbar myeloid sarcoma is rarely seen, the specific symptoms and related medical history are unclear. Surgery and hematological treatment are effective for understanding and recognizing this rare tumor.
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Affiliation(s)
- Cheng-Rui Bai
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, 95 Yong An Rd, Beijing, 100050, China
| | - Xiang Li
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, 95 Yong An Rd, Beijing, 100050, China
| | - Jing-Shi Wang
- Department of Hematology, Beijing Friendship Hospital Affiliated of Capital Medical University, 95 Yong An Rd, Beijing, 100050, China
| | - Jin-Jun Li
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, 95 Yong An Rd, Beijing, 100050, China
| | - Ning Liu
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, 95 Yong An Rd, Beijing, 100050, China
| | - Qi Fei
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, 95 Yong An Rd, Beijing, 100050, China
| | - Dong Li
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, 95 Yong An Rd, Beijing, 100050, China
| | - Yong Yang
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, 95 Yong An Rd, Beijing, 100050, China.
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Hu G, Lu A, Wu J, Jia Y, Zuo Y, Ding M, Zhang L. Characteristics and prognosis of pediatric myeloid sarcoma in the cytogenetic context of t(8;21). Pediatr Hematol Oncol 2021; 38:14-24. [PMID: 32803999 DOI: 10.1080/08880018.2020.1803462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The prognosis of myeloid sarcoma (MS) is controversial. Many reports indicated that orbital-MS has a good prognosis and is closely related to t(8;21), but the prognostic role of MS in pediatric t(8;21) AML is unclear. We retrospectively analyzed data from 127 patients with pediatric t(8;21) AML diagnosed between January 2010 and June 2018. We compared patients with (n = 30) and without MS (n = 97). The median follow-up time was 52.6 months. The proportion of t(8;21) AML patients with MS was 23.6%. Males were more likely to have MS than females. The complete remission rate after the first course of induction chemotherapy and the 3-year relapse-free survival (RFS) among patients with MS were lower than those among patients without MS (60% vs. 78.4%, p = 0.045) (68.8 ± 8.8% vs. 88.0 ± 3.4%, p = 0.004). The female sex and a higher level of RUNX1/RUNX1T1 transcripts after consolidation were risk factors for poor RFS among patients with MS. Our data showed that MS was an independent risk factor in pediatric t(8;21) AML. Close monitoring of measurable residual disease of the bone marrow and extramedullary lesions is needed to guide stratified treatment.
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Affiliation(s)
- Guanhua Hu
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Aidong Lu
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Jun Wu
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Yueping Jia
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Yingxi Zuo
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Mingming Ding
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Leping Zhang
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
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Liu R, Du J, Gao L, Liu Y, Liu S. Myeloid sarcoma of the nasal cavity in a 15-month-old child: A case report. Medicine (Baltimore) 2020; 99:e21119. [PMID: 32629746 PMCID: PMC7337411 DOI: 10.1097/md.0000000000021119] [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: 02/05/2023] Open
Abstract
INTRODUCTION Myeloid sarcoma (MS) is a rare tumor mass. It may occur at any extramedullary anatomic sites but is uncommon in the sinonasal location.MS commonly presents concurrently with acute myeloid leukemia (AML), but it may predate AML over several months or years, named isolated MS. PATIENT CONCERNS We report a case of a 15-month-old child who presented with mouth breathing, bilateral rhinorrhea, palpebral edema and proptosis. The routine blood tests were normal for the first few months. Computed tomography scan revealed neoplasm in nasal cavity. DIAGNOSIS The patient was definitely diagnosed with isolated MS in the nasal cavity through immunohistochemistry combined with clinical features and radiological investigations, and MS further progressed to AML which was confirmed by hematologist. INTERVENTIONS Endoscopic sinus surgery was performed to acquire specimens. After diagnosis, the patient was promptly treated with systemic chemotherapy. OUTCOMES All symptoms gradually subsided and the mass of nasal cavity was invisible. No relapse occurred during follow-up. CONCLUSION Sinonasal MS may be misdiagnosed and should be considered when symptoms persist and worsen. Prompt clinic examinations are essential for cases with suspected MS. Diagnosis of MS is dependent on the immunohistological investigations combined with clinical features, radiological investigations. Early diagnosis and systemic chemotherapy are vital for patients to achieve best prognosis.
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MESH Headings
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Diagnostic Errors/prevention & control
- Early Diagnosis
- Edema/etiology
- Exophthalmos/etiology
- Eyelid Diseases/pathology
- Humans
- Immunohistochemistry/methods
- Infant
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/surgery
- Male
- Nasal Cavity/diagnostic imaging
- Nasal Cavity/pathology
- Nasal Cavity/surgery
- Sarcoma, Myeloid/complications
- Sarcoma, Myeloid/diagnostic imaging
- Sarcoma, Myeloid/metabolism
- Tomography, X-Ray Computed/methods
- Treatment Outcome
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Affiliation(s)
- Ruowu Liu
- Department of Otolaryngology-Head and Neck Surgery
| | - Jintao Du
- Department of Otolaryngology-Head and Neck Surgery
| | - Limin Gao
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yafeng Liu
- Department of Otolaryngology-Head and Neck Surgery
| | - Shixi Liu
- Department of Otolaryngology-Head and Neck Surgery
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Myeloid sarcoma of the tongue as a first manifestation of acute promyelocytic leukemia: A case report. Rep Pract Oncol Radiother 2020; 25:174-177. [PMID: 32021572 DOI: 10.1016/j.rpor.2019.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/02/2019] [Accepted: 12/30/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction We describe a 35-year-old male patient showing a myeloid sarcoma (MS) of the tongue as the first manifestation of acute promyelocytic leukemia (APL). The MS can appear in all parts of the human body, but it is extremely rare in the tongue. Clinical case The main symptoms were a pain in the tongue, asthenia, gingivorrhagia, fever. We found a tumor in the tongue, which was irregular in size and located in the posterior region of the right lateral edge of the tongue. The diagnosis of MS was made by the anatomopathological and immunohistochemical study, while the definite diagnosis of APL was confirmed by the molecular test. The treatment of APL was based on the administration of trans-retinoic acid 45 mg/m2 daily continuously and daunorubicin 60 mg/m2 every other day for 4 doses, with a favorable therapeutic response to APL and MS. Conclusion Promyelocytic myeloid cells can infiltrate many organs extramedullary, such as the tongue, and this might precede bone marrow infiltration. The early identification of myeloid sarcoma allows to carry out an early treatment of the APL.
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Xu LH, Wang Y, Chen ZY, Fang JP. Myeloid sarcoma is associated with poor clinical outcome in pediatric patients with acute myeloid leukemia. J Cancer Res Clin Oncol 2020; 146:1011-1020. [PMID: 31919567 DOI: 10.1007/s00432-020-03128-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/06/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE The impact of myeloid sarcoma (MS) on clinical outcome of pediatric acute myeloid leukemia (AML) patients remains controversial. Moreover, little is known about the role of stem cell transplantation (SCT) in such patients. METHODS Clinical data of patients with AML under 18 years of age were retrieved from the TARGET dataset. We analyzed the prevalence, clinical profile, molecular characteristics, and prognosis of MS in these patients. RESULTS Among 884 pediatric patients with AML, the frequency of MS was 12.3%. Pediatric AML with MS was associated with age under 1-year, abnormal cytogenetics, and KMT2A rearrangement. Moreover, MS was associated with a low complete remission rate, high induction death, poor 5-year EFS, and OS. KMT2A rearrangement had a negative impact on clinical outcome in AML patients with MS. In addition, SCT had no significant effect on the survival of AML patients with MS. Multivariate analysis revealed that MS was an unfavorable prognostic factor in pediatric AML in terms of EFS (Hazard ratio 1.670, P < 0.001) and OS (Hazard ratio 1.623, P = 0.004). CONCLUSIONS The presence of MS at diagnosis of pediatric AML is associated with poor clinical outcomes, particularly when associated with KMT2A rearrangements. Moreover, pediatric patients with AML and MS may not benefit from SCT.
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Affiliation(s)
- Lu-Hong Xu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107, West Yan Jiang Road, Guangzhou, Guangdong Province, People's Republic of China.
| | - Yin Wang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107, West Yan Jiang Road, Guangzhou, Guangdong Province, People's Republic of China
| | - Zhi-Yuan Chen
- Department of Pulmonary, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Jian-Pei Fang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107, West Yan Jiang Road, Guangzhou, Guangdong Province, People's Republic of China.
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20
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RAF Kinase Inhibitor Protein in Myeloid Leukemogenesis. Int J Mol Sci 2019; 20:ijms20225756. [PMID: 31744053 PMCID: PMC6888401 DOI: 10.3390/ijms20225756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 02/07/2023] Open
Abstract
RAF kinase inhibitor protein (RKIP) is an essential regulator of intracellular signaling. A somatic loss of RKIP expression is a frequent event in solid human cancers, and a role of RKIP as metastasis-suppressor is widely accepted nowadays. Recently, RKIP loss has been described in acute myeloid leukemia (AML) and a series of other myeloid neoplasias (MNs). Functional in vitro and in vivo experiments revealed that RKIP is an essential player within the development of these liquid tumors; however, the respective role of RKIP seems to be complex and multi-faceted. In this review, we will summarize the current knowledge about RKIP in myeloid leukemogenesis. We will initially describe its involvement in physiologic hematopoiesis, and will then proceed to discuss its role in the development of AML and other MNs. Finally, we will discuss potential therapeutic implications arising thereof.
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21
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Khoshnaw N, Yassin AK, Alwan AF, Hassan HA, Mula‐Hussain L. Challenges associated with limited-resources cancer care facility: Bilateral breast myeloid sarcoma as an example. Clin Case Rep 2019; 7:2022-2026. [PMID: 31788245 PMCID: PMC6878049 DOI: 10.1002/ccr3.2407] [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: 04/05/2019] [Revised: 07/22/2019] [Accepted: 08/11/2019] [Indexed: 11/25/2022] Open
Abstract
Myeloid sarcoma (MS) is a rare myeloid malignancy. It can arise before, concurrent with, or following different malignant hematological diseases, most commonly acute myeloid leukemia (AML), myelodysplastic syndrome, or myeloproliferative neoplasms. Here we describe a 30-year-old female with AML-M1 who presented to the hematology department with bilateral breast pain and tenderness. Available diagnostic measures including ultrasound of breast and magnetic resonance imaging were used to determine the nature of these breast lumps. MS was definitively diagnosed via biopsy and the patient was treated with systemic chemotherapy. Despite her AML treatment she unfortunately died secondary to disease progression. The authors consider this case of particular educational value due to the bilateral and aggressive nature of this patient's disease in the setting of a cancer-care facility with limited resources. KEY CLINICAL MESSAGE In retrospect, if breast MS had been considered earlier in this patient's presentation, a referral to an outside center with matched stem cell transplantation capability may have been warranted after complete remission following first bone marrow relapse, rather than continuing chemotherapy alone.
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Affiliation(s)
- Najmaddin Khoshnaw
- Department of HematologyHiwa Cancer HospitalSulaymaniyahKurdistanIraq
- Program of HematologyKurdistan Board of Medical SpecialtiesErbilKurdistanIraq
| | - Ahmed K. Yassin
- Program of HematologyKurdistan Board of Medical SpecialtiesErbilKurdistanIraq
- Department of MedicineCollege of MedicineHawler Medical UniversityErbilKurdistanIraq
| | - Alaa F. Alwan
- Department of Clinical HematologyNational Center of HematologyMustansiriyah UniversityBaghdadBaghdadIraq
| | - Hemin A. Hassan
- Department of HematopathologyShorash HospitalSulaymaniyahKurdistanIraq
| | - Layth Mula‐Hussain
- Division of Radiation OncologyZhianawa Cancer CenterSulaymaniyahKurdistanIraq
- Program of Radiation OncologyKurdistan Board of Medical SpecialtiesErbilKurdistanIraq
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22
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Romero M, Saavedra C, Rodríguez M, Henao-Martínez AF. An 83 year-old man with fever and speech difficulties. Brain Pathol 2019; 28:1025-1026. [PMID: 30536771 DOI: 10.1111/bpa.12667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Martha Romero
- Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Carlos Saavedra
- Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Myriam Rodríguez
- Department of Hematology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
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23
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Khaja M, Omesh T, Niazi M, Shaikh D, Mudunuru SA, Reyes OA, Malik S. Co-Occurrence of Myeloid Sarcoma of the Lymph Node and Acute Monocytic Myeloid Leukemia: A Case Report and Literature Review. Case Rep Oncol 2018; 11:791-799. [PMID: 30627094 PMCID: PMC6323399 DOI: 10.1159/000494830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/23/2018] [Indexed: 12/13/2022] Open
Abstract
Background Acute myeloid leukemia (AML) is the most common leukemia in adults. According to the French-American-British (FAB) system, monocytic leukemia is classified as M5. Myeloid sarcoma further occurs in 3–5% of AML. This is defined as an extramedullary tumor of myeloid cells in the lymph nodes, soft tissues, periosteum, bone, central nervous system (CNS), spinal cord, intestine, mediastinum, prostate, uterus, or ovaries. Case Presentation Here, we describe the case of a 29-year-old female who presented with fever, swelling of gums, neck pain, and weakness, which had persisted for 1 week. The patient had a white blood cell (WBC) count of 53.5 K/μL, and a peripheral smear revealed a myeloid blast cell (blast) percentage of 8%. Computed tomography (CT) of the neck indicated lymphadenopathy. Fine needle aspiration of the cervical lymph node showed groups of atypical immature myeloid cells, mixed with occasional megakaryocytes, and infiltration of eosinophilic myeloid cells into the lymph node, consistent with myeloid sarcoma. Flow cytometry analysis revealed intermediate to large circulating blasts, with irregular nuclei, fine chromatin, and distinct nucleoli, indicative of AML, with monocytic differentiation. The patient responded well to chemotherapy with fludarabine, cytarabine, granulocyte colony stimulating factor (G-CSF), and idarubicin; WBC counts returned to normal and patient was discharged to home. Conclusion Myeloid sarcoma of the lymph node is a rare co-occurrence with AML. Results of our study are consistent with the conclusion that early diagnosis and appropriate treatment improve survival.
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Affiliation(s)
- Misbahuddin Khaja
- Division of Pulmonary and Critical Care Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
| | - Toolsie Omesh
- Division of Pulmonary and Critical Care Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
| | - Masooma Niazi
- Division of Pathology, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
| | - Danial Shaikh
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
| | - Sitarama Arvind Mudunuru
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
| | - Olga Alexandra Reyes
- Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
| | - Sandeep Malik
- Division of Hematology and Oncology, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
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Melzer J. Clouds of different colors: A prospective look at head and neck surgical resident call experience. EAR, NOSE & THROAT JOURNAL 2018; 96:E19-E24. [PMID: 29236277 DOI: 10.1177/014556131709601205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Graduate medical education programs typically set up call under the assumption that residents will have similar experiences. The terms black cloud and white cloud have frequently been used to describe residents with more difficult (black) or less difficult (white) call experiences. This study followed residents in the department of head and neck surgery during call to determine whether certain residents have a significantly different call experience than the norm. It is a prospective observational study conducted over 16 months in a tertiary care center with a resident training program in otolaryngology. Resident call data on total pages, consults, and operative interventions were examined, as well as subjective survey data about sleep and perceived difficulty of resident call. Analysis showed no significant difference in call activity (pages, consults, operative interventions) among residents. However, data from the resident call surveys revealed perceived disparities in call difficulty that were significant. Two residents were clearly labeled as black clouds compared to the rest. These residents did not have the highest average number of pages, consults, or operative interventions. This study suggests that factors affecting call perception are outside the objective, absolute workload. These results may be used to improve resident education on sleep training and nighttime patient management in the field of otolaryngology and may influence otolaryngology residency programs.
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Affiliation(s)
- Jonathan Melzer
- Department of Otolaryngology-Head and Neck Surgery, U.S. Naval Hospital, Naples, Italy, PSC 827, Box 183, FPO AE 09617-0002.
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Myeloid Sarcoma Predicts Superior Outcome in Pediatric AML; Can Cytogenetics Solve the Puzzle? CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e249-e254. [DOI: 10.1016/j.clml.2018.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/13/2018] [Accepted: 03/27/2018] [Indexed: 12/13/2022]
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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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Li L, Wang Y, Lian CG, Hu N, Jin H, Liu Y. Clinical and pathological features of myeloid leukemia cutis. An Bras Dermatol 2018; 93:216-221. [PMID: 29723350 PMCID: PMC5916393 DOI: 10.1590/abd1806-4841.20186327] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 02/14/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Myeloid leukemia cutis is the terminology used for cutaneous manifestations of myeloid leukemia. OBJECTIVE The purpose of this study was to study the clinical, histopathological and immunohistochemical features of myeloid leukemia cutis. METHODS This was a retrospective study of clinical and pathological features of 10 patients with myeloid leukemia cutis. RESULTS One patient developed skin lesions before the onset of leukemia, seven patients developed skin infiltration within 4-72 months after the onset of leukemia, and two patients developed skin lesions and systemic leukemia simultaneously. Of these patients, five presented with generalized papules or nodules, and five with localized masses. The biopsy of skin lesions showed a large number of tumor cells within the dermis and subcutaneous fat layer. Immunohistochemical analysis showed strong reactivity to myeloperoxidase (MPO), CD15, CD43 and CD45 (LCA) in most cases. NPM1 (nucleophosmin I) and FLT3-ITD (Fms-like tyrosine kinase 3-internal tandem duplication) mutations were identified in one case. Five patients with acute myelogenous leukemia and one patient with chronic myelomonocytic leukemia died within two months to one year after the onset of skin lesions. STUDY LIMITATIONS This was a retrospective and small sample study. CONCLUSIONS In patients with myelogenous leukemia, skin infiltration usually occurs after, but occasionally before, the appearance of hemogram and myelogram abnormalities, and the presence of skin infiltration is often associated with a poor prognosis and short survival time. myeloid leukemia cutis often presents as generalized or localized nodules or masses with characteristic pathological and histochemical findings.
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Affiliation(s)
- Li Li
- Department of Dermatology, Peking Union Medical College Hospital,
Chinese Academy Medical Sciences - Beijing, China
| | - Yanan Wang
- Department of Dermatology, Peking Union Medical College Hospital,
Chinese Academy Medical Sciences - Beijing, China
| | - Christine Guo Lian
- Department of Pathology, Brigham & Women's Hospital, Harvard
Medical School - Boston, USA
| | - Nina Hu
- Department of Pathology, Brigham & Women's Hospital, Harvard
Medical School - Boston, USA
| | - Hongzhong Jin
- Department of Dermatology, Peking Union Medical College Hospital,
Chinese Academy Medical Sciences - Beijing, China
| | - Yuehua Liu
- Department of Dermatology, Peking Union Medical College Hospital,
Chinese Academy Medical Sciences - Beijing, China
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Loss of RKIP is a frequent event in myeloid sarcoma and promotes leukemic tissue infiltration. Blood 2018; 131:826-830. [PMID: 29295844 DOI: 10.1182/blood-2017-09-804906] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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29
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Cuglievan B, Menegaz BA, Garces S, Rytting ME. Acute myeloid leukaemia masquerading as a primary CNS tumour. BMJ Case Rep 2017; 2017:bcr-2017-220891. [DOI: 10.1136/bcr-2017-220891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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30
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[Two cases of myeloid sarcomas with review of literature]. Rev Med Interne 2017; 38:774-777. [PMID: 28668372 DOI: 10.1016/j.revmed.2017.06.002] [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: 01/16/2017] [Accepted: 06/01/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Myeloid sarcomas are uncommon proliferations of immature myeloid cells occurring in any extramedullary organ. We report here two cases of myeloid sarcomas in patients with, respectively, a polycythemia vera and a myelodysplastic syndrome. CASE REPORTS The first is an 81-year-old woman who presented with osteolytic lesions. Diagnosis has been highlighted using anatomopathological study after bone marrow biopsy, but it was delayed because of a very localized basin lesion and few positive myeloid markers. The second patient is an 86-year-old man who presented with pancytopenia and several lymph nodes. Lymph node cytology failed because of the rarity of blast cells. Diagnosis was done after anatomopathological study on lymph node biopsy which revealed a localized form of myeloid sarcoma. CONCLUSION The diagnosis of myeloid sarcoma must be considered when unusual tumors occur in patients with a chronic myeloid disease. In that case, therapeutic options are those of an acute myeloid leukemia.
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Bourlon C, Lipton JH, Deotare U, Gupta V, Kim DD, Kuruvilla J, Viswabandya A, Thyagu S, Messner HA, Michelis FV. Extramedullary disease at diagnosis of AML does not influence outcome of patients undergoing allogeneic hematopoietic cell transplant in CR1. Eur J Haematol 2017; 99:234-239. [PMID: 28556258 DOI: 10.1111/ejh.12909] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Extramedullary disease (EMD) at diagnosis of acute myeloid leukemia (AML) has been associated with increased risk of relapse and worse outcomes post-chemotherapy. This study sought to investigate the association of EMD with outcomes following allogeneic hematopoietic cell transplantation (allo-HCT). METHODS This single-center retrospective study investigated the impact of EMD at diagnosis on the outcome of patients transplanted for AML in first complete remission (CR1). The study included 303 consecutive patients with AML transplanted in CR1, median age 51 years (range 18-71). RESULTS EMD at diagnosis was documented in 39 patients (13%), either histologically (26 patients) or clinically/radiologically (13 patients). Among the 39 EMD patients, 16 had CNS disease, seven had gingival infiltration, and five had leukemia cutis. On univariate analysis, EMD had no significant impact on survival, with a 3-year OS of 55% (95% CI 38-69) compared to 48% for the non-EMD group (95% CI 42%-55%) (P=.84). Likewise, 3-year CIR was 18% vs 19% (P=.86) and 3-year NRM was 26% vs 33% (P=.83) for EMD vs non-EMD groups, respectively. Multivariate analysis confirmed these results. CONCLUSIONS We conclude that EMD at diagnosis of AML does not seem to influence outcomes following allo-HCT performed in CR1.
