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Barnard P, Mouline O. A Rare Case of Partial Small Bowel Obstruction Secondary to Intestinal Myeloid Sarcoma. Cureus 2024; 16:e52956. [PMID: 38283782 PMCID: PMC10810725 DOI: 10.7759/cureus.52956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 01/30/2024] Open
Abstract
This case report details a rare case of small bowel myeloid sarcoma (MS) in an otherwise fit and well 49-year-old male presenting initially with vague obstructive symptoms and weight loss. The patient ultimately required an operation for a small bowel obstruction where a laparotomy and small bowel resection were performed due to three cicatrising completely obstructing lesions in the mid-jejunum. Fewer than 1% of patients with acute myeloid leukaemia (AML) present with MS as an initial diagnosis, and only 6.5% of these are intestinal in origin. This report adds to the current body of literature on this rare condition, emphasises the diagnostic challenges resulting in delays to diagnosis, and discusses the crucial role of early and accurate identification for optimal treatment and prognosis. Surgery may be warranted in patients with complications such as obstruction; however, systemic chemotherapy tailored to AML is the primary therapeutic approach for MS patients.
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Affiliation(s)
| | - Omar Mouline
- General Surgery, Cairns Hospital/James Cook University, Cairns, AUS
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2
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Post-transplant leukemia relapse in organs: biology. and behavior in 585 reports. Crit Rev Oncol Hematol 2020; 157:103170. [PMID: 33316638 DOI: 10.1016/j.critrevonc.2020.103170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/21/2020] [Accepted: 11/05/2020] [Indexed: 02/07/2023] Open
Abstract
Resistance of extramedullary leukemia growth post-transplant prevents cure. Review of its behavior detailed in 585 published cases should lead to better treatment. Leukemic tumors were found up to 13 years after transplant, most in sites inaccessible to physical exam. In 83%, marrow was not in morphologic relapse; next relapse was most often extramedullary. Induction protocols alone produced few durable responses in acute leukemias and fatal marrow aplasia in 17 %. Overall, 120 patients survived over 2 years, 43 relapse-free up to 18 years, the majority after combined tumor-directed and systemic therapy. Overall median survival was 9 months. This review highlights how results can improve: by defining extent of leukemia involvement with scans before transplant, and emergently when leukemic tumor is found after, ablating tumor directly to abort metastasis, and determining dosing of systemic chemotherapy that protects, without ablating, donor marrow. Monitoring total body remission with body scans should increase transplant cures.
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3
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Ono K, Mikami Y, Hosoe N. Primary granulocytic sarcoma of the small intestine diagnosed by single-balloon enteroscopy: A case report. Dig Endosc 2020; 32:436. [PMID: 31858650 DOI: 10.1111/den.13611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Keiko Ono
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Yohei Mikami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
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4
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Dalland JC, Meyer R, Ketterling RP, Reichard KK. Myeloid Sarcoma With CBFB-MYH11 Fusion (inv(16) or t(16;16)) Prevails in the Abdomen. Am J Clin Pathol 2020; 153:333-341. [PMID: 31671434 DOI: 10.1093/ajcp/aqz168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Myeloid sarcoma with CBFB-MYH11 fusion may be enriched in abdominal sites. The clinicopathologic features of 11 cases are reported. METHODS We collected clinical features, morphology, immunophenotype, and bone marrow (BM) involvement of myeloid sarcoma cases with CBFB-MYH11 fusion. RESULTS Eleven of 29 total myeloid sarcoma cases were CBFB-MYH11 positive and all 11 involved abdominal sites. The blastic infiltrate was associated with eosinophils in four of 11 cases and plasmacytoid dendritic cell (pDC) nodules in four of six cases. CD34, CD117, and myeloperoxidase were expressed in eight of nine, 10 of 10, and 10 of 10 cases, respectively. Ten of 10 cases showed no BM involvement. CONCLUSIONS Our current series, combined with a literature review, identifies a compelling series of 31 (94%) of 33 cases of myeloid sarcoma with CBFB-MYH11 fusion showing a marked predilection for abdominal sites. In addition, the lack of obvious associated eosinophils, presence of pDC nodules, and lack of concurrent BM involvement suggest that "myeloid sarcoma with CBFB-MYH11 fusion" may represent a unique phenomenon.
