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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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Jain A, Gupta P, Gupta N, Senguttuvan G, Kapadia AB, Thirunavukkarasu B, Nada R, Varma N. Acute monocytic leukemia presenting as generalized lymphadenopathy and skin rash in a toddler: highlighting the clinicopathologic mimics. Diagn Cytopathol 2020; 49:E156-E163. [PMID: 33095510 DOI: 10.1002/dc.24649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/13/2020] [Indexed: 01/26/2023]
Abstract
Acute myeloid leukemia (AML) is the fifth most common malignancy in children. Extramedullary involvement in acute myeloid leukemia is rare and can be seen in soft tissues, central nervous system, skin and lymphoreticular organs. The clinical presentations can often be non-specific and hence, the diagnosis can be very challenging, especially in cases without a prior hematologic diagnosis. We report a case of pediatric acute monocytic leukemia presenting with generalized lymphadenopathy and cutaneous rash. Fine-needle aspiration was performed from the lymph nodes and a cytologic diagnosis of infiltration by a lymphoreticular malignancy was suggested. Peripheral blood, bone marrow and cerebrospinal fluid involvement were noted subsequently. Flow cytometry on the bone marrow aspirate confirmed a diagnosis of acute monocytic leukemia. The index case besides highlighting an uncommon presentation of acute monocytic leukemia in a toddler, also emphasizes the need to consider acute monocytic leukemia as a cytomorphologic differential in such presentations.
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Affiliation(s)
- Aleena Jain
- Department of Pathology, PGIMER, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | | | | | | | | | - Neelam Varma
- Department of Hematology, PGIMER, Chandigarh, India
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Matanes F, AbdelAzeem BMA, Shah G, Reddy V, Saad A, Papadantonakis N. Chronic myelomonocytic leukemia associated with myeloid sarcomas and NPM1 mutation: a case report and literature review. Ther Adv Hematol 2019; 10:2040620719854596. [PMID: 31217941 PMCID: PMC6557017 DOI: 10.1177/2040620719854596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/12/2019] [Indexed: 12/18/2022] Open
Abstract
We present a case of chronic myelomonocytic leukemia (CMML) associated with myeloid sarcomas. The CMML also harbored a NPM1 mutation, which is uncommonly described outside the context of acute myeloid leukemia (AML). We describe our treatment strategy, which involved remission-induction chemotherapy that led to rapid resolution of myeloid sarcomas, and we present a literature review highlighting the treatment challenges that similar cases pose.
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Affiliation(s)
- Faris Matanes
- Jordan University of Science and Technology, Irbid, Jordan; and Vascular Biology and Hypertension Program, University of Alabama at Birmingham, USA
| | | | - Gaurav Shah
- Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vishnu Reddy
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ayman Saad
- Division of Hematology, Ohio State University, Columbus, OH, USA
| | - Nikolaos Papadantonakis
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, NP 2540, Birmingham, AL 35294-3300, USA
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Gajendra S, Goel S, Sharma R, Dhiman P, Sachdev R. Myeloid Sarcoma Presented as Generalized Lymphadenopathy: Mimicking Malignant Lymphoma. Indian J Hematol Blood Transfus 2018; 34:173-177. [PMID: 29398826 DOI: 10.1007/s12288-017-0807-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/22/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Smeeta Gajendra
- 1Department of Pathology and Lab Medicine, Medanta The Medicity, Sector 38, Gurgaon, Haryana 122001 India
| | - Shalini Goel
- 1Department of Pathology and Lab Medicine, Medanta The Medicity, Sector 38, Gurgaon, Haryana 122001 India
| | - Rashi Sharma
- 1Department of Pathology and Lab Medicine, Medanta The Medicity, Sector 38, Gurgaon, Haryana 122001 India
| | - Pratibha Dhiman
- 2Department of Medical Oncology and Hematology, Medanta The Medicity, Sector 38, Gurgaon, Haryana 122001 India
| | - Ritesh Sachdev
- 1Department of Pathology and Lab Medicine, Medanta The Medicity, Sector 38, Gurgaon, Haryana 122001 India
