1
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Kobayashi K, Umekawa Y. Rapid progression from MDS to AML with gastric submucosal tumour as an extramedullary infiltration. BMJ Case Rep 2024; 17:e258856. [PMID: 38565228 PMCID: PMC10989113 DOI: 10.1136/bcr-2023-258856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
We present a rare case of myeloid sarcoma in the stomach of an elderly woman initially diagnosed with anaemia. Myeloid sarcoma, an unusual extramedullary manifestation of acute myeloid leukaemia (AML), primarily affects lymph nodes, bones, spine and skin, with gastrointestinal involvement being infrequent. Despite normal results from the initial endoscopy, a follow-up examination after 4 months revealed multiple submucosal gastric tumours. These developments coincided with worsening of anaemia and an increase in peripheral myeloblasts. Pathological evaluation and immunohistochemical staining confirmed gastric extramedullary infiltration associated with AML. This case highlights the importance of comprehensive diagnostic processes when suspecting leukaemic transformations, especially in myelodysplastic syndrome (MDS). Due to financial constraints, additional critical studies such as cytogenetics and next-generation sequencing were not performed. Nonetheless, this rare case demonstrates the visual observation of rapid progression from MDS to AML and concurrent early myeloid sarcoma development in an elderly patient.
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Affiliation(s)
- Keigo Kobayashi
- Department of Internal Medicine, General Incorporated Foundation Kurashiki Medical Center, Kurashiki, Okayama, Japan
| | - Yasuhiro Umekawa
- Department of Internal Medicine, General Incorporated Foundation Kurashiki Medical Center, Kurashiki, Okayama, Japan
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2
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Lizardo-Thiebaud Maria J, Emilio AH, Jesus DDLM, Montante-Montes de Oca D. The immutable relevance of myeloid sarcomas: Clinicopathological study of fourteen cases. Pathol Res Pract 2024; 255:155176. [PMID: 38394809 DOI: 10.1016/j.prp.2024.155176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
An extramedullary myeloid tumor or chloroma is an infrequent manifestation of a myeloid neoplasm. It is considered an equivalent to an acute myeloid leukemia. It is confirmed through biopsy, where infiltrating neoplastic myeloid cells distort the parenchyma. A total of twenty-nine cases were diagnosed as MS between 198 and 2023. Upon re-evaluation, only fourteen cases fulfilled the criteria for MS. The most common differential diagnosis were lymphomas, leukemic infiltration, and extramedullary hematopoiesis. Few were isolated cases; the rest were in the context of progression of a myeloid neoplasm. The majority had a myelomonocytic morphology and immunophenotype. The most reliable markers were CD45, HLA-DR, CD68 and CD4. The study highlights the complexity and impact of an accurate diagnosis of a myeloid sarcoma.
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Affiliation(s)
- J Lizardo-Thiebaud Maria
- Department of Anatomic Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Delgado-de la Mora Jesus
- Department of Anatomic Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Daniel Montante-Montes de Oca
- Department of Anatomic Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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3
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Xie H, Zhang H, Xiao L, Li L. 18 F-FDG PET/CT Imaging of Isolated Myeloid Sarcoma in the Right Humerus. Clin Nucl Med 2024; 49:201-203. [PMID: 38170922 DOI: 10.1097/rlu.0000000000005009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
ABSTRACT Myeloid sarcoma is a neoplastic mass formed by the infiltration of primitive or immature myeloid cells into organs and tissues outside the bone marrow. It may occur before, at the same time, or manifest as the recurrence of acute myeloid leukemia, myelodysplastic syndromes, and chronic myeloproliferative syndromes. It may involve any organ or tissue, including skin, soft tissue, lymph nodes, and gastrointestinal tract and bone. Isolated humerus involvement is extremely rare. Herein, we present the FDG PET/CT findings of a rare case of isolate myeloid sarcoma in the right humerus, which showed only increased bone density with moderate FDG uptake.
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Affiliation(s)
- Hangyu Xie
- From the Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
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4
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Pervaiz A, Brimioulle M, Qureishi A, Royston D. Nasopharyngeal myeloid sarcoma as a manifestation of acute monomyelocytic leukaemia. BMJ Case Rep 2023; 16:e251681. [PMID: 38123315 DOI: 10.1136/bcr-2022-251681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
This case report describes the case of a man in his seventies presenting with a nasopharyngeal deposit of myeloid sarcoma associated with acute monomyelocytic leukaemia. He presented with right nasal obstruction associated with unilateral pulsatile tinnitus. CT and MRI scans of sinuses identified a moderately restricting mucosal swelling of the right torus tubarius, and a biopsy of the lesion diagnosed a nasal deposit of myeloid sarcoma.
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Affiliation(s)
| | | | - Ali Qureishi
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Daniel Royston
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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5
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Takeyasu S, Morita K, Saito S, Toho M, Oyama T, Obo T, Taoka K, Shimura A, Maki H, Shibata E, Watanabe Y, Suzuki F, Zhang L, Kobayashi H, Hinata M, Kurokawa M. Myeloid sarcoma and pathological fracture: a case report and review of literature. Int J Hematol 2023; 118:745-750. [PMID: 37707761 PMCID: PMC10673718 DOI: 10.1007/s12185-023-03656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023]
Abstract
Myeloid sarcoma is a rare clinical entity that presents as an isolated proliferation of leukemic cells, concurrently with or at relapse of acute myeloid leukemia (AML), myelodysplastic syndromes/neoplasms (MDS), chronic myeloid leukemia (CML), and myeloproliferative neoplasm (MPN). Myeloid sarcoma disrupts the normal architecture of its surrounding tissues. When it forms in long bones, it can cause their pathological fracture. We recently experienced a rare case of MDS presenting with myeloid sarcoma in the femur that eventually resulted in its pathological fracture. Detailed chromosomal analysis of the bone marrow cells suggested emergence of myeloid sarcoma during the fast-paced progression of MDS just after acquiring trisomy 22. A comprehensive review of previous cases of myeloid sarcoma-associated pathological fracture indicated possible involvement of structural rearrangements of chromosomes 9 and 22. Management of myeloid sarcoma should continue to improve, and clinicians should note that myeloid sarcoma with specific chromosomal alterations needs extra medical attention to prevent pathological fracture.
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Affiliation(s)
- Sho Takeyasu
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Ken Morita
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Seitaro Saito
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Masanori Toho
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Takashi Oyama
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Takafumi Obo
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Kazuki Taoka
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Arika Shimura
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Hiroaki Maki
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Eisuke Shibata
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Fumio Suzuki
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Liuzhe Zhang
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Kobayashi
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Munetoshi Hinata
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
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6
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Yamada R, Miyata-Takata T, Tanaka R, Komohara Y, Takata K. Myeloid sarcoma incidentally found in lymph nodes dissected for advanced gastric cancer. J Clin Exp Hematop 2023; 63:139-142. [PMID: 37380469 PMCID: PMC10410623 DOI: 10.3960/jslrt.23013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 06/30/2023] Open
Abstract
Myeloid sarcoma (MS) is a condition characterized by a tumor mass of myeloid blasts in any site of the body other than the bone marrow, with or without acute myeloid leukemia. A 93-year-old man underwent laparoscopy-assisted distal gastrectomy with D1 lymphadenectomy for advanced gastric cancer. Other than metastatic foci of gastric cancer cells, some dissected lymph nodes showed destructive architecture with proliferation of small- to medium-sized atypical hematopoietic cells. Those cells were focally positive for naphthol AS-D chloroacetate esterase. Immunohistochemically, positive results were obtained for CD4, CD33, CD68 (KP1), Iba-1, lysozyme, myeloperoxidase, and PU.1, with focally positive results for CD13, CD14, CD68 (PGM1), CD163, and CD204, and negative results for AE1/AE3, CD1a, CD3, CD20, and S-100 protein. These results suggested MS with phenotypically myelomonocytic differentiation. We report a rare case of MS incidentally found in specimens resected for other purposes. Careful diagnosis and consideration of differential diagnoses including MS using an adequate panel of antibody markers for dissected lymph nodes is warranted.
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Zhang M, Yang X, Si Y, Kan Y, Yang J. 18 F-FDG PET/CT Findings of Myeloid Sarcoma Involving the Left Ventricle and Kidney in a Pediatric Patient. Clin Nucl Med 2023; 48:103-105. [PMID: 36179330 DOI: 10.1097/rlu.0000000000004423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 1-year-old girl presented with vomiting for 1 week. Abdominal ultrasound revealed a mass with increased blood flow in the left lower abdomen. A malignancy was suspected. 18 F-FDG PET/CT showed multiple lesions in the left ventricular wall, the kidney, and the left lower abdomen. Biopsy of the left abdominal mass confirmed the diagnosis of myeloid sarcoma associated with acute myeloid leukemia. After 4 cycles of chemotherapy, follow-up PET/CT was performed for evaluating the therapy response, which showed complete resolution.
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Affiliation(s)
- Mingyu Zhang
- From the Department of Nuclear Medicine, Beijing Friendship Hospital of Capital Medical University, Beijing, People's Republic of China
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8
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Xu C, Wang Z, Xu Y, Wang C. [Isolated myeloid sarcoma of the cervix: a clinicopathological analysis of three cases]. Zhonghua Bing Li Xue Za Zhi 2022; 51:1164-1166. [PMID: 36323550 DOI: 10.3760/cma.j.cn112151-20220825-00725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- C Xu
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
| | - Z Wang
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
| | - Y Xu
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
| | - C Wang
- Department of Pathology, Jiangsu Province Hospital (the First Affiliated Hospital of Nanjing Medical University), Nanjing 210029, China
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9
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Soni A, Jindal S, Narang V, Singh A, Paul D, Kaur H. Isolated pancreatic myeloid sarcoma: A potential mimicker of pancreatic adenocarcinoma. INDIAN J PATHOL MICR 2022; 65:676-678. [PMID: 35900500 DOI: 10.4103/ijpm.ijpm_202_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Myeloid sarcoma (MS) is an extramedullary proliferation of immature myeloid cells which may occur as a progression of myelodysplastic syndrome (MDS), myeloproliferative neoplasm (MPN), or myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN) and as acute myeloid leukemia (AML) relapse. Rarely may it be de novo. Lymph nodes, skin, lungs, intestine are the commonly involved sites. However, an isolated pancreatic MS is seldom reported in the literature. Herein, we report one such case which was misdiagnosed as pancreatic adenocarcinoma on the clinico-radiological examination which misled us away from preoperative diagnostic sampling, and a Whipple pancreaticoduodenectomy was performed. Histopathological examination in conjunction with immunohistochemistry revealed the final diagnosis of isolated MS of the pancreas. We emphasize that although rare, a clinical suspicion along with preoperative histopathological examination may lead to early diagnosis, targeted management, and a better clinical outcome in such cases.
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Affiliation(s)
- Ankita Soni
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Saveena Jindal
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vikram Narang
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Aminder Singh
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Davinder Paul
- Department of Oncology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Harpreet Kaur
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Alam S, Palaniyandy V, Thirunavukkarasu C, Kumaresan N. Testicular myeloid sarcoma: a relapse of acute myeloid leukaemia after allogeneic peripheral blood stem cell transplantation- a rare presentation. BMJ Case Rep 2022; 15:e240820. [PMID: 35304354 PMCID: PMC8935182 DOI: 10.1136/bcr-2020-240820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/04/2022] Open
Abstract
Myeloid sarcoma is an uncommon pathological diagnosis of proliferation of blasts of one or more of the myeloid lineages in regions other than the blood and bone marrow. Myeloid sarcoma of the testis after allogeneic bone marrow stem cell transplantation is very rare and only few cases are reported in the literature. It is usually misdiagnosed as malignant lymphoma, particularly with large cell lymphoma, due to similar histological morphology. Due to difficulty in diagnosis, it is suggested that an appropriate panel of immunohistochemical marker studies be performed in conjunction with clinical correlation to avoid misleading diagnosis and improper treatment of patients. We report an interesting case of a 49-year-old man with a diagnosis of acute myelogenous leukaemia. He had undergone allogeneic peripheral blood stem cell transplantation, achieved complete molecular remission and later relapsed with myeloid sarcoma of the testis.
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MESH Headings
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local
- Peripheral Blood Stem Cell Transplantation
- Sarcoma, Myeloid/diagnosis
- Sarcoma, Myeloid/pathology
- Sarcoma, Myeloid/therapy
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Affiliation(s)
- Shanawaz Alam
- Urology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Velmurugan Palaniyandy
- Urology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | | | - Natarajan Kumaresan
- Urology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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Beer A, Beck R, Schedel A, von Bonin M, Meinel J, Friedrich UA, Menzel M, Suttorp M, Brenner S, Fitze G, Lange B, Knöfler R, Hauer J, Auer F. A rare PALB2 germline variant causing G2/M cell cycle arrest is associated with isolated myelosarcoma in infancy. Mol Genet Genomic Med 2021; 9:e1746. [PMID: 34382369 PMCID: PMC8457705 DOI: 10.1002/mgg3.1746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/12/2021] [Accepted: 07/01/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Isolated myelosarcoma of infancy is a rare presentation of acute myelogenous leukaemia (AML). Because of its rarity and early onset in infancy underlying genetic predisposition is potentially relevant in disease initiation. METHODS AND RESULTS We report an oncologic emergency in an infant with thoracic and intraspinal aleukaemic myeloid sarcoma causing acute myelon compression and lower leg palsy. Whole-exome sequencing of the patient's germline DNA identified a rare PALB2 (OMIM 610355) variant (p.A1079S), which is located in a domain critical for the gene's proper function within the homology-directed repair pathway. In line with potential DNA damage repair defects mediated by the PALB2 deregulation, the patient's fibroblasts showed increased sensitivity towards radiation and DNA intercalating agents. CONCLUSION Therefore, we suggest PALB2 p.A1079S as a pathogenic variant potentially contributing to the here observed patient phenotype.
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Affiliation(s)
- Angelina Beer
- Neonatology and Pediatric Intensive CareDepartment of PediatricsUniversity Hospital Carl Gustav CarusDresdenGermany
| | - Ricardo Beck
- Department of Pediatric SurgeryUniversity Hospital Carl Gustav CarusDresdenGermany
- Pediatric Oncology and HematologyDepartment of PediatricsUniversity Hospital Carl Gustav CarusDresdenGermany
| | - Anne Schedel
- Pediatric Oncology and HematologyDepartment of PediatricsUniversity Hospital Carl Gustav CarusDresdenGermany
| | - Malte von Bonin
- Medical Clinic IUniversity Hospital Carl Gustav CarusDresdenGermany
- German Cancer Consortium (DKTKDresdenGermany
- German Cancer Research Center (DKFZHeidelbergGermany
| | - Jörn Meinel
- Institute of PathologyUniversity Hospital Carl Gustav CarusDresdenGermany
| | - Ulrike Anne Friedrich
- Pediatric Oncology and HematologyDepartment of PediatricsUniversity Hospital Carl Gustav CarusDresdenGermany
| | - Maria Menzel
- Pediatric Oncology and HematologyDepartment of PediatricsUniversity Hospital Carl Gustav CarusDresdenGermany
| | - Meinolf Suttorp
- Medical FacultyPediatric Hematology & OncologyTechnical UniversityDresdenGermany
| | - Sebastian Brenner
- Neonatology and Pediatric Intensive CareDepartment of PediatricsUniversity Hospital Carl Gustav CarusDresdenGermany
| | - Guido Fitze
- Department of Pediatric SurgeryUniversity Hospital Carl Gustav CarusDresdenGermany
| | - Björn Lange
- Pediatric Oncology and HematologyDepartment of PediatricsUniversity Hospital Carl Gustav CarusDresdenGermany
| | - Ralf Knöfler
- Pediatric Oncology and HematologyDepartment of PediatricsUniversity Hospital Carl Gustav CarusDresdenGermany
| | - Julia Hauer
- Pediatric Oncology and HematologyDepartment of PediatricsUniversity Hospital Carl Gustav CarusDresdenGermany
- National Center for Tumor Diseases (NCT)DresdenGermany
- German Cancer Research Center (DKFZ)HeidelbergGermany
| | - Franziska Auer
- National Center for Tumor Diseases (NCT)DresdenGermany
- German Cancer Research Center (DKFZ)HeidelbergGermany
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12
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Cross A, