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Shrinivas Y, Palaniswamy SS, Subramanyam P. Role of 18 F-FDG-PET/CT in an AML-M5a Subtype Patient with Rare Constellation of Hemophagocytic Lymphohistiocytosis & Bilateral Multiple Breast Chloromas. World J Nucl Med 2024; 23:49-53. [PMID: 38595838 PMCID: PMC11001452 DOI: 10.1055/s-0044-1779280] [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] [Indexed: 04/11/2024] Open
Abstract
We report a treated case of acute myeloid leukemia (AML-M5a subtype) with monocytic differentiation (AMoL) presenting with fever and body pains. Initial 18 F-FDG-PET/CT ( 18 F-flurodeoxyglucose positron emission tomography/computed tomography) identified multiple lymph nodal, and marrow lesions. Biopsy confirmed hemophagocytic lymphohistiocytosis (HLH). Post HLH treatment, follow-up PET/CT demonstrated unsuspected FDG avid bilateral breast lesions ( n = 5), which proved to be chloromas, that is, extranodal manifestation of AML. 18 F-FDG-PET/CT has helped not only in identifying the various sites of disease involvement but also in guiding the sites for biopsy. Finally, 18 F-FDG-PET/CT was useful in monitoring therapy response for both these coexisting pathologies, which are said to be resistant to treatment based on FLT3-ITD tyrosine kinase-3 internal tandem duplication mutation positivity and high-grade AML status. This case represents a rare constellation of different etiologies that needed to be differentiated. It also emphasizes the challenges in interpreting PET/CT findings, especially in difficult clinical scenarios. Disease distribution in HLH/presence of chloromas, etc., can mimic stage IV lymphoma in a known case of AML. So the nuclear medicine physician should be aware of the different complications in the background of AML, especially in patients with poor prognostic factors.
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Affiliation(s)
- Yuvan Shrinivas
- Amrita School of Medicine, Amrita Vishwa Vidyapeetham University, Cochin, Kerala, India
- Department of Radiodiagnosis, GITAM Institute of Medical Sciences And Research (deemed to be university), Visakhapatnam, Andhra Pradesh, India
| | - Shanmuga Sundaram Palaniswamy
- Department of Nuclear Medicine & Molecular Imaging, Amrita Institute of Medical Sciences & Research Centre, Cochin, Kerala, India
| | - Padma Subramanyam
- Department of Nuclear Medicine & Molecular Imaging, Amrita Institute of Medical Sciences & Research Centre, Cochin, Kerala, India
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Hsu J, Factor R, Lowell DA, Sobolewski R, Ghate SV. Myeloid Sarcoma of the Breast: A Diagnostic Dilemma With Pathologic Correlation. JOURNAL OF BREAST IMAGING 2023; 5:459-466. [PMID: 38416899 DOI: 10.1093/jbi/wbad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Indexed: 03/01/2024]
Abstract
Myeloid sarcoma (MS) is a rare extramedullary solid tumor arising most often in patients with current or subsequent acute myeloid leukemia (AML). Patients of all ages may present with involvement of the skin, lymph nodes, intestinal tract, bone, and/or central nervous system. Isolated involvement of the breast is rare, and only a small number of cases have been described in the literature. Breast MS may present as a palpable mass on clinical evaluation. In this broad literature review from 2010 to 2022, the most common findings on mammography are either solitary or multiple masses, followed by architectural distortion and, less commonly, no discrete findings. Sonography may demonstrate hypoechoic or mixed echogenicity mass(es) with circumscribed or indistinct, not discrete margins. Myeloid sarcoma may present as an enhancing mass or nonmass enhancement on breast MRI and is typically moderately radiotracer avid on 18F-fluorodeoxyglucose-PET. At histopathology, MS is characterized by myeloid blasts in varying stages of granulocytic or neutrophilic maturation; diagnosis typically requires immunophenotyping. There is no consensus for treatment of MS, although systemic chemotherapy for AML is often used as MS is considered the tissue equivalent of AML. This article will discuss and illustrate imaging and pathology findings when the breast is involved by MS.
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Affiliation(s)
- Joyce Hsu
- Duke University Hospital, Department of Radiology, Durham, NC, USA
| | - Rachel Factor
- Duke University Hospital, Department of Pathology, Durham, NC, USA
| | - Dorothy A Lowell
- Duke University Hospital, Department of Breast Imaging, Durham, NC, USA
| | - Robin Sobolewski
- Allegheny Health Network, Breast Imaging Division, Pittsburgh, PA, USA
| | - Sujata V Ghate
- Duke University Hospital, Department of Breast Imaging, Durham, NC, USA
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Gallardo MS, Joyrich R, Taub JW. Pediatric acute myeloid leukemia with breast chloromas. EJHAEM 2023; 4:488-490. [PMID: 37206254 PMCID: PMC10188463 DOI: 10.1002/jha2.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 05/21/2023]
Affiliation(s)
- Maria S Gallardo
- Division of Pediatric Hematology/Oncology Children's Hospital of Michigan Detroit Michigan USA
| | - Richard Joyrich
- Department of Hematology-Oncology Karmanos Cancer Institute, Wayne State University Detroit Michigan USA
| | - Jeffrey W Taub
- Division of Pediatric Hematology/Oncology Children's Hospital of Michigan Detroit Michigan USA
- Discipline of Pediatrics Central Michigan University College of Medicine Detroit Michigan USA
- Department of Pediatrics Wayne State University School of Medicine Detroit Michigan USA
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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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Wu HY, Liu L, Gu L, Luo YH. Clinical characteristics and management of primary granulocytic sarcoma of the breast: A case report. Medicine (Baltimore) 2019; 98:e16648. [PMID: 31464900 PMCID: PMC6736367 DOI: 10.1097/md.0000000000016648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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
RATIONALE Primary granulocytic sarcoma of the breast is a rare and poor-prognosis malignancy. Clinicians do not have sufficient knowledge of this disease and often misdirect it as other soft tissue sarcomas or inflammation. PATIENT CONCERNS A 42-year-old female presented with a self-discovered asymptomatic growing and palpable right breast mass that had been present for 4 months. DIAGNOSES The patient was diagnosed as primary myeloid sarcoma. INTERVENTIONS The patient received modified radical mastectomy in the right breast and sentinel lymph node biopsy. Pathological diagnosis is primary granulocytic sarcoma. Then the patient accepted acute myeloid leukemia-induction chemotherapy. OUTCOMES The follow-up of this patient has no evidence of disease progression or spread during 1 year. LESSONS Granulocytic sarcoma in the breast tissue is rare. But it still should be considered in the differential diagnosis of any tumor in the breast. The present study discusses comprehensively the clinical and pathological characteristics to improve the understanding of myeloid sarcoma.
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Zhai J, Kong X, Yang X, Gao J, Xuan L, Wang X, Wang J, Fang Y. An uncommon granulocytic sarcoma of the breast: a case report and literature review. Onco Targets Ther 2018; 11:3685-3690. [PMID: 29983576 PMCID: PMC6026916 DOI: 10.2147/ott.s149149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Granulocytic sarcoma (GS) is an uncommon extramedullary manifestation of acute myeloid leukemia. GS is often likely to be clinically misdiagnosed as another type of primary breast cancer due to its rarity. We report an uncommon case of breast GS in a patient and review the relevant literature.
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Affiliation(s)
- Jie Zhai
- Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Xue Yang
- Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Jidong Gao
- Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Lixue Xuan
- Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Xiang Wang
- Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, ;
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China, ;
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Myeloid Sarcoma after Allogenic Stem Cell Transplantation for Acute Myeloid Leukemia: Successful Consolidation Treatment Approaches in Two Patients. Case Rep Oncol Med 2018; 2018:7697283. [PMID: 29682375 PMCID: PMC5851332 DOI: 10.1155/2018/7697283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 02/01/2018] [Indexed: 12/30/2022] Open
Abstract
Myeloid sarcoma is an extramedullary (EM) manifestation (i.e., manifestation outside the bone marrow) of acute myeloid leukemia (AML); it is assumed to be relatively uncommon and can be the only manifestation of leukemia relapse after allogenic stem cell transplantation (allo-SCT). An EM sarcoma can manifest in any part of the body, although preferentially manifesting in immunological sanctuary sites as a single or multiple tumors. The development of myeloid sarcoma after allo-SCT is associated with certain cytogenetic abnormalities, developing of graft versus host disease (GVHD), and treatment with donor lymphocytes infusion (DLI). It is believed that posttransplant myeloid sarcomas develop because the EM sites evade immune surveillance. We present two patients with EM myeloid sarcoma in the breast and epipharynx, respectively, as the only manifestation of leukemia relapse. Both patients were treated with a combination of local and systemic therapy, with successfully longtime disease-free survival. Based on these two case reports, we give an updated review of the literature and discuss the pathogenesis, diagnosis, and treatment of EM sarcoma as the only manifestation of AML relapse after allo-SCT. There are no standard guidelines for the treatment of myeloid sarcomas in allotransplant recipients. In our opinion, the treatment of these patients needs to be individualized and should include local treatment (i.e., radiotherapy) combined with systemic therapy (i.e., chemotherapy, immunotherapy, DLI, or retransplantation). The treatment has to consider both the need for sufficient antileukemic efficiency versus the risk of severe complications due to cumulative toxicity.
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Sharma A, Das AK, Pal S, Bhattacharyya S. Fine-needle aspiration cytology of granulocytic sarcoma presenting as a breast lump - Report of a rare case with a comprehensive literature search. J Lab Physicians 2018; 10:113-115. [PMID: 29403218 PMCID: PMC5784281 DOI: 10.4103/jlp.jlp_114_17] [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] [Indexed: 11/21/2022] Open
Abstract
Myeloid sarcoma is a neoplasm of myeloid cells that can arise before or concurrent with or may follow acute myeloid leukemia. Very rarely, it can present as an isolated breast lump. We have diagnosed a case of myeloid sarcoma by fine-needle aspiration cytology (FNAC), in a 52-year-old woman who presented with the right-sided breast lump. FNAC showed hypercellular smears with immature myeloid cells few neutrophils and many large round cells with high nuclear-cytoplasmic ratio, prominent nucleoli and a moderate amount of granular cytoplasm. The blast cells were myeloperoxidase positive and complete blood count, and peripheral blood examination were normal. We report this case for its rarity and as a note of caution to a pathologist to consider myeloid sarcoma in the differential diagnosis of breast lump to provide the correct diagnosis and avoid incorrect treatment of a curable disease.
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Affiliation(s)
- Abhishek Sharma
- Department of Pathology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Anjan Kr Das
- Department of Pathology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Subrata Pal
- Department of Pathology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | - Subodh Bhattacharyya
- Department of Pathology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
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Affiliation(s)
- Kamal Kant Sahu
- a Department of Internal Medicine , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Uday Yanamandra
- a Department of Internal Medicine , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Pankaj Malhotra
- a Department of Internal Medicine , Post Graduate Institute of Medical Education and Research , Chandigarh , India
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