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Swink D, Mena Albors L, Lester D, Watson CD. Unusual Presentation of a Granulocytic Sarcoma. Cureus 2024; 16:e53980. [PMID: 38469018 PMCID: PMC10927350 DOI: 10.7759/cureus.53980] [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: 08/17/2022] [Accepted: 01/31/2024] [Indexed: 03/13/2024] Open
Abstract
A granulocytic sarcoma is an unusual tumor outside of bone marrow. It is composed of immature cells of the granulocytic cell line. We present a rare case of a 76-year-old male with a history of myelodysplastic syndrome who presented with a large bowel obstruction secondary to lesions at the cecum and transverse colon. He underwent exploratory laparotomy with extended right hemicolectomy. A pathological examination confirmed a granulocytic sarcoma as the cause of the obstruction.
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Affiliation(s)
- Daniel Swink
- General Surgery, University of Central Florida College of Medicine, Ocala, USA
| | - Laura Mena Albors
- General Surgery, University of Central Florida College of Medicine, Ocala, USA
| | - Danis Lester
- General Surgery, University of Central Florida College of Medicine, Ocala, USA
| | - Carrie D Watson
- General Surgery, University of Central Florida College of Medicine, Ocala, USA
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2
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Bladder Myeloid Sarcoma with TP53 mutated Myelodysplastic Syndrome/Myeloproliferative Neoplasm Overlap syndrome: Response to Decitabine-Venetoclax regimen. Leuk Res Rep 2022; 17:100286. [PMID: 34976720 PMCID: PMC8683948 DOI: 10.1016/j.lrr.2021.100286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/04/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022] Open
Abstract
Myeloid sarcoma (MS) is a rare extramedullary blast proliferation of immature cells of myeloid origin. It is commonly associated with acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), or myeloproliferative neoplasm (MPN), and may precede, coincide with, or follow the diagnosis of a myeloid disorder. MS treatment is controversial, but AML induction like regimens is usually recommended. We present an unusual case of de novo TP53 mutated MDS/MPN overlap with bladder MS. Due to the high-risk nature of the disease, the patient was induced with decitabine and venetoclax combination therapy, resulting in complete remission. The response was further consolidated by an allogeneic hematopoietic stem cell transplantation.
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3
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Clinicopathologic Features of Myelodysplastic Syndromes Involving Lymph Nodes. Am J Surg Pathol 2021; 45:930-938. [PMID: 33739784 DOI: 10.1097/pas.0000000000001689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Lymph nodes (LNs) involved by a myelodysplastic syndrome (MDS) are rare and uncommonly biopsied. In this study, we report 6 MDS patients who underwent an LN biopsy that showed MDS, and we summarize the clinicopathologic features of this cohort. All patients presented with lymphadenopathy (generalized in 5), 5 patients had splenomegaly, and 3 patients had hepatomegaly. Histologically, the LN architecture was distorted without complete effacement. MDS cells, mostly of the myeloid lineage, produced interfollicular expansion. These myeloid cells exhibited a spectrum of maturation, and immature and atypical forms were common, including eosinophils. Scattered megakaryocytes and nucleated erythroid cells were often present. Concurrent bone marrow aspirate and biopsy specimens in these patients showed persistent/resistant MDS. Following the diagnosis of LN involvement, patients did not respond well to therapy and all died by the time of the last follow-up, with a median survival of 6.7 months (range, 4.5 to 21.6 mo). In summary, patients with MDS uncommonly develop clinically evident lymphadenopathy prompting biopsy as a result of infiltration by MDS. MDS in LNs can be subtle, showing incomplete and sometimes mild distortion of the architecture, and ancillary studies including immunohistochemical and flow cytometric immunophenotypic analysis are often needed to establish the diagnosis. These data also suggest that the emergence of lymphadenopathy attributable to MDS is associated with poor treatment response and prognosis in MDS patients and that aggressive therapy or alternative treatment regimens need to be explored in this context.
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4
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Abstract
The article presents clinical description and instrumental findings (ultrasound examination and multi-slice computed tomography of the orbits) of a rare lacrimal gland tumor, which precedes or concurs with acute myeloblastic leukemia. Due to the low incidence of myeloid (granulocytic) sarcoma, it is not possible to develop a proper algorithm for its diagnosis and treatment. Few descriptions that are available in the literature neither give an idea of the variety of manifestations and the order of organ involvement, nor allow any vital prognosis. Verification of the diagnosis can only be based on immunohistochemical findings of the primary tumor and bone marrow biopsy material. The authors emphasize the importance of combination treatment (radiation therapy of the orbits and chemotherapy) in the prevention of leukemia.
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Affiliation(s)
- V G Likhvantseva
- Lomonosov Moscow State University, 1 Leninskie Gory, Moscow, Russian Federation, 119991
| | - T N Safonova
- Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021
| | - K A Kuzmin
- Lomonosov Moscow State University, 1 Leninskie Gory, Moscow, Russian Federation, 119991
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5
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Takano H, Takahashi K, Taki K. Myelodysplastic hematopoiesis mimicking the bone marrow in a mediastinal myelolipoma. Clin Case Rep 2017; 5:385-388. [PMID: 28396752 PMCID: PMC5378849 DOI: 10.1002/ccr3.777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 11/01/2016] [Accepted: 11/27/2016] [Indexed: 11/07/2022] Open
Abstract
Myelolipoma is one of the rare causes of posterior mediastinal tumor. Surgical excision is effective, which differs from the treatment of extramedullary disease usually concomitant with myelodysplastic syndrome. Cytogenetic analysis suggests the bone marrow cell originating myelolipoma.
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Affiliation(s)
- Hina Takano
- Department of Hematology Japan Red Cross Musashino Hospital Tokyo Japan
| | - Ken Takahashi
- Department of Thoracic Surgery Japan Red Cross Musashino Hospital Tokyo Japan
| | - Kazuhiro Taki
- Department of Pathology Japan Red Cross Musashino Hospital Tokyo Japan
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6
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Nizery-Guermeur C, Le Gall-Ianotto C, Brenaut E, Couturier MA, Talagas M, Andrieu-Key S, Guillerm G, Misery L, Karam A. Cutaneous granulocytic sarcoma and Koebner phenomenon in a context of myelodysplastic syndrome. JAAD Case Rep 2016; 1:207-11. [PMID: 27051731 PMCID: PMC4808728 DOI: 10.1016/j.jdcr.2015.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
| | - Christelle Le Gall-Ianotto
- Department of Dermatology, University Hospital of Brest, Brest, France
- Laboratory of Neurosciences of Brest (EA4685), University of Western Brittany, Brest, France
- Correspondence to: Christelle Le Gall-Ianotto, PhD, Laboratory of Neurosciences of Brest, 22 Avenue Camille Desmoulins, F-29200 Brest.
| | - Emilie Brenaut
- Department of Dermatology, University Hospital of Brest, Brest, France
- Laboratory of Neurosciences of Brest (EA4685), University of Western Brittany, Brest, France
| | | | - Matthieu Talagas
- Laboratory of Neurosciences of Brest (EA4685), University of Western Brittany, Brest, France
- Laboratory of Pathology, University Hospital of Brest, Brest, France
| | | | - Gaelle Guillerm
- Department of Clinical Hematology, University Hospital of Brest, Brest, France
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
- Laboratory of Neurosciences of Brest (EA4685), University of Western Brittany, Brest, France
| | - Allan Karam
- Department of Dermatology, University Hospital of Brest, Brest, France
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7
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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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8
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Rogers R, Ettel M, Cho M, Chan A, Wu XJ, Neto AG. Myeloid sarcoma presenting as a colon polyp and harbinger of chronic myelogenous leukemia. World J Gastrointest Oncol 2016; 8:321-325. [PMID: 26989468 PMCID: PMC4789618 DOI: 10.4251/wjgo.v8.i3.321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/11/2015] [Accepted: 12/21/2015] [Indexed: 02/05/2023] Open
Abstract
Myeloid sarcoma, also known as granulocytic sarcoma or chloroma is an unusual accumulation of malignant myeloid precursor cells in an extramedullary site, which disrupts the normal architecture of the involved tissue. It is known to occur more commonly in patients with acute myelogenous leukemia and less commonly in those with myelodysplastic syndrome and myeloproliferative neoplasm, such as chronic myelogenous leukemia. The most common sites of involvement include bone, skin and lymph nodes. However, rare cases have been reported in the gastrointestinal tract, genitourinary tract, or breast. Most commonly, a neoplastic extramedullary proliferation of myeloid precursors in a patient would have systemic involvement of a myeloid neoplasm, including in the bone marrow and peripheral blood. Infrequently, extramedullary disease may be the only site of involvement. It may also occur as a localized antecedent to more generalized disease or as a site of recurrence. Herein, we present the first case in the English literature of a patient presenting with an isolated site of myeloid sarcoma arising in the form of a colonic polyp which, after subsequent bone marrow biopsy, was found to be a harbinger of chronic myelogenous leukemia.
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9
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Ohanian M, Faderl S, Ravandi F, Pemmaraju N, Garcia-Manero G, Cortes J, Estrov Z. Is acute myeloid leukemia a liquid tumor? Int J Cancer 2013; 133:534-43. [PMID: 23280377 DOI: 10.1002/ijc.28012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 12/04/2012] [Accepted: 12/18/2012] [Indexed: 12/16/2022]
Abstract
Extramedullary manifestations of acute myeloid leukemia (AML) were described as early as the 19th century. However, the incidence, clinical significance and pathobiology of extramedullary AML remain ill defined. We reviewed case reports, retrospective case series, pilot studies and imaging studies of extramedullary leukemia (EML) to determine its frequency, characteristics, clinical presentation and significance. EML precedes or accompanies development of AML and occurs during or following treatment, even during remission. Although imaging studies are rarely conducted and the true incidence of EML has yet to be verified, authors have reported several estimates based on retrospective and autopsy studies. The incidence of EML in patients with AML of all ages is estimated to be about 9% and EML in children with AML was detected in 40% of patients at diagnosis. The combination of positron emission tomography and computed tomography were the most sensitive and reliable techniques of detecting and monitoring EML. Based on our literature review, the frequency of EML is likely underreported. The well-documented nature of EML in patients with AML suggests that AML can manifest as a solid tumor. The extent to which EML accompanies AML and whether EML is derived from bone marrow are unknown. Furthermore, questions remain regarding the role of the microenvironment, which may or may not facilitate the survival and proliferation of EML, and the implications of these interactions with regard to minimal residual disease, tumor cell quiescence and relapse. Therefore, prospective studies of detection and characterization of EML in patients with AML are warranted.
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Affiliation(s)
- Maro Ohanian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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10
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Sachdev R, George TI, Schwartz EJ, Sundram UN. Discordant immunophenotypic profiles of adhesion molecules and cytokines in acute myeloid leukemia involving bone marrow and skin. Am J Clin Pathol 2012; 138:290-9. [PMID: 22904142 DOI: 10.1309/ajcp34yerpzscykq] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
We investigated the role of adhesion molecules in skin involvement by acute myeloid leukemia (AML) using immunohistochemical analysis. Ten paired cases of skin and bone marrow biopsy specimens from patients with myeloid leukemia cutis (MLC) and 15 bone marrow biopsy specimens from patients without MLC were studied with antibodies directed against CD29, CD34, CD54, CD62-L, CD183, and cutaneous lymphocyte antigen (CLA). CLA was expressed in all cases of leukemia whereas CD54 was negative within blasts. CD62-L was expressed in 4 of 10 specimens of marrow infiltrates with MLC and 6 of 10 specimens of matching skin infiltrates; in marrows without MLC, only 2 of 15 were positive. CD29 was expressed in 1 of 10 marrow infiltrate specimens with MLC and 4 of 10 matching skin infiltrate specimens; in marrows without MLC, only 1 of 15 were positive. CD183 was expressed in 1 of 10 marrow infiltrate specimens with MLC and 4 of 10 matching skin infiltrate specimens; in marrows without MLC, CD183 was negative. The gain of CD62-L, CD29, and CD183 expression in bone marrow and skin infiltrates in leukemia cutis, relative to bone marrow infiltrates of cases without MLC, suggests a role for these markers in AML homing to skin.