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Affiliation(s)
- Joanna C Dalland
- Department of Laboratory Medicine and Pathology, Divisions of Hematopathology, Rochester, MN
| | - Reid Meyer
- Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN
| | - Rhett P Ketterling
- Department of Laboratory Medicine and Pathology, Divisions of Hematopathology, Rochester, MN
- Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN
| | - Kaaren K Reichard
- Department of Laboratory Medicine and Pathology, Divisions of Hematopathology, Rochester, MN
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Mizumoto R, Tsujie M, Wakasa T, Kitani K, Manabe H, Fukuda S, Okada K, Satoi S, Ishikawa H, Kawasaki T, Hanamoto H, Yukawa M, Inoue M. Isolated myeloid sarcoma presenting with small bowel obstruction: a case report. Surg Case Rep 2020; 6:2. [PMID: 31900687 PMCID: PMC6942080 DOI: 10.1186/s40792-019-0759-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/06/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Myeloid sarcoma (MS) is a solid tumor consisting of myeloid blasts or immature myeloid cells, which are unusual outside the bone marrow. CASE PRESENTATION We present a rare case of isolated myeloid sarcoma of the small bowel in a 54-year-old man who was admitted to our hospital with repeated symptoms of intestinal obstruction. A small bowel series via an ileus tube revealed severe jejunal obstruction. Computed tomography revealed that the obstruction was likely caused by a jejunal tumor. The patient underwent laparoscopy-assisted partial resection of the jejunum with lymphadenectomy. Histopathological examination of the surgical specimen confirmed that MS had been responsible for the obstruction. CONCLUSIONS Patients with MS require systemic chemotherapy, as do patients with acute myeloid leukemia. Hence, an early, accurate diagnosis is imperative for treating this malignancy. It is also important to list MS in the differential diagnosis of a small bowel tumor, even in nonleukemic patients.
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Affiliation(s)
- Rie Mizumoto
- Department of Surgery, Kindai University Nara Hospital, 1248-1 Otoda, Ikoma, Nara, 630-0293, Japan
| | - Masanori Tsujie
- Department of Surgery, Kindai University Nara Hospital, 1248-1 Otoda, Ikoma, Nara, 630-0293, Japan
| | - Tomoko Wakasa
- Department of Pathology and Laboratory Medicine, Kindai University Nara Hospital, 1248-1 Otoda, Ikoma, Nara, 630-0293, Japan
| | - Kotaro Kitani
- Department of Surgery, Kindai University Nara Hospital, 1248-1 Otoda, Ikoma, Nara, 630-0293, Japan
| | - Hironobu Manabe
- Department of Surgery, Kindai University Nara Hospital, 1248-1 Otoda, Ikoma, Nara, 630-0293, Japan
| | - Shuichi Fukuda
- Department of Surgery, Kindai University Nara Hospital, 1248-1 Otoda, Ikoma, Nara, 630-0293, Japan
| | - Kaoru Okada
- Department of Surgery, Kindai University Nara Hospital, 1248-1 Otoda, Ikoma, Nara, 630-0293, Japan
| | - Shumpei Satoi
- Department of Surgery, Kindai University Nara Hospital, 1248-1 Otoda, Ikoma, Nara, 630-0293, Japan
| | - Hajime Ishikawa
- Department of Surgery, Kindai University Nara Hospital, 1248-1 Otoda, Ikoma, Nara, 630-0293, Japan
| | - Toshihiko Kawasaki
- Department of Gastroenterology and Hepatology, Kindai University Nara Hospital, 1248-1 Otoda, Ikoma, Nara, 630-0293, Japan
| | - Hitoshi Hanamoto
- Department of Hematology, Kindai University Nara Hospital, 1248-1 Otoda, Ikoma, Nara, 630-0293, Japan
| | - Masao Yukawa
- Department of Surgery, Kindai University Nara Hospital, 1248-1 Otoda, Ikoma, Nara, 630-0293, Japan.