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Wang X, Li WS, Zheng Y, Ying ZX, Wang YX, Wang YM, Zheng JF, Xiao SX. The progression of CD56 + myeloid sarcoma: A case report and literature review. Oncol Lett 2016; 11:3091-3096. [PMID: 27123069 DOI: 10.3892/ol.2016.4352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/23/2015] [Indexed: 11/05/2022] Open
Abstract
The current study presents a case of cluster of differentiation (CD)56+ myeloid sarcoma in a patient that initially presented with skin lesions, and provides evidence for the clinical and differential diagnosis of myeloid sarcoma. The patient of the present case report was a 65-year-old man who was admitted to hospital with a six-month history of bilateral purple-red papules and nodules, which were present on the upper limbs of the patient and had spread over his whole body one month prior to admission to the hospital. Pathological examination demonstrated a diffuse infusion of primitive round cells at the papillary dermis and subcutaneous tissues. The infiltrated cells were 40-60 µm in diameter and morphologically identical. Immunohistochemical examination revealed that the cells expressed myeloperoxidase, CD56, CD43 and T-cell intracytoplasmic antigen. In addition, several cells expressed CD34, and 90% of the cells expressed Ki67. While the majority of cells in myeloid sarcoma do not express CD56, the present case was a myeloid sarcoma that expressed CD56, which is extremely rare. The sarcoma in the present patient progressed rapidly, and the patient died eight months following the onset of disease. Clinicians should be aware of CD56+ myeloid sarcoma, which is easily misdiagnosed and inappropriately treated. Consequently, myeloid sarcoma may have a high malignancy and poor outcome for patients.
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Affiliation(s)
- Xin Wang
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Wen-Sheng Li
- Department of Pathology, The Third Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Yan Zheng
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Zhao-Xia Ying
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Yong-Xian Wang
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Ying-Mei Wang
- Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Jun-Feng Zheng
- Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Sheng-Xiang Xiao
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
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Vennepureddy A, Valecha G, Murukutla S, Hussein S, Terjanian T. Bronchial myeloid sarcoma with concurrentAspergillus fumigatusinfection in a patient presenting with hemoptysis. Expert Rev Hematol 2015; 8:433-7. [DOI: 10.1586/17474086.2015.1044747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Djurdjevic P, Jovanovic D, Antic D. Isolated myeloid sarcoma of the neck and chest: differential diagnosis and therapeutic approach. Open Med (Wars) 2014; 10:34-38. [PMID: 28352674 PMCID: PMC5152951 DOI: 10.1515/med-2015-0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 06/04/2014] [Indexed: 12/26/2022] Open
Abstract
In this article, we present the case of a 57-year-old man with cervical and mediastinal tumor mass, normal blood count as well as virusological status. Cervical tumor tissue biopsy revealed cells positive for CD34, CD13, LCA, CD33, and CD163 but negative for T-cell and B-cell markers, NK-cell markers, plasmacytic markers and anaplastic large cell lymphoma markers. These features were consistent with myeloid sarcoma of the neck with involvement of the mediastinum. We discussed differential diagnosis and therapy of isolated myeloid sarcoma and suggest that clinical presentation, cell morphology, complete immunophenotype, and specific genotypic lesions in some cases, must be evaluated.
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Affiliation(s)
- Predrag Djurdjevic
- Clinic for hematology, Clinical Center Kragujevac, Medical Faculty, University of Kragujevac
| | - Danijela Jovanovic
- Clinic for hematology, Clinical Center Kragujevac, Medical Faculty, University of Kragujevac
| | - Darko Antic
- Clinic for hematology, Clinical Center of Serbia, Koste Todorovica 2, 11 000 Belgrade, Serbia, Tel&fax +381 11 30 65 112
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