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Affiliation(s)
- Reena Sachdev
- Department of Pathology, Stanford University Medical Center, Stanford, CA
| | - Tracy I. George
- Department of Pathology, Stanford University Medical Center, Stanford, CA
| | - Erich J. Schwartz
- Department of Pathology, Stanford University Medical Center, Stanford, CA
| | - Uma N. Sundram
- Department of Pathology, Stanford University Medical Center, Stanford, CA
- Department of Dermatology, Stanford University Medical Center, Stanford, CA
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11
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Baytan B, Evim MS, Güneş AM, Kocaeli H, Balaban S, Korfalı E, Tüzüner N. Cerebellar granulocytic sarcoma: a case report. Turk J Haematol 2012; 29:177-80. [PMID: 24744651 PMCID: PMC3986958 DOI: 10.5505/tjh.2012.65002] [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: 06/24/2009] [Accepted: 04/30/2010] [Indexed: 11/04/2022] Open
Abstract
Granulocytic sarcoma is a rare tumor composed of immature granulocytic cells that is usually associated with acute myelogenous leukemia. Intraparenchymal cranial localization without skull, meningeal, or bone marrow invasion is extremely rare. The mechanisms of intraparenchymal cranial localization of GS remains unknown, as only 10 cases with cerebellar granulocytic sarcoma have been previously reported. Herein, we report a four year old boy with cerebellar localization of granulocytic sarcoma.
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Affiliation(s)
- Birol Baytan
- Uludağ University, School of Medicine, Department of Pediatric Hematology, Bursa, Turkey
| | - Melike Sezgin Evim
- Uludağ University, School of Medicine, Department of Pediatric Hematology, Bursa, Turkey
| | - Adalet Meral Güneş
- Uludağ University, School of Medicine, Department of Pediatric Hematology, Bursa, Turkey
| | - Hasan Kocaeli
- Uludağ University, School of Medicine, Department of Neurosurgery, Bursa, Turkey
| | - Saduman Balaban
- Uludağ University, School of Medicine, Department of Pathology, Bursa, Turkey
| | - Ender Korfalı
- Uludağ University, School of Medicine, Department of Neurosurgery, Bursa, Turkey
| | - Nükhet Tüzüner
- İstanbul University, School of Medicine, Department of Pathology, Bursa, Turkey
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12
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Ur Rehman J, Mohammad S, Muhammad A, Mouhammad K. Acute myeloid leukemia post-allogeneic peripheral stem cell transplant with gastric chloroma. Ann Saudi Med 2011; 31:658-60. [PMID: 21727746 PMCID: PMC3221145 DOI: 10.4103/0256-4947.81805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jalil Ur Rehman
- From the Department of Oncology, King Faisal Specialist Hospital, Jeddah, Saudi Arabia
| | - Shinawi Mohammad
- From the Department of Oncology, King Faisal Specialist Hospital, Jeddah, Saudi Arabia
| | - Aslam Muhammad
- From the Department of Oncology, King Faisal Specialist Hospital, Jeddah, Saudi Arabia
| | - Kelta Mouhammad
- From the Department of Oncology, King Faisal Specialist Hospital, Jeddah, Saudi Arabia
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13
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Magro CM, Porcu P, Schaefer J, Erter JW, Furman RR, Shitabata PK, Crowson AN. Cutaneous CD4+ CD56+ hematologic malignancies. J Am Acad Dermatol 2010; 63:292-308. [PMID: 20541283 DOI: 10.1016/j.jaad.2009.08.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 08/14/2009] [Accepted: 08/14/2009] [Indexed: 10/19/2022]
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15
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Cho WH, Choi YJ, Choi BK, Cha SH. Isolated recurrence of intracranial granulocytic sarcoma mimicking a falx meningioma in acute myeloblastic leukemia. J Korean Neurosurg Soc 2010; 47:385-8. [PMID: 20539800 DOI: 10.3340/jkns.2010.47.5.385] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 02/11/2010] [Accepted: 05/03/2010] [Indexed: 11/27/2022] Open
Abstract
Intracranial granulocytic sarcomas are rare tumors, which are composed of immature granulocytic cells. Although it has been well known that these tumors are associated with acute myeloblastic leukemia (AML), they have been almost always related to bone marrow relapse. However, isolated recurrence of granulocytic sarcoma following complete remission from prior AML is extremely rare, especially in the central nervous system. A 44-year-old male presented with isolated recurrence of granulocytic sarcoma mimicking a falx meningioma two years after complete remission by allogenic peripheral blood stem cell transfusion (PBSCT) in the acute myelomonoblastic leukemia (FAB, M4). Because of depressed mental state and mass effect, total surgical resection was performed. Pathological findings were compatible with the granulocytic sarcoma. There was no evidence of leukemic relapse in the peripheral blood. We suggest that this phenomenon can be explained by the hypothesis that a certain barrier effect such as blood brain barrier might lead to the proliferation of intracranial leukemic cells which metastasized before PBSCT.
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Affiliation(s)
- Won Ho Cho
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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16
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Serefhanoglu S, Goker H, Aksu S, Buyukasik Y, Sayinalp N, Haznedaroglu IC, Ozcebe OI. Spinal myeloid sarcoma in two non-leukemic patients. Intern Med 2010; 49:2493-7. [PMID: 21088356 DOI: 10.2169/internalmedicine.49.3878] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Myeloid sarcoma, formerly termed granulocytic sarcoma or chloroma, consists of neoplastic granulocytic precursors and myeloblasts. Isolated chloromas (granulocytic sarcomas) are rare tumors. Spinal complications of chloromas, such as cord compression secondary to epidural tumor or cauda equine syndrome have been described but are rare. We herein report two cases with spinal granulocytic sarcomas in non-leukemic patients. The case of a previously healthy 22-year-old man diagnosed with multiple spinal granulocytic sarcomas with no evidence of bone marrow or other hematological involvement is described. And, a 43-year-old woman diagnosed cervical spinal granulocytic sarcoma with no evidence of bone marrow or other hematological involvement is described. The tumor was totally removed by microsurgery. The histopathological examination was consistent with granulocytic sarcoma. Granulocytic sarcoma should be considered in the differential diagnosis of an epidural mass in patients with or without acute leukemia, because early diagnosis followed by appropriate combined chemotherapy and radiation may obviate surgical intervention and eventually prevent leukemic transformation.