| | - Masatoshi Inoue
- Department of Surgery, Kindai University Nara Hospital, 1248-1 Otoda, Ikoma, Nara, 630-0293, Japan
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Nemésio RA, Costa B, Abrantes C, Leite JS. Myeloid sarcoma of the small intestine in a patient without overt acute myeloid leukaemia: a challenging diagnosis of a rare condition. BMJ Case Rep 2018; 2018:bcr-2017-222718. [PMID: 29848520 DOI: 10.1136/bcr-2017-222718] [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] [Indexed: 01/14/2023] Open
Abstract
Myeloid sarcoma (MS) is a rare condition that most commonly occurs in the setting of acute myeloidleukaemia (AML) or other chronic myeloproliferative disorders. It presents as an abnormal growth that can develop anywhere in the human body, and its clinical manifestations are often non-specific.We present the case of a patient admitted to the emergency room with bowel obstruction. After careful clinical assessment, she underwent a right hemicolectomy. After a thorough examination of the surgical pathology specimen, including testing a wide array of immunohistochemical markers, the patient was timely diagnosed with MS, allowing for the implementation of the appropriate treatment to achieve complete remission. This is crucial, since non-leukaemic patients with untreated MS always progress to AML, and have a better prognosis if adequate therapy is implemented early. Our patient is now in the second postoperative year and shows no signs of relapse.
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Affiliation(s)
- Rodrigo Athayde Nemésio
- Surgery A Department, Coimbra University Hospital Centre, Coimbra, Portugal.,Clínica Universitária de Cirurgia III, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Beatriz Costa
- Surgery A Department, Coimbra University Hospital Centre, Coimbra, Portugal.,Clínica Universitária de Cirurgia III, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Carlos Abrantes
- Pathology Department, Coimbra University Hospital Centre, Coimbra, Portugal.,Pathology Department, Instituto Portugues de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | - Júlio Soares Leite
- Surgery A Department, Coimbra University Hospital Centre, Coimbra, Portugal.,Clínica Universitária de Cirurgia III, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Koh FH, Chan HL, Petersson F, Chong CS. Thinking out of the Gut: a case of obscure lower GI bleeding. Gut 2017; 66:2068-2159. [PMID: 27965282 DOI: 10.1136/gutjnl-2016-313252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 12/08/2022]
Abstract
CLINICAL PRESENTATION A middle-aged man was admitted for episodes of fresh per-rectal bleeding, which were not associated with defecation. He was recently investigated for macrocytic anaemia in the outpatient haematology clinic. Examination of the perineum revealed grade 1 internal haemorrhoids with no signs of bleeding.Initial laboratory tests revealed macrocytic anaemia (haemoglobin 10.5 g/dL, normal 12.9-17.0 g/dL; mean corpuscular haemoglobin 95.3 fL, normal 80.0-95.0 fL). Peripheral blood film showing blasts, dysplastic neutrophils, nucleated red blood cells and hypogranular platelets.The patient underwent a sigmoidoscopy and rubber band ligation of the internal haemorrhoids after persistent fresh per-rectal bleeding. The bleeding persisted with the development of hypotension and a significant drop of haemoglobin to 4.8 g/dL requiring blood transfusions and intensive care monitoring. Repeated endoscopy, including intubation of the terminal ileum, revealed uncomplicated right-sided diverticulosis. CT mesenteric angiography performed during an episode of significant bleeding revealed extravasation of contrast in the ileum, but mesenteric angiography was unsuccessful, possibly due to a temporary cessation of bleeding. Bleeding subsequently recurred and in light of the persistent bleeding with no clear source and with a total of 12 units of packed cell transfused, exploratory laparotomy, on-table enteroscopy (figure 1) with small bowel resection was performed. Histopathological examination of the specimen was performed (figures 2-4).gutjnl;66/12/2068/GUTJNL2016313252F1F1GUTJNL2016313252F1Figure 1Multiple ileal lesions with stigmata of recent bleed.gutjnl;66/12/2068/GUTJNL2016313252F2F2GUTJNL2016313252F2Figure 2Area of ulceration associated with atypical mononuclear infiltrate.gutjnl;66/12/2068/GUTJNL2016313252F3F3GUTJNL2016313252F3Figure 3Atypical mononuclear infiltrate composed of cells with enlarged, irregular nuclei containing variably prominent nucleoli.gutjnl;66/12/2068/GUTJNL2016313252F4F4GUTJNL2016313252F4Figure 4Atypical cells displayed cytoplasmic expression of myeloperoxidase. QUESTION What is the diagnosis?
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Affiliation(s)
- Frederick H Koh
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health System, Singapore, Singapore
| | - Hian-Li Chan
- Department of Haematology-Oncology, National Univeristy Hospital, National University Health System, Singapore, Singapore
| | - Fredrik Petersson
- Department of Haematology-Oncology, National Univeristy Hospital, National University Health System, Singapore, Singapore
| | - Choon-Seng Chong
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health System, Singapore, Singapore
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Gupta S, Chawla I, Singh V, Singh K. Granulocytic sarcoma (chloroma) presenting as colo-colic intussusception in a 16-year-old boy: an unusual presentation. BMJ Case Rep 2014; 2014:bcr-2014-206138. [PMID: 25150243 DOI: 10.1136/bcr-2014-206138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 16-year-old boy presented with intestinal obstruction with left lumbar mass. On evaluation with ultrasonography and contrast-enhanced CT of abdomen he was found to have left colo-colic intussusception. On exploratory laparotomy he was found to have invagination of necrosed distal transverse colon and splenic flexure with omentum into descending colon with enlarged mesenteric lymph nodes for which left hemicolectomy was performed. Histopathology and immunohistochemistry was suggestive of submucosal infiltration by immature myeloid precursors with few metamyelocytes and occasional eosinophils and the cells showed cytoplasmic granular positivity with myeloperoxidase stain suggestive of granulocytic sarcoma (chloroma-extra-medullary manifestation of acute myeloid leukaemia). Our patient received three cycles of cytarabine+daunorubicin chemotherapy in the postoperative period and is doing well at 12 months of follow-up. Granulocytic sarcoma (chloroma) presenting as colo-colic intussusception is very rare and has not been reported in literature so far.
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Affiliation(s)
- Saurabh Gupta
- Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Inderjit Chawla
- Department of Surgery, Government Medical College, Patiala, Punjab, India
| | - Vishwajeet Singh
- Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Karnail Singh
- Department of Surgery, Government Medical College, Patiala, Punjab, India
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Small-bowel myeloid sarcoma: Report of a case with atypical presentation. Int J Surg Case Rep 2014; 5:613-6. [PMID: 25105775 PMCID: PMC4200883 DOI: 10.1016/j.ijscr.2014.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 07/03/2014] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Small-bowel myeloid sarcoma is rare. Acute bowel obstruction is its usual clinical presentation. PRESENTATION OF CASE We report a case of small-bowel myeloid sarcoma that occurred in a 64-year-old woman who presented chronic secretory diarrhoea, hypokalaemia, and weight loss. Immature white blood cells in a peripheral smear and small-bowel capsule endoscopic features were the main diagnostic clues. The patient experienced capsule retention and developed acute bowel obstruction. Urgent laparotomy showed a stricturing ileal mass and pathology of the resected bowel specimen unveiled a CD34+, CD117+, and myeloperoxidase-positive myeloid sarcoma. The diarrhoea promptly resolved after surgery, and the patient is now undergoing chemotherapy. DISCUSSION Secretory diarrhoea can be the first manifestation of small-bowel myeloid sarcoma. Capsule endoscopy may provide a diagnostic clue, but it can trigger an acute bowel obstruction. Differential diagnosis of the pathologic specimen may be difficult and a high suspicion index of is mandatory to perform immunophenotyping to determine the correct management. CONCLUSION Chronic diarrhoea with alarm features can be the first manifestation of small-bowel myeloid sarcoma.
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10
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Mandal PK, Dolai TK. A rare case of isolated myeloid sarcoma of the small gut with inv(16)(p13;q22) without bone marrow involvement. Blood Res 2014; 49:66-9. [PMID: 24724071 PMCID: PMC3974963 DOI: 10.5045/br.2014.49.1.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 01/13/2014] [Accepted: 03/04/2014] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Tuphan Kanti Dolai
- Department of Hematology, Nilratan Sircar Medical College, Kolkata, India
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Yoldaş T, Erol V, Demir B, Hoşcoşkun C. A rare cause of mechanical obstruction: Intestinal myeloid sarcoma. ULUSAL CERRAHI DERGISI 2013; 30:176-8. [PMID: 25931908 DOI: 10.5152/ucd.2013.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 12/02/2012] [Indexed: 12/12/2022]
Abstract
Myeloid sarcoma is a rare aggressive tumour that originates from immature extramedullary myeloid cells. It can be seen as a relapse in patients with acute myeloid leukaemia. Sometimes it can be seen in the form of a solid tumour without any evidence of leukaemia. A case of a 44-year-old male patient who was admitted with symptoms and signs of mechanical intestinal bowel obstruction was operated on. The operation findings showed small bowel obstruction due to a mass. The mass was then resected with end-to-end intestinal anastomosis. The resected mass pathology results were consistent with myeloid sarcoma. The post-operative period was uneventful and adjuvant therapy was applied. In this case report we aimed to evaluate the clinical signs and treatment modalities of small intestinal myeloid sarcoma.