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Affiliation(s)
- Christianne Bourlon
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jeffrey H Lipton
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Uday Deotare
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Vikas Gupta
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dennis D Kim
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - John Kuruvilla
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Auro Viswabandya
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Santhosh Thyagu
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hans A Messner
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Fotios V Michelis
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Bashoura L, Eapen GA, Faiz SA. Pulmonary Manifestations of Lymphoma and Leukemia. Clin Chest Med 2017; 38:187-200. [DOI: 10.1016/j.ccm.2016.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Batdorf BH, Kroft SH, Hosking PR, Harrington AM, Mackinnon AC, Olteanu H. Evaluation of CD43 expression in non-hematopoietic malignancies. Ann Diagn Pathol 2017; 29:23-27. [PMID: 28807337 DOI: 10.1016/j.anndiagpath.2017.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES CD43 is normally expressed only on the surface of leukocytes, and is considered a sensitive and specific marker for hematologic malignancies. As such, it may have diagnostic utility in confirming hematolymphoid lineage in cases that are negative for CD45. Aberrant CD43 expression has been described in non-hematopoietic tumors, although literature data on this topic is variable and sometimes contradictory. To clarify and expand on existing literature findings, we evaluated CD43 expression by immunohistochemistry (IHC) in a large cohort (307) of non-hematopoietic neoplasms, including poorly differentiated malignancies. METHODS 17 tissue microarrays and sections from 19 individual cases were stained with CD43 (clone DF-T1) monoclonal antibody. The proportion of positive cells, stain localization (nuclear, cytoplasmic or membranous), and intensity (compared to internal leukocyte controls) were recorded in all cases. RESULTS There were 98/307 (32%) positive cases, that showed focal weak nuclear staining in 1-25% of cells, including 23/25 (92%) pancreatic ductal adenocarcinomas; 31/34 (91%) breast invasive ductal carcinomas; 13/15 (87%) papillary thyroid carcinomas; 3/4 (75%) follicular thyroid carcinomas; 6/15 (40%) renal cell carcinomas; 9/28 (32%) lung adenocarcinomas; 1/13 (8%) lung squamous cell carcinomas (SCCs); 2/8 (25%) prostate adenocarcinomas; 8/62 (13%) colon adenocarcinomas; and 2/21 (10%) neuroendocrine neoplasms. None of the positive cases demonstrated strong, membranous CD43 expression comparable to that seen in background mature lymphocytes or segmented neutrophils. Negative cases included 11 cervical SCCs, 12 cervical adenocarcinomas, 19 urothelial carcinomas, 10 lung small cell carcinomas, 11 sarcomas, and 19 poorly differentiated carcinomas from various tissue sites. CONCLUSIONS In our cohort, most non-hematopoietic neoplasms are negative for CD43 expression, with a subset showing focal, weak nuclear positivity. This data indicates that uniform and strong membranous staining appears to be specific to hematopoietic neoplasms.
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Affiliation(s)
- Bjorn H Batdorf
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Steven H Kroft
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Paul R Hosking
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | | | - Horatiu Olteanu
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States.
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Liang Y, Gao J, Wu D, Li S, Chen H, Ding L, Tong J, Xu Y. Long-Term Remission following Autologous Hematopoietic Cell Transplantation in a Patient with Multiple Nonleukemic Myeloid Sarcoma and a Review of the Literature. Acta Haematol 2017; 137:117-122. [PMID: 28301836 DOI: 10.1159/000455998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/09/2017] [Indexed: 12/18/2022]
Abstract
Multiple nonleukemic myeloid sarcoma (MS) is a rare form of MS that is developed in multiple anatomic sites other than bone marrow at diagnosis, without a preceding myeloid neoplasm. The prevalence, prognosis, and optimal management of multiple nonleukemic MS have not been addressed. The role of allogenic or autologous hematopoietic cell transplantation (HCT) for nonleukemic MS is also less well defined. We present a case of MS characterized by systemic lymphadenopathies and multiple effusions, which presumably had a very poor prognosis. The patient was treated with acute myeloid leukemia-type induction chemotherapy and autologous peripheral blood stem cell transplantation, and, unexpectedly, she has remained disease free for more than 6 years. We also reviewed the literature on this rare disease, and found that multiple nonleukemic MS was associated with younger age and a worse prognosis when compared with the overall nonleukemic MS population. We suggest that autologous HCT represents a valid option for young patients with chemosensitive disease and should be performed at the status of minimal residual disease-negative complete remission.
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Affiliation(s)
- Yun Liang
- Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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35
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Myeloid sarcoma in children - diagnostic and therapeutic difficulties. Contemp Oncol (Pozn) 2017; 20:444-448. [PMID: 28239280 PMCID: PMC5320455 DOI: 10.5114/wo.2016.65602] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/24/2015] [Indexed: 12/15/2022] Open
Abstract
Myeloid sarcoma (MS) is a malignant extramedullary tumour, which consists of immature cells of myeloid origin. It may occur de novo, concurrently or precede the diagnosis of acute myeloid leukemia (AML), myelodysplastic syndrome (MDS) or chronic myeloid leukemia (CML). MS can also be a manifestation of the relapse of the disease. The more frequent sites of involvement are the skin, orbit, bone, periosteum, lymph nodes, gastrointestinal tract, soft tissue, central nervous system and testis. Because of its different localization and symptoms, and the lack of diagnostics algorithm, myeloid sarcoma is a real diagnostic challenge, in particular in patients without initial bone marrow involvement. The correct diagnosis of MS is important for adequate therapy, which is often delayed because of a high misdiagnosis rate. In the paper, the role of immunohistochemistry, cytogenetic and molecular genetic analyses is emphasized as well as the breadth of unclear aspects of this disorder in children.
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36
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Ren ZX, Jiang HQ, Zhang LX, Deng QD, Zhang JY, Mu XP, Yang J. Disseminated cobblestone-like skin lumps in a newborn. J Eur Acad Dermatol Venereol 2016; 31:e291-e292. [PMID: 27896875 DOI: 10.1111/jdv.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Z X Ren
- Department of Neonatology, Women and Children Hospital of Guang Dong Province, Guang Zhou Medical University, Guangzhou, Guangdong, China
| | - H Q Jiang
- Department of Neonatology, Women and Children Hospital of Jiang Men City, Guangdong, China
| | - L X Zhang
- Department of Neonatology, Women and Children Hospital of Jiang Men City, Guangdong, China
| | - Q D Deng
- Department of Neonatology, Women and Children Hospital of Guang Dong Province, Guang Zhou Medical University, Guangzhou, Guangdong, China
| | - J Y Zhang
- Department of Pathology, Women and Children Hospital of Guang Dong Province, Guang Zhou Medical University, Guangzhou, Guangdong, China
| | - X P Mu
- Department of Clinical Laboratory, Women and Children Hospital of Guang Dong Province, Guang Zhou Medical University, Guangzhou, Guangdong, China
| | - J Yang
- Department of Neonatology, Women and Children Hospital of Guang Dong Province, Guang Zhou Medical University, Guangzhou, Guangdong, China
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Abstract
Acute erythroid leukemia is rare, with isolated reports on presentation as an extramedullary tumor mass (myeloid sarcoma). We describe a case of pure erythroid leukemia presenting as an orbital mass in a 1-year, 9-month-old girl. This is only the second case described in a child. Tissue biopsy of the tumor mass showed medium-sized cells that were glycophorin A positive and negative with conventional myeloid markers. Flow cytometry, bone marrow aspirate, and trephine confirmed the diagnosis of pure erythroid leukemia.
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38
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Chen Z, Wang W, Cortes JE, Liu E, Miranda RN, Zhao C, Yuan J, Lu X, Yang W, Ameri MD, Kantarjian HM, Medeiros LJ, Hu S. Differential clinical and prognostic impact of myeloid sarcoma vs medullary myeloid blast phase of chronic myelogenous leukemia in the era of tyrosine kinase inhibitor therapy. Blood Cancer J 2016; 6:e418. [PMID: 27152845 PMCID: PMC4916296 DOI: 10.1038/bcj.2016.27] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Z Chen
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - W Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J E Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E Liu
- Department of Pathology, Institute of Hematology & Blood Diseases Hospital, Tianjin, China
| | - R N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Zhao
- Department of Pathology, University of Iowa, Iowa City, IA, USA
| | - J Yuan
- Department of Pathology, University of Nebraska, Omaha, NE, USA
| | - X Lu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - W Yang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M D Ameri
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - H M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L J Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Hu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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39
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Dong A, Bai C, Zuo C. Diffuse Pleural Myeloid Sarcoma Mimicking Malignant Mesothelioma. J Thorac Oncol 2016; 11:603-5. [DOI: 10.1016/j.jtho.2015.12.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/16/2015] [Indexed: 11/30/2022]
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40
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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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41
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42
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Tomasian A, Sandrasegaran K, Elsayes KM, Shanbhogue A, Shaaban A, Menias CO. Hematologic malignancies of the liver: spectrum of disease. Radiographics 2015; 35:71-86. [PMID: 25590389 DOI: 10.1148/rg.351130008] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The incidence of hematologic malignancies and their extranodal manifestations is continuously increasing. Previously unsuspected hepatic involvement in hematologic malignancies such as Hodgkin disease and non-Hodgkin lymphoma, posttransplant lymphoproliferative disorder, myeloid sarcoma (chloroma), multiple myeloma, Castleman disease, and lymphohistiocytosis may be seen by radiologists. Although the imaging features of more common hepatic diseases such as hepatocellular carcinoma, metastases, and infection may overlap with those of hepatic hematologic malignancies, combining the imaging features with clinical manifestations and laboratory findings can facilitate correct diagnosis. Clinical features that suggest a hematologic neoplasm as the cause of liver lesions include a young patient (<40 years of age), no known history of cancer, abnormal bone marrow biopsy results, fever of unknown origin, and night sweats. Imaging features that suggest hematologic malignancy include hepatosplenomegaly or splenic lesions, vascular encasement by a tumor without occlusion or thrombosis, an infiltrating mass at the hepatic hilum with no biliary obstruction, and widespread adenopathy above and below the diaphragm. Familiarity with the imaging features of hepatic hematologic malignancies permits correct provisional diagnosis and may influence therapeutic management. For example, when biopsy is performed, core biopsy may be needed in addition to fine-needle aspiration so that the tissue architecture of the neoplasm can be discerned. The predominant treatment of hematologic malignancies is chemotherapy or radiation therapy rather than surgery. Online supplemental material is available for this article.
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Affiliation(s)
- Anderanik Tomasian
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (A.T., C.O.M.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A. Shanbhogue); and Department of Radiology, University of Utah, Salt Lake City, Utah (A. Shaaban)
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43
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Kaygusuz G, Kankaya D, Ekinci C, Topçuoğlu P, Kuzu I. Myeloid sarcomas: a clinicopathologic study of 20 cases. Turk J Haematol 2015; 32:35-42. [PMID: 25805673 PMCID: PMC4439905 DOI: 10.4274/tjh.2013.0087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: Myeloid sarcoma is a tumoral mass of mature or immature myeloid blasts in extramedullary anatomic locations. It can be seen de novo or in association with acute myeloid leukemia, myeloproliferative neoplasias, or myelodysplastic syndrome. Isolated myeloid sarcoma can be seen as a relapse in cases with allogenic bone marrow transplantation. Although it may involve any tissue in the body, the most common locations are skin, soft tissues, lymph nodes, and the gastrointestinal tract. Immunohistochemically, most cases show myelomonocytic or pure monoblastic differentiation. We reviewed the clinicopathological features of 20 cases of myeloid sarcoma diagnosed in our institute in view of the literature. Materials and Methods: The cases diagnosed between 2005 and 2012 at the Ankara University Faculty of Medicine, Department of Pathology, were selected. Clinicopathological findings including the age and sex of the patients; symptoms; anatomic location; accompanying hematological disease; and the morphological, immunohistochemical, and cytogenetic features of the cases were noted. Results: Sixteen of the patients were male and 4 were female. The median age at diagnosis was 47 years. The most commonly involved locations were the lymph nodes and skin. Immunohistochemically, eleven cases were of the myelomonocytic and 7 cases were of the myeloid phenotype, whereas 2 cases showed pure monoblastic differentiation. The median follow-up period for the 18 cases with known clinical data was 33 weeks. Five patients died of the disease in an average of 36 weeks. Conclusion: Myeloid sarcoma is a rare presentation of leukemias, myeloproliferative neoplasias, or myelodysplastic syndrome, composed of immature myelomonocytic cells in extramedullary tissues. It may present with variable morphological and phenotypic features, always creating a challenge in pathological diagnosis.
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Affiliation(s)
- Gülşah Kaygusuz
- Ankara University Faculty of Medicine, Department of Pathology, Ankara, Turkey. E-mail:
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44
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Shen J, Du X, Diao X, Zhao L, Wang W, Yu Y, Luo H. Myeloid Sarcoma Presenting With Multiple Skin and Subcutaneous Mass Without Leukemic Manifestations After Renal Transplantation. Transplant Proc 2015; 47:2227-32. [PMID: 26361685 DOI: 10.1016/j.transproceed.2015.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/02/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Myeloid sarcoma is well described and known in clinical practice, however, it is a rare condition after receiving renal transplantation. Immunosuppressive therapy is thought to be the main cause in these cases. CASE REPORT A 45-year-old woman accepted a right kidney transplantation because of her chronic renal insufficiency and uremia in May 2011. She had to receive a left kidney transplantation again in February 2012 because she had renal failure again after receiving the right kidney transplantation. She received immune inhibitors treatment. After the latter operation, her renal function was normal. The third operation was done to remove the right transplanted kidney in July 2012. The diagnosis of the kidney was myeloid sarcoma. The blood and bone marrow biopsy had no evidence of leukemia. She then received chemotherapy. There was a small skin nodule on the left arm of approximately 0.5 cm in August 2012; after that its diameter enlarged progressively to about 5 cm and more nodules and masses gradually appeared on her face, arms, trunk, lower limbs, and feet over the course of 1 year. The skin biopsy specimen obtained from her left arm showed myeloid sarcoma too. She was admitted to the Orthopedics Department for severe pain and swelling in the left foot in September 2014 and underwent an operation for resecting the mass in the left foot. Pain was apparently alleviated and the incision healed well. CONCLUSIONS The patient is still alive with no evidence of leukemia after a 30-month follow-up.
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Affiliation(s)
- J Shen
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - X Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - X Diao
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - L Zhao
- Department of Medical Information Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - W Wang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Y Yu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - H Luo
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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45
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Aggressive Myeloid Sarcoma Causing Recurrent Spinal Cord Compression. World Neurosurg 2015; 84:866.e7-10. [DOI: 10.1016/j.wneu.2015.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/06/2015] [Accepted: 04/08/2015] [Indexed: 11/23/2022]
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46
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Hu SCS, Chen WT, Chen GS. Myeloid sarcoma of the vulva as the initial presentation of acute myeloid leukaemia. Br J Dermatol 2015; 174:234-6. [PMID: 26252545 DOI: 10.1111/bjd.14063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- S C-S Hu
- Department of Dermatology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan.,Department of Dermatology, College of Medicine, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan
| | - W-T Chen
- Department of Pathology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan
| | - G-S Chen
- Department of Dermatology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan.,Department of Dermatology, College of Medicine, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan
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47
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Tan YB. Myeloid Sarcoma Masquerading as Granulation Tissue: A Diagnostic Pitfall. Int J Surg Pathol 2015; 23:553-6. [PMID: 26063639 DOI: 10.1177/1066896915588931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Myeloid sarcoma is an uncommon neoplasm, comprising an extramedullary tumorous proliferation of immature myeloid cells. Its rarity and tendency for diverse clinical presentation contribute to difficulty in timely diagnosis. This report describes a case of a painful back lump in an elderly Chinese male, which was initially diagnosed as a carbuncle. Histology on the saucerization specimen was reported as inflamed granulation tissue. Failure of expected wound healing prompted surgical debridement; microscopic examination on the subsequent specimen revealed an immature myeloid population with an increased MIB-1 proliferative index, highlighted by myeloperoxidase, lysozyme, CD117, and CD43 immunoreactivity, in keeping with myeloid sarcoma. Despite aggressive management, the patient eventually died. This report draws attention to potential pitfalls in the pathological diagnosis of this uncommon tumor and briefly summarizes its salient features.