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Affiliation(s)
- Songul Serefhanoglu
- Department of Internal Medicine, Division of Hematology, Hacettepe University Medical School, Ankara, Turkey.
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17
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Choi ER, Ko YH, Kim SJ, Jang JH, Kim K, Kang WK, Jung CW, Kim DH. Gastric recurrence of extramedullary granulocytic sarcoma after allogeneic stem cell transplantation for acute myeloid leukemia. J Clin Oncol 2009; 28:e54-5. [PMID: 19917867 DOI: 10.1200/jco.2009.23.7560] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E Ryoung Choi
- Department of Medicine, Pathology, and Division of Hematology/Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Granulocytic sarcoma presenting as a thrombosed external hemorrhoid in a patient with myelodysplastic syndrome overt leukemia. Clin J Gastroenterol 2008; 1:145-147. [PMID: 26193692 DOI: 10.1007/s12328-008-0025-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Accepted: 06/18/2008] [Indexed: 10/21/2022]
Abstract
A 67-year-old Japanese man complained of a painful lump in his anus. He had a 15-month history of myelodysplastic syndrome (MDS) and had been diagnosed with MDS overt leukemia. A solid lump measuring 1.0 cm in diameter was detected in the anal verge. Under a diagnosis of a thrombosed external hemorrhoid, thrombectomy was performed under local anesthesia. One week after thrombectomy, the wound had not healed, and grayish-green tissue was seen at the bottom. A biopsy of the wound revealed atypical mononuclear cell infiltration. Myeloperoxidase and lysozyme were positive on immunohistochemical staining. Finally, the diagnosis of granulocytic sarcoma (GS) was made. Though it is well known that perianal complications occur quite often in patients with leukemia, it is unusual for a diagnosis of GS of the anus to be definitely established. To our knowledge, there has not been a previous report of GS presenting as a thrombosed external hemorrhoid. The development of GS should be considered during the management of such lesions, especially in patients with bone marrow disorders, such as acute myeloid leukemia (AML) or high-risk MDS.
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de Arruda Câmara VM, Morais JC, Portugal R, da Silva Carneiro SC, Ramos-e-Silva M. Cutaneous granulocytic sarcoma in myelodysplastic syndrome. J Cutan Pathol 2008; 35:876-9. [PMID: 18494822 DOI: 10.1111/j.1600-0560.2007.00916.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Granulocytic sarcoma is an extramedullary tumor of immature cells of granulocytic series, generally associated to acute myelogenous leukemia. The skin is one of the most commonly affected sites. Granulocytic sarcoma can complicate myelodysplastic syndromes and is considered a sign of poor prognosis. They are often misdiagnosed with non-Hodgkin lymphoma of the lymphoblastic type, Burkitt lymphoma and large cell lymphoma. In children, the differential diagnoses also include small, round cell tumors. It is important to diagnose these lesions early because they can precede peripheral blood and bone marrow transformation to acute myelogenous leukemia. We report a case of an elderly patient with myelodysplastic syndrome who developed multiple cutaneous granulocytic sarcoma lesions and discuss prognostic and treatment implications.
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Affiliation(s)
- Viviane Marins de Arruda Câmara
- Sector of Dermatology and Post Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil
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Quintás-Cardama A, Harb AJ, Amin HM, Verstovsek S. Granulocytic sarcoma with massive scalp involvement. Am J Hematol 2008; 83:340-2. [PMID: 17685484 DOI: 10.1002/ajh.20909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Alfonso Quintás-Cardama
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030-1402, USA
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Abstract
Thirty-two cases of granulocytic sarcoma (GS) are reported in this paper. Age range was from 16 - 70 years. GS was accompanied by AML in 13 cases, ALL (My+) in one case, CML in 11 cases and MDS in two cases. GS was diagnosed simultaneously with leukemia in five cases and preceded the leukemia in eight. Lymph node and soft tissue were the most commonly detected localizations. Seven cases had first been diagnosed as NHL. Histopathologically blastic, immature and mature variants were found in 11, nine and 11 cases respectively and overall survival was shortest in the blastic type. Myeloperoxidase and lysozyme were found to be positive in 30 and 24 cases respectively. Therapy was radiation in five cases and surgery in three. Systemic chemotherapy was given to the cases. The clinical outcome of the patients after the diagnosis of GS was poor. GS is a unique entity; prognosis is poor but it is important to detect the signaling pathways associated with migration of myeloid cells to the extra-medullary tissues. The critical factors for detecting this interesting tumor are to be aware of this disease, cooperation between clinician and pathologist and the application of special stains to detect the myeloid origin.
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Affiliation(s)
- Semra Paydas
- Department of Oncology, Cukurova University Faculty of Medicine, Adana, Turkey.
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Imamura T, Matsuo S, Yoshihara T, Chiyonobu T, Mori K, Ishida H, Nishimura Y, Kasubuchi Y, Naya M, Morimoto A, Hibi S, Imashuku S. Granulocytic Sarcoma Presenting with Severe Adenopathy (Cervical Lymph Nodes, Tonsils, and Adenoids) in a Child with Juvenile Myelomonocytic Leukemia and Successful Treatment with Allogeneic Bone Marrow Transplantation. Int J Hematol 2004; 80:186-9. [PMID: 15481450 DOI: 10.1532/ijh97.04040] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The occurrence of adenopathy in patients with myelodysplastic syndrome-associated extramedullary myeloid cell tumors has rarely been reported. We describe a 7-year-old girl with juvenile myelomonocytic leukemia who showed the novel chromosomal abnormality t(9;12)(p22;q24.1) and who developed severe adenopathy of the cervical lymph nodes, tonsils, and adenoids that was manifested as granulocytic sarcoma. Following chemotherapy, the patient underwent a conditioning regimen of busulfan, cyclophosphamide, and total body irradiation followed by successful allogeneic bone marrow transplantation from her single HLA locus-mismatched mother at 6 months after her diagnosis. The patient continues to be well and in remission 3 years after stem cell transplantation.
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Affiliation(s)
- Toshihiko Imamura
- Department of Pediatrics, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan.