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Affiliation(s)
- Tayfun Yoldaş
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Varlık Erol
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Batuhan Demir
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Cüneyt Hoşcoşkun
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
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Kim NR, Lee WK, Lee JI, Cho HY. Multiple Jejunal Myeloid Sarcomas Presenting with Intestinal Obstruction in a Non-leukemic Patient: A Case Report with Ultrastructural Observations. KOREAN JOURNAL OF PATHOLOGY 2012; 46:590-4. [PMID: 23323112 PMCID: PMC3540339 DOI: 10.4132/koreanjpathol.2012.46.6.590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 04/16/2012] [Accepted: 04/25/2012] [Indexed: 11/25/2022]
Abstract
Myeloid sarcoma is a rare extramedullary myeloid tumor, which is frequently misdiagnosed when no evidence of leukemia is initially observed. Here, we report on a peculiar case of a 49-year-old man afflicted with multiple masses in the jejunum, the superior mesentery, and the serosa of the transverse colon, without leukemic manifestation. The tumor was composed of undifferentiated small round cells containing eosinophilic cytoplasm, which were negative for myeloperoxidase, nonspecific esterase, lysozyme, terminal deoxynucleotidyl transferase, leukocyte common antigen, CD3, CD4, CD15, CD20, CD30, CD43, CD56, CD68/PG-M1, CD79a, human melanoma black-45, c-kit, and CD34 with positivity only for CD68/KP1, CD99, and vimentin. Under electron microscopy, those cells had abundant membrane-bound cytoplasmic granules that measured 200 to 300 nm in diameter, which were consistent with granulocytic azurophilic granules. The tumor was finally diagnosed as a myeloid sarcoma. The presence of non-leukemic myeloid sarcomas showing immunonegativity for conventional myeloid-leukemic markers necessitated a diagnosis by ultrastructural observation.
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Affiliation(s)
- Na Rae Kim
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea
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Small Intestinal Obstruction with Intussusception due to Acute Myeloid Leukemia: A Case Report. Case Rep Gastrointest Med 2012; 2012:425358. [PMID: 22928122 PMCID: PMC3426187 DOI: 10.1155/2012/425358] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 06/24/2012] [Indexed: 11/19/2022] Open
Abstract
Myeloid sarcoma is known to precede the development of acute myeloid leukemia (AML) and can be the only clinical manifestation. Gastrointestinal involvement by AML is rare with the commonest site being small intestine. Patients present with vague abdominal pain and/or obstruction. Prognosis is usually poor as most of them rapidly progress to AML. We report a case of 25-year-old man with complaints of abdominal pain and vomiting of one-year duration. OGD scopy revealed infiltration of lesser curvature of stomach. Subsequently patient came back within a week with signs and symptoms of acute intestinal obstruction for which an ileal resection was done. Although the histology of stomach biopsy and ileal segments showing similar features were thought to be non-Hodgkin's lymphoma, immunohistochemistry confirmed the diagnosis of myeloid sarcoma. Bone marrow investigations confirmed involvement by AML. Patient succumbed to the disease due to extensive involvement of AML. This case highlights the primary gastrointestinal manifestation of AML which can often prove to be a diagnostic difficulty clinically and histologically. Prompt diagnosis is essential to hasten the management.
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A rare case of myeloid sarcoma presenting as an anorectal ulcer. Case Rep Med 2012; 2012:537278. [PMID: 22666268 PMCID: PMC3364052 DOI: 10.1155/2012/537278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 03/16/2012] [Indexed: 02/06/2023] Open
Abstract
Myeloid Sarcoma is a rare tumor composed of myeloblasts occurring at an extramedullary site like bones, or various soft tissues. Myeloid sarcoma may involve the gastrointestinal tract very rarely either solitarily, or occurring simultaneously with acute myeloid leukemia. Its diagnosis is challenging and needs biopsy and immunohistochemical staining. We are describing a case of myeloid sarcoma which presented as a painful anal ulcer mimicking an atypical fissure. Its appearance resembled crohn's disease on sigmoidoscopy. A biopsy of the ulcer along with histochemical staining led to the diagnosis of myeloid sarcoma. Our case demonstrates the need for aggressive evaluation of any common gastrointestinal complaint with an atypical presentation.
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16
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Zaenker S, Schweyer S, Hasenkamp J, Truemper L, Wulf G. Granulocytic Sarcoma by AML M4eo (inv16) after Allogeneic Stem Cell Transplantation without Bone Marrow Involvement. Case Rep Hematol 2011; 2011:692982. [PMID: 22937311 PMCID: PMC3420739 DOI: 10.1155/2011/692982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 07/04/2011] [Indexed: 02/07/2023] Open
Abstract
Granulocytic sarcoma (GS) represents a rare type of extramedullar manifestation from the acute myeloid leukaemia (AML). We report the case of a patient with recurrences of AML M4eo leukaemia in the uterus and the small intestine at 3 and 5 years, respectively, after matched related peripheral blood stem cell transplantation (PBSCT). The patient underwent the withdrawal of immunosuppression, hysterectomy, and local irradiation at first relapse, as well as systemic chemotherapy and donor lymphocyte infusions at second recurrence, inducing a second and third complete remission, respectively. At year six after transplantation, the patient experienced disease progression by meningeosis leukaemia to which she succumbed despite intrathecal chemotherapy. Following allogeneic stem cell transplantation, awareness for atypical manifestations of granulocytic sarcoma appears prudent, the cellular immunotherapy should aim at immunological disease control.
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Affiliation(s)
- Stephan Zaenker
- Department of Haematology/Oncology, University Medicine Goettingen, Robert-Koch-Street 40, 37075 Goettingen, Germany
| | - Stefan Schweyer
- Center of Pathology, University Medicine Goettingen, Robert-Koch-Street 40, 37075 Goettingen, Germany
| | - Justin Hasenkamp
- Department of Haematology/Oncology, University Medicine Goettingen, Robert-Koch-Street 40, 37075 Goettingen, Germany
| | - Lorenz Truemper
- Department of Haematology/Oncology, University Medicine Goettingen, Robert-Koch-Street 40, 37075 Goettingen, Germany
| | - Gerald Wulf
- Department of Haematology/Oncology, University Medicine Goettingen, Robert-Koch-Street 40, 37075 Goettingen, Germany
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Kwan LY, Targan SR, Shih DQ. A case of steroid-dependent myeloid granulocytic sarcoma masquerading as Crohn’s disease. World J Gastroenterol 2011; 17:2446-9. [PMID: 21633646 PMCID: PMC3103799 DOI: 10.3748/wjg.v17.i19.2446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 02/08/2011] [Accepted: 02/15/2011] [Indexed: 02/06/2023] Open
Abstract
Small bowel tumors and Crohn’s disease are common causes of small bowel obstruction. Early stage neoplasms can easily be mistaken for Crohn’s disease. Therefore, thorough work-ups including imaging studies and endoscopic evaluation with biopsies are critical for accurate diagnosis. Here we report a case of an otherwise healthy female with progressive onset of multiple, recurrent obstructive symptoms secondary to terminal ileal narrowing who was referred for management of steroid-dependent Crohn’s disease. After thorough evaluation, the diagnosis was revised to myeloid granulocytic sarcoma involving the terminal ileum. In this case, a delay in diagnosis can be detrimental for prognosis, as myeloid granulocytic sarcoma is highly predictive of underlying acute myeloid leukemia and needs urgent referral for chemotherapy and/or resection.
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18
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Alvarez P, Navascués CA, Ordieres C, Pipa M, Vega IF, Granero P, Alvarez JA, Rodríguez M. Granulocytic sarcoma of the small bowel, greater omentum and peritoneum associated with a CBFβ/MYH11 fusion and inv(16) (p13q22): a case report. Int Arch Med 2011; 4:3. [PMID: 21255400 PMCID: PMC3032668 DOI: 10.1186/1755-7682-4-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 01/21/2011] [Indexed: 12/14/2022] Open
Abstract
Introduction Granulocytic sarcoma (GS) is an extramedullary disease which is composed of immature myeloid cells or myeloblasts and usually occurs in association with acute myeloid leukemia (AML), as an initial presentation or a relapse. GS has been associated with various cytogenetic abnormalities, particularly with the t(8;21) translocation and less frequently the inv(16) type. Case presentation We present a rare case of GS of the small bowel, greater omentum and peritoneum, which caused obstruction, in a patient with AML associated with a CBFβ/MYH11 fusion gene and an inv(16) (p13q22). In this patient there was only mild myeloid hyperplasia in bone marrow aspiration but molecular analysis identified a CBFβ-MYH11 fusion and inv(16) (p13;q22). Conclusion Because of its nonspecific clinical and radiologic findings, this entity can be misdiagnosed and can mimic other solid neoplasms, making it a diagnostic challenge. In a GS with no or minimal morphological changes in bone marrow aspiration it is very important to perform a cytogenetic analysis to benefit from the diagnosis and therapeutic strategy.