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48
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Hagen PA, Singh C, Hart M, Blaes AH. Differential Diagnosis of Isolated Myeloid Sarcoma: A Case Report and Review of the Literature. Hematol Rep 2015; 7:5709. [PMID: 26330997 PMCID: PMC4508548 DOI: 10.4081/hr.2015.5709] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/09/2015] [Accepted: 04/16/2015] [Indexed: 12/31/2022] Open
Abstract
Myeloid sarcoma (MS) is a rare disease entity identified as a variety of manifestations defined by the occurrence of extramedullary myeloid cell masses with or without bone marrow involvement. This case describes an unusual presentation of isolated MS in a 60-year-old otherwise healthy male, who initially presented to his primary care physician with vague abdominal pain. After extensive workup including three omental biopsies, umbilical core biopsy, and inguinal lymph node biopsy, he was ultimately diagnosed with isolated MS with extensive extramedullary tumor burden. Despite advanced extramedullary disease, peripheral cell counts were normal and bilateral bone marrow biopsies unremarkable with normal cellular lineages, morphology, and cytogenetics. The patient underwent induction chemotherapy and is now greater than 100 days post myeloablative unrelated donor marrow transplantation with no evidence of disease recurrence and 100% donor status with full chimerism. This case demonstrates that making a prompt diagnosis with rapid initiation of treatment in myeloid sarcoma can be challenging due to its varied clinical presentation, cytomorphology, cytochemistry, and cytogenetic overlap with other lymphoid malignancies. Once a diagnosis of MS has been made, moving quickly to induction therapy is important. Several studies have shown that improved overall survival is attained when MS is treated as acute myeloid leukemia and increased survival is noted for patients undergoing bone marrow transplantation. Further prospective studies are needed to elucidate the many remaining questions in regards to the natural history, prognosis, and optimal treatment strategies for this deadly disease.
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Affiliation(s)
- Patrick A Hagen
- Division of Hematology/Oncology/Transplantation, Department of Medicine , MN, USA
| | | | - Melissa Hart
- Division of Pathology, University of Minneapolis , MN, USA
| | - Anne H Blaes
- Division of Hematology/Oncology/Transplantation, Department of Medicine , MN, USA
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Huang XL, Tao J, Li JZ, Chen XL, Chen JN, Shao CK, Wu B. Gastric myeloid sarcoma without acute myeloblastic leukemia. World J Gastroenterol 2015; 21:2242-2248. [PMID: 25717265 PMCID: PMC4326167 DOI: 10.3748/wjg.v21.i7.2242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/10/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
Myeloid sarcomas (MS) involve extramedullary blast proliferation from one or more myeloid lineages that replace the original tissue architecture, and these neoplasias are called granulocytic sarcomas, chloromas or extramedullary myeloid tumors. Such tumors develop in lymphoid organs, bones (e.g., skulls and orbits), skin, soft tissue, various mucosae, organs, and the central nervous system. Gastrointestinal (GI) involvement is rare, while the occurrence of myeloid sarcomas in patients without leukemia is even rare. Here, we report a case of a 38-year-old man who presented with epigastric pain and progressive jaundice. An upper GI endoscopy had shown extensive multifocal hyperemic fold thickening and the spread of nodular lesions in the body of the stomach. Biopsies from the gastric lesions indicated myeloid sarcoma of the stomach. However, concurrent peripheral blood and bone marrow examinations showed no evidence of acute myeloid leukemia. For diagnosis, the immunohistochemical markers must be checked when evaluating a suspected myeloid sarcoma case. Accurate MS diagnosis determines the appropriate therapy and prognosis.
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Abu Saadeh F, Collins V, Al-Saadi M, Gleeson N. An unusual relapse in acute myeloid leukaemia. BMJ Case Rep 2015; 2015:bcr-2014-207395. [PMID: 25701833 DOI: 10.1136/bcr-2014-207395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A 40-year-old nulliparous woman, with a history of acute myeloid leukaemia (AML), presented at a gynaecological clinic with an incidental finding of a 5 cm pelvic mass on ultrasound during workup for subfertility. Biopsies confirmed a myeloid sarcoma. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy, followed by chemotherapy and radiotherapy. She recovered well from her surgery, 21 months postsurgery with no evidence of recurrence.
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Affiliation(s)
- Feras Abu Saadeh
- Department of Gynaecology, St. James's Hospital, Dublin, Ireland
| | - Vicki Collins
- Department of Gynaecology, St. James's Hospital, Dublin, Ireland
| | | | - Noreen Gleeson
- Department of Gynaecology, St. James's Hospital, Dublin, Ireland
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