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23
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Nappi O, Boscaino A, Wick MR. Extramedullary hematopoietic proliferations, extraosseous plasmacytomas, and ectopic splenic implants (splenosis). Semin Diagn Pathol 2004; 20:338-56. [PMID: 14694984 DOI: 10.1053/j.semdp.2003.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hematopoietic proliferations are well known to present ectopically outside the bone marrow, either in benign or malignant form. As such, they present a distinct problem with respect to morphologic interpretation because of their uncommonality in extramedullary sites and their capacity to simulate other lesions histologically. This review considers extramedullary myeloid tumors ("granulocytic sarcoma," "erythroblastic sarcoma," "megakaryocytic sarcoma"), tumefactive extramedullary hematopoiesis, and the peculiar condition known as "splenosis," with consideration of their clinical, microscopic, and cytohistochemical chararacteristics.
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Affiliation(s)
- Oscar Nappi
- Division of Anatomic Pathology, Histopathology, & Diagnostic Cytopathology, Department of Laboratory Medicine & Pathology, A. Cardarelli Hospital, Naples, Italy
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24
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Nishimura S, Kyuma Y, Kamijo A, Maruta A. Isolated Recurrence of Granulocytic Sarcoma Manifesting as Extra- and Intracranial Masses. Neurol Med Chir (Tokyo) 2004; 44:311-6. [PMID: 15253547 DOI: 10.2176/nmc.44.311] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 30-year-old female presented with a rare case of isolated recurrence of granulocytic sarcoma manifesting as extra- and intracranial masses 16 months after successful treatment of acute myeloblastic leukemia (M-2). She presented with a swelling located on her forehead that had appeared just after hitting her forehead, and never diminished in size. The mass was elastic hard and not freely mobile. Computed tomography and magnetic resonance imaging demonstrated enhanced masses in the right frontal extra- and intracranial region with no bone destruction. There was no evidence of relapse in the bone marrow. Needle aspiration biopsy of the subscalpal mass was performed. Fluorescence in situ hybridization revealed AML1/MTG8 fusion gene associated with t(8; 21). Two courses of systemic chemotherapy with high-dose cytarabine and total neural axis irradiation resulted in complete remission.
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MESH Headings
- Adult
- Antineoplastic Agents/therapeutic use
- Biopsy, Needle
- Brain Injuries/complications
- Brain Neoplasms/etiology
- Brain Neoplasms/pathology
- Core Binding Factor Alpha 2 Subunit
- Cytarabine/therapeutic use
- DNA-Binding Proteins/genetics
- Female
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Myeloid, Acute/etiology
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Magnetic Resonance Imaging
- Proto-Oncogene Proteins/genetics
- RUNX1 Translocation Partner 1 Protein
- Sarcoma, Myeloid/drug therapy
- Sarcoma, Myeloid/etiology
- Sarcoma, Myeloid/pathology
- Transcription Factors/genetics
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Affiliation(s)
- Satoshi Nishimura
- Department of Neurosurgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.
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25
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Chang HY, Wong KM, Bosenberg M, McKee PH, Haynes HA. Myelogenous leukemia cutis resembling stasis dermatitis. J Am Acad Dermatol 2003; 49:128-9. [PMID: 12833025 DOI: 10.1067/mjd.2003.233] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Leukemia cutis may clinically mimic many inflammatory dermatoses. A patient with myelodysplastic syndrome presented with an acute eruption of bilateral, lower-extremity, tender, indurated, brown plaques that clinically resembled chronic stasis dermatitis. Histologic study revealed a dermal myeloblastic leukemic infiltrate.
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Affiliation(s)
- Howard Y Chang
- Division of Dermatology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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26
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Tsimberidou AM, Kantarjian HM, Estey E, Cortes JE, Verstovsek S, Faderl S, Thomas DA, Garcia-Manero G, Ferrajoli A, Manning JT, Keating MJ, Albitar M, O'Brien S, Giles FJ. Outcome in patients with nonleukemic granulocytic sarcoma treated with chemotherapy with or without radiotherapy. Leukemia 2003; 17:1100-3. [PMID: 12764375 DOI: 10.1038/sj.leu.2402958] [Citation(s) in RCA: 163] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Granulocytic sarcoma (GS) is an extramedullary tumor composed of immature myeloid cells. The objectives of this study were to describe the frequency, presenting characteristics, and survival in patients with nonleukemic GS by conducting a review of all untreated patients presenting to the MD Anderson Cancer Center between January 1990 and June 2002. In all, 21 patients with nonleukemic GS, 1520 patients with acute myeloid leukemia (AML), and 402 patients with high-risk myelodysplastic syndrome (MDS) were identified. GS occurred in 1.4% of patients with AML, and 1.1% of patients with AML or high-risk MDSs. The median patient age was 57 years (range, 7-81). Among 20 patients with available cytogenetics in tissue and/or bone marrow, six had chromosome 8 abnormalities. The median follow-up of surviving patients is 12 months (range, 7-75). In all, 20 patients were treated. Patients were treated with AML-type chemotherapy (n=16), chemotherapy and radiotherapy (n=3), or radiotherapy alone (n=1). A total of 13 patients (65%) achieved complete remission and one patient (5%) achieved partial remission. The median overall survival was 20 months (range, 1-75), median overall failure-free survival was 12 months (range, 1-75). The median survival of patients with chromosome 8 abnormalities was 12 months compared with 40 months of those without (P=0.17). Novel therapies for patients with GS are required.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Chromosome Aberrations
- Chromosomes, Human, Pair 8/genetics
- Combined Modality Therapy
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/mortality
- Myelodysplastic Syndromes/therapy
- Remission Induction
- Sarcoma, Myeloid/drug therapy
- Sarcoma, Myeloid/genetics
- Sarcoma, Myeloid/mortality
- Sarcoma, Myeloid/radiotherapy
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- A-M Tsimberidou
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, 1400 Holcombe Boulevard, Houston, TX 77030, USA
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27
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Fulciniti F, Zeppa P, Marino G, Martinelli V, Ciancia R, Del Vecchio L, Rotoli B, Palombini L. Lymphnode localization of extramedullary myeloid cell tumor in myelodysplastic syndrome: report of one case diagnosed by fine-needle cytology. Diagn Cytopathol 2003; 28:136-9. [PMID: 12619094 DOI: 10.1002/dc.10256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Trilineage extramedullary myeloid tumor (EMT) is an uncommon medical condition mostly diagnosed in patients affected by acute or chronic myeloid leukemia or, more rarely, by a myelodysplastic syndrome, among which the most frequent is refractory anemia with excess of blasts in transformation (RAEB-t). The prognostic significance of EMT is still unclear, although the appearance of trilineage EMT is often considered to affect the outcome adversely. A 70-year-old lady with previous history of intestinal resection for colonic adenocarcinoma in 1995 and subsequently treated with 5-fuorouracyl developed a refractory anemia with excess of blasts (RAEB) in 1998. During the follow-up, a progression to RAEB-t was recorded. During chemotherapy for this condition, slight enlargement of left supraclavicular and right submandibular nodes was noticed. Fine-needle biopsy was performed with ancillary studies. A diagnosis of trilineage extramedullary myeloid tumor was reached. The patient was treated with low doses of chemotherapy with a good response lasting 12 months. The peculiar cytologic picture of this condition when corroborated by ancillary studies (immunocytochemistry and flow cytometry) is diagnostic of this rare condition. Furthermore, the extramedullary myeloid tumor in this case did not significantly affect the response to the chemotherapy of RAEB-t.