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Affiliation(s)
- Paloma Alvarez
- Service of Digestive, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
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Benjazia E, Khalifa M, Benabdelkader A, Laatiri A, Braham A, Letaief A, Bahri F. Granulocytic sarcoma of the rectum: Report of one case that presented with rectal bleeding. World J Gastrointest Pathophysiol 2010; 1:144-6. [PMID: 21607155 PMCID: PMC3097956 DOI: 10.4291/wjgp.v1.i4.144] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 08/12/2010] [Accepted: 08/19/2010] [Indexed: 02/06/2023] Open
Abstract
Granulocytic sarcoma is an uncommon and localized extramedullary tumor composed of immature granulocytic cells. It may present in association with acute myeloid leukaemia, myelodysplastic syndrome and chronic myelogenous leukaemia. Granulocytic sarcoma may occur in any anatomical site but involvement of the gastrointestinal tract is rare, especially in the rectum. We report on the case of a 17 year old female who presented with rectal bleeding, abdominal pain and weight loss one mo prior to admission. Rectosigmoidoscopy revealed a rectal polypoid and ulcerated mass. The histological examination of the mass showed granulocytic sarcoma. Bone marrow examination was compatible with acute promyelocytic leukaemia (FAB type M3). This case report is a reminder of this peculiar sign of tumoral syndrome in acute myeloid leukaemia. We also discuss diagnostic methods and analyze the disease course.
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Ochs RC, Gormley RH, Luger S, Bagg A. Isolated bowel relapse in acute promyelocytic leukemia: an unusual site of extramedullary recurrence. J Clin Oncol 2010; 28:e550-3. [PMID: 20713873 DOI: 10.1200/jco.2010.29.7424] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Rachel C Ochs
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Tsikitis VL, Corning C, Henderson J, Rose J. Chloroma/Granulocytic sarcoma: abdominal & pelvic presentation of acute myelogenous leukemia. J Cancer 2010; 1:98-100. [PMID: 20842230 PMCID: PMC2938071 DOI: 10.7150/jca.1.98] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
There is limited literature documenting granulocytic sarcoma of the colon. We report a case of a 28 year-old female with a colonic granulocystic sarcoma of the colon as a complication of AML, as it is an important consideration with surgical management of typhilitis.
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Rénard C, Girard S, Pracros JP, Dijoud F, André JM, Mialou V, Bertrand Y. [Granulocytic sarcoma, a diagnostic challenge: 3 pediatric cases]. Arch Pediatr 2009; 17:149-53. [PMID: 19945260 DOI: 10.1016/j.arcped.2009.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Revised: 07/13/2009] [Accepted: 10/25/2009] [Indexed: 12/15/2022]
Abstract
Granulocytic sarcoma (GS) is a rare extramedullary tumor frequently associated with acute myeloblastic leukemia (AML). We report 3 cases of pediatric granulocytic sarcomas with various locations: skin, orbit, and bowel. Cases 1 and 2 were associated with AML; case 3 was isolated. In all 3 cases, the diagnosis was delayed or initially missed. Pathology and immunohistochemistry data identified the disease. GS is treated with chemotherapy, like AML. The prognosis of GS seems better than that of isolated AML.
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Affiliation(s)
- C Rénard
- Institut d'hématologie et d'oncologie pédiatrique, 1, place Joseph-Renaut, 69008 Lyon, France.
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Kumar B, Bommana V, Irani F, Kasmani R, Mian A, Mahajan K. An uncommon cause of small bowel obstruction: isolated primary granulocytic sarcoma. QJM 2009; 102:491-3. [PMID: 19433489 DOI: 10.1093/qjmed/hcp051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Kumar
- St. Vincent Mercy Medical Center, Toledo, Ohio 43608, USA
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Hayden JT, Wood KM, Pedler S, Lawson A, Skinner R. Invasive aspergillosis of the small bowel in an infant with acute myeloid leukemia and intestinal obstruction. Pediatr Hematol Oncol 2009; 26:84-91. [PMID: 19206013 DOI: 10.1080/08880010802625399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Acute myeloid leukemia was diagnosed in an infant with fever and pancytopenia. Intestinal obstruction was present at diagnosis and laparotomy performed after failure of conservative management demonstrated leukemic infiltration of the resected terminal ileum. Fever and intestinal obstruction persisted, necessitating a second ileal resection, which revealed invasive aspergillosis. Subsequent retrospective analysis identified occasional fungal hyphae in the initial resection specimen. With the combination of intensive chemotherapy and aggressive prolonged antifungal therapy the child survived. Invasive aspergillosis may unusually present at nonpulmonary sites at initial presentation of acute leukemia. Microbiological or histological diagnosis is needed to guide aggressive appropriate management.
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Affiliation(s)
- James T Hayden
- Department of Paediatric and Adolescent Oncology, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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Granulocytic sarcoma of the colon in a child with acute myeloid leukemia presenting as hematochezia. J Pediatr Hematol Oncol 2008; 30:981-3. [PMID: 19131797 DOI: 10.1097/mph.0b013e31818c010c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Granulocytic sarcoma (GS), an extramedullary myeloid tumor composed of immature cells of the granulocytic series, can occur in patients with acute myeloid leukemia (AML), myelodysplastic syndrome, or chronic myelogenous leukemia. It can occur in any organ or tissue, but the most common involved areas are the skin, bone/spine, and lymph nodes. However, its occurrence in the gastrointestinal tract is relatively rare, and is especially rare in the colon in adults. No case of GS involving the colon in children has ever been reported. We report here an extremely rare case of GS in the colon of a 10-year-old boy with AML presenting with hematochezia. Colonic GS was diagnosed by colonofiberscopic biopsy. His hematochezia responded rapidly to induction chemotherapy and the patient remained in complete remission after 3-month follow-up. In conclusion, hematochezia may be due to colonic involvement of GS, which should be considered in the differentials in addition to thrombocytopenia, as it is usually encountered in AML patients.
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Lee SY, Park SJ, Kim YH, Lee JH. Nonleukemic granulocytic sarcoma presenting as intussusception of small bowel. Int J Clin Oncol 2008; 13:467-70. [PMID: 18946761 DOI: 10.1007/s10147-008-0774-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Accepted: 02/25/2008] [Indexed: 11/26/2022]
Abstract
Granulocytic sarcoma (GS) is defined as a localized tumor mass composed of myeloid blasts and/or immature myeloid cells in an extramedullary site. Usually, GS occurs concomitantly with or after acute myelogenous leukemia (AML), myeloproliferative disorder, or myelodysplastic syndrome. In rare cases, it occurs as a "preleukemic" condition and may precede the onset of AML, which occurs within several months if the patient is not treated with AML-type systemic chemotherapy. Recently, we discovered one case of nonleukemic GS in the small intestine incidentally when intussusception was suspected. The patient visited the emergency department, in October 2006, with symptoms of small-bowel obstruction. Intussusception due to a small-intestinal mass was suspected after evaluation, and small-intestine segmental resection was performed. The patient had no previous history of leukemia, and immunohistochemical staining was used to diagnose GS. Bone-marrow biopsy performed subsequently revealed no lesions that could be suspected as leukemia. The patient received three cycles of chemotherapy, applied as for AML (cytosine arabinoside and anthracycline), and is currently, as of October 29, 2007, showing no other marked indisposition; he has been disease-free for 12 months.
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Affiliation(s)
- Su Youn Lee
- Department of Surgery, Kyung Hee University College of Medicine, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea
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Göhring G, Erlacher M, van Buiren M, Jüttner E, Niemeyer CM, Schlegelberger B. Mesenteric chloroma with t(16;16) followed by acute myelomonocytic leukemia with clonal evolution. ACTA ACUST UNITED AC 2007; 179:162-4. [DOI: 10.1016/j.cancergencyto.2007.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 08/31/2007] [Indexed: 11/30/2022]
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