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MESH Headings
- Aged
- Anemia, Refractory, with Excess of Blasts/complications
- Anemia, Refractory, with Excess of Blasts/drug therapy
- Anemia, Refractory, with Excess of Blasts/pathology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy, Needle/methods
- Female
- Flow Cytometry
- Humans
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/etiology
- Leukemia, Myeloid/pathology
- Lymph Nodes/pathology
- Neoplasms, Second Primary
- Soft Tissue Neoplasms/drug therapy
- Soft Tissue Neoplasms/etiology
- Soft Tissue Neoplasms/pathology
- Treatment Outcome
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Affiliation(s)
- Franco Fulciniti
- Dipartimento di Scienze Biomorfologiche e Funzionali, Sezione di Anatomia Patologica e Citopatologia, Università degli Studi di Napoli Federico II, Naples, Italy
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28
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Ahn JY, Kwon SO, Shin MS, Kang SH, Kim YR. Meningeal chloroma (granulocytic sarcoma) in acute lymphoblastic leukemia mimicking a falx meningioma. J Neurooncol 2002; 60:31-5. [PMID: 12416543 DOI: 10.1023/a:1020236031949] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Isolated chloromas (granulocytic sarcomas) are rare tumors. Chloromas are masses composed of immature granulocytic cells. Granulocytic sarcoma occurs primarily in patients with acute myelogenous leukemia and may also arise in patients with other myeloproliferative disorders, but rarely in patients with acute lymphoblastic leukemia (ALL). When dural-based, granulocytic sarcoma may be indistinguishable from meningioma radiologically. We now describe one patient affected by ALL with isolated granulocytic sarcoma mimicking a falx meningioma as initial CNS relapses. These unusual clinical manifestation and radiological finding in ALL should be considered as recurrence of leukemia. Early detection and antileukemic treatment of granulocytic sarcoma are necessarily important for favorable prognosis.
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Affiliation(s)
- Jung Yong Ahn
- Department of Neurosurgery, Pundang CHA Hospital, Pochon University College of Medicine, Sungnam, South Korea.
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29
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Schwarz J, Trnková Z, Bedrlíková R, Jirásek A, Záková D, Trnený M, Sedlácková E, Kodetová D, Valenta J, Stöckbauer P, Haskovec C, Soukup J. Aleukemic granulocytic sarcoma with AML1/ETO fusion gene expression and clonal T cell populations. Leuk Res 2001; 25:1137-42. [PMID: 11684288 DOI: 10.1016/s0145-2126(01)00086-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We report a unique case of aleukemic granulocytic sarcoma of the neck, originally misdiagnosed as non-Hodgkin's lymphoma (NHL), though chloroma was also suspected due to a greenish macroscopic appearance and the presence of myeloid chloroacetate esterase (CAE)+ cells. The proof of clonal T cell receptor gamma chain (TcRgamma) gene rearrangements in the recurring tumor was deemed to confirm the initial diagnosis of T cell NHL. Altogether five distinct types of clonal TcRgamma gene rearrangements were found in the tumor, bone marrow and peripheral blood. Only retrospectively, using RT-PCR, did we detect the acute myeloid leukemia subset-specific fusion gene AML1/ETO in the frozen samples of the relapsed tumor, as well as in the otherwise unaffected bone marrow and peripheral blood (representing 'minimal initial disease' in the latter two samples). Simultaneous staining verified that the neoplastic CAE+ cells and CD45RO+ T cells were different populations.
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Affiliation(s)
- J Schwarz
- Institute of Hematology and Blood Transfusion, U Nemocnice 1, 128 20 Prague 2, Czech Republic.
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30
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Mourad W, Kfoury H, Al Husseini H. The value of CD34, myeloperoxidase and chloroacetate esterase (Leder) stain in the diagnosis of granulocytic sarcoma. Ann Saudi Med 2001; 21:287-91. [PMID: 17261930 DOI: 10.5144/0256-4947.2001.287] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The differentiation of extramedullary myelogenous leukemia/granulocytic sarcoma (GS) from malignant lymphoma can sometimes be difficult. In the current study, we explored the value of CD34, myeloperoxidase and nonspecific esterase (Leder) stains in differentiating GS from lymphomas. MATERIALS AND METHODS Fifteen cases of phenotypically confirmed GS were stained for CD34, myeloperoxidase and Leder stains. The same stains were performed in 16 malignant lymphomas as controls. The GS cases were also immunostained for CD3 and CD20 to detect the incidence of aberrant T and B lymphocyte expression. RESULTS CD34 was expressed in 7 of the 15 cases of GS (46%). Myeloperoxidase was expressed in 10 of the 15 cases (66%), and Leder stain was positive in 9 cases (60%). All 15 cases had expression of at least one marker; 8 cases had expression of two markers and one case had expression of all 3 markers. None of the lymphomas showed expression of any of the three markers. Five cases (35%) of GS showed T cell antigen expression and 2 (14%) showed B cell antigen expression. CONCLUSION Our findings suggest that in cases of GS, the use of the combination of CD34, myeloperoxidase and Leder stains can help reach a definitive diagnosis, especially if lymphoma is difficult to exclude. Expression of B and T cell antigens in such lesions should not rule out the diagnosis of GS.
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Affiliation(s)
- W Mourad
- Department of Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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31
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Hiçsönmez G, Cetin M, Yenicesu I, Olcay L, Koç A, Aktaş D, Tunçbilek E, Tuncer M. Evaluation of children with myelodysplastic syndrome: importance of extramedullary disease as a presenting symptom. Leuk Lymphoma 2001; 42:665-74. [PMID: 11697496 DOI: 10.3109/10428190109099328] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Thirty-three children diagnosed with primary myelodysplastic syndrome (MDS) in a single institution over an 8 year period were evaluated with special emphasis on children who presented with extramedullary disease (EMD). EMD was present at diagnosis in 12 (36%) of the 33 children with MDS. Three patients with juvenile myelomonocytic leukemia (JMML) and 2 patients with chronic myelomonocytic leukemia (CMML) presented with pleural effusion. Pericardial effusion was present in 3 of these patients, two of whom also had thrombosis. Pyoderma gangrenosum, relapsing polychondritis were the initial findings in another two cases with JMML. Lymphadenopathy (n=1), gingival hypertrophy (n=2), orbital granulocytic sarcoma (n=1) and spinal mass (n=1) were the presenting findings in 5 patients with refractory anemia with excess of blasts in transformation. Since high-dose methylprednisolone (HDMP, 20-30 mg/kg/day) has been shown to induce differentiation and apoptosis of myeloid leukemic cells in children with different morphological subtypes of acute myeloid leukemia in vivo and in vitro, 25 children with de novo MDS were treated with combined HDMP and cytotoxic chemotherapy. Dramatic improvement of EMD and decrease in blast cells both in the peripheral blood and bone marrow were obtained following administration of short-course HDMP treatment alone as observed in children with AML. HDMP, combined with low-dose cytosine arabinoside and mitoxantrone were used for the remission induction. Remission was achieved in 8 (80%) of 10 children who presented with EMD and in 9 (60%) of 15 children without EMD. Long-term remission (>6 years) was obtained in 4 (two with JMML and two with CMML), three of whom presented with EMD. In conclusion EMD can be a presenting finding in childhood MDS as observed in adults. In addition, the beneficial effect of HDMP combined with more intensive chemotherapy should be explored as alternative therapy in children with MDS not suitable for bone marrow transplantation.
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Affiliation(s)
- G Hiçsönmez
- Department of Pediatric Hematology, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
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32
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Yavorkovsky LL, Zain J, Wu CD, Trivelli L, Cook P. Monocytic leukemia cutis diagnosed simultaneously with refractory anemia with monocytosis: a case report. Am J Hematol 2001; 66:120-2. [PMID: 11421290 DOI: 10.1002/1096-8652(200102)66:2<120::aid-ajh1027>3.0.co;2-v] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A case of leukemia cutis (LC) of monocytic lineage in a patient with myelodysplastic syndrome (MDS) is presented. Cutaneous infiltrates were recognized concurrent with diagnosis of refractory anemia (RA) with monocytosis. Skin infiltrates subsequently spontaneously regressed although MDS progressed with increasing monocytosis, anemia, and thrombocytopenia. Death occurred 6 months after diagnosis with evolution of acute monoblastic leukemia complicated by sepsis. This case supports previous observations of poor prognosis associated with leukemia cutis. LC associated with MDS is reviewed including the role of monocytes.
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Affiliation(s)
- L L Yavorkovsky
- Department of Medicine, The Brooklyn Hospital Center, New York 10201, USA.
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33
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Chang CC, Eshoa C, Kampalath B, Shidham VB, Perkins S. Immunophenotypic profile of myeloid cells in granulocytic sarcoma by immunohistochemistry. Correlation with blast differentiation in bone marrow. Am J Clin Pathol 2000; 114:807-11. [PMID: 11068557 DOI: 10.1309/www7-dg6x-hc16-d7j2] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The present study was designed to evaluate the lineage differentiation (particularly monocytic differentiation) of immature myeloid cells in granulocytic sarcoma (GS) by immunohistochemistry and correlate the results with lineage differentiation of blasts in the bone marrow and to determine the degree of maturation of the infiltrating myeloid cells in GS by immunohistochemistry using CD34 and HLA-DR. Immunohistochemical stains were performed on paraffin-embedded tissue from 17 GS lesions with lineage-associated markers: myeloperoxidase, CD68 (KP1), CD68 (PG-Ml), glycophorin A, factor VIII, and CD56; and with markers for blasts and immature myeloid cells: CD34 and HLA-DR. Our results show that positive staining with PG-M1, but not KP1, suggests monocytic differentiation of myeloid cells in GS and correlates with the monocytic differentiation of blasts in the bone marrow. Expression of CD56 is frequent in GS, especially when the marrow blasts have monocytic differentiation, and should not be interpreted as a primary natural-killer cell process. The immature myeloid cells in GS are frequently HLA-DR positive. However, CD34 positivity of the immature myeloid cells is relatively uncommon, except in cases with underlying myelodysplastic syndrome or chronic myelogenous leukemia.
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Affiliation(s)
- C C Chang
- Dept of Pathology, Medical College of Wisconsin, Milwaukee 53006, USA
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34
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Murakami Y, Nagae S, Matsuishi E, Irie K, Furue M. A case of CD56+ cutaneous aleukaemic granulocytic sarcoma with myelodysplastic syndrome. Br J Dermatol 2000; 143:587-90. [PMID: 10971333 DOI: 10.1111/j.1365-2133.2000.03714.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We describe a 70-year-old man with cutaneous granulocytic sarcoma who presented with numerous cutaneous nodules but without any leukaemic involvement of the peripheral blood. The tumour cells were positive for lysozyme, peroxidase, CD11a, CD11c, CD33 and HLA-DR, and weakly positive for CD4 and CD14, suggesting granulocytic differentiation. The bone marrow at admission showed dysplasia of the erythrocytic and granulocytic lineage and complex chromosomal abnormalities in association with an increase in monocytes. The patient was diagnosed as having granulocytic sarcoma of monocytic lineage with concomitant myelodysplastic syndrome. In this case, tumour cells also expressed the neural cell adhesion molecule (CD56), which has been suggested as a possible risk factor for developing granulocytic sarcoma in acute myelogenous leukaemia.
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Affiliation(s)
- Y Murakami
- Department of Dermatology, Faculty of Medicine, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.
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35
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Ravandi-Kashani F, Cortes J, Giles FJ. Myelodysplasia presenting as granulocytic sarcoma of mediastinum causing superior vena cava syndrome. Leuk Lymphoma 2000; 36:631-7. [PMID: 10784409 DOI: 10.3109/10428190009148412] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Granulocytic sarcomas (GS) are extramedullary tumor masses of immature myeloid cells, most frequently associated with hematological disorders including acute myeloid leukemia (AML), chronic myelogenous leukemia (CML), and myelodysplastic syndrome (MDS). Recent interest has centered upon the possible biologic properties that enable theses myeloid cells to adhere to tissues and establish a tumor mass. GS presenting as a mediastinal mass is relatively infrequent, and more uncommon is presentation with the superior vena cava syndrome. We present one such case and review some of the available literature.
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Affiliation(s)
- F Ravandi-Kashani
- Department of Leukemia, University of Texas, M.D. Anderson Cancer Center, Houston 77030, USA
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36
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Hurford MT, Gujral S, Schuster SJ, Schwarting R. Extramedullary myeloid cell tumor of the urinary bladder in a patient with myelodysplastic syndrome. Pathol Res Pract 1999; 195:699-703; discussion 705-6. [PMID: 10549034 DOI: 10.1016/s0344-0338(99)80061-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report a case of extramedullary myeloid cell tumor of the urinary bladder in an elderly male with a three year history of myelodysplastic syndrome (refractory anemia with excess blasts), noninvasive papillary transitional cell carcinoma of the urinary bladder, and in situ transitional cell carcinoma of the left ureter. Light microscopy demonstrated a poorly differentiated neoplasm composed of medium to large cells with eosinophilic cytoplasm. The tumor cells showed immunohistochemical expression of myeloperoxidase, lysozyme, CD15, CD68 and CD43. Bone marrow examination following cystectomy demonstrated refractory anemia with excess blasts (6-10%) and a normal karyotype. Cytogenetics, approximately 1 year after cystectomy, demonstrated a deletion of the short arm of chromosome number 12. Four years after presentation, the patient succumbed to pulmonary aspergillosis.
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MESH Headings
- Aged
- Aged, 80 and over
- Antigens, CD/biosynthesis
- Bone Marrow Examination
- Carcinoma, Transitional Cell/complications
- Carcinoma, Transitional Cell/metabolism
- Carcinoma, Transitional Cell/pathology
- Chromosome Deletion
- Chromosomes, Human, Pair 12/genetics
- Chromosomes, Human, Pair 20/genetics
- Fatal Outcome
- Humans
- Immunohistochemistry
- Leukemia, Myeloid/complications
- Leukemia, Myeloid/metabolism
- Leukemia, Myeloid/pathology
- Male
- Myelodysplastic Syndromes/complications
- Myelodysplastic Syndromes/diagnosis
- Myelodysplastic Syndromes/genetics
- Neoplasms, Second Primary/complications
- Neoplasms, Second Primary/metabolism
- Neoplasms, Second Primary/pathology
- Peroxidase/biosynthesis
- Ureteral Neoplasms/complications
- Ureteral Neoplasms/metabolism
- Ureteral Neoplasms/pathology
- Urinary Bladder Neoplasms/complications
- Urinary Bladder Neoplasms/metabolism
- Urinary Bladder Neoplasms/pathology
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Affiliation(s)
- M T Hurford
- Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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37
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Yamamoto K, Hamaguchi H, Nagata K, Hara M, Tone O, Tomita H, Ito U. Isolated recurrence of granulocytic sarcoma of the brain: successful treatment with surgical resection, intrathecal injection, irradiation and prophylactic systemic chemotherapy. Jpn J Clin Oncol 1999; 29:214-8. [PMID: 10340046 DOI: 10.1093/jjco/29.4.214] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We describe a 40-year-old male who developed an isolated recurrence of granulocytic sarcoma (GS) of the brain 2 years following successful treatment of acute myeloblastic leukemia (AML; M2). Computed tomography (CT) scans and magnetic resonance (MR) images demonstrated a homogeneously enhanced tumor mass in the left temporal lobe and massive peritumoral edema. There was no evidence of relapse in the bone marrow. The patient underwent an emergency surgical resection of the tumor. Five courses of injection with cytarabine and prednisolone through an Ommaya reservoir and whole brain irradiation (total 40 Gy) were performed. Furthermore, prophylactic systemic chemotherapy with cytarabine and etoposide was added. He has been in complete remission for 21 months. Our results, together with other reported cases, indicate that a favorable outcome could be obtained by intensive and combined treatment for an isolated recurrence of GS of the brain if the bone marrow remained in complete remission.
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Affiliation(s)
- K Yamamoto
- Department of Hematology, Musashino Red Cross Hospital, Tokyo, Japan
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Critical Commentary. Pathol Res Pract 1999. [DOI: 10.1016/s0344-0338(99)80062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hiçsönmez G, Cetin M, Tunç B, Tuncer AM, Gümrük F, Yenicesu I. Dramatic resolution of pleural effusion in children with chronic myelomonocytic leukemia following short-course high-dose methylprednisolone. Leuk Lymphoma 1998; 29:617-23. [PMID: 9643576 DOI: 10.3109/10428199809050922] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
High-dose methylprednisolone (HDMP) which can induce--differentiation and -apoptosis of myeloid leukemic cells has been shown to be very effective in the treatment of extramedullary infiltration (EMI) of children with acute myeloblastic leukemia (AML). In the present study 2 children with chronic myelomonocytic leukemia (CMML) who had pleural effusions were given a single daily dose of oral methylprednisolone (20 mg/kg or 30 mg/kg). In addition to dramatic improvement of respiratory symptoms, pleural effusions disappeared in four days in both patients possibly due to apoptotic cell death induced by HDMP treatment. Further studies are needed to determine whether high-dose corticosteroids are also effective on the resolution of pleural effusions associated with other malignant disease.
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Affiliation(s)
- G Hiçsönmez
- Department of Pediatric Hematology, Ihsan, Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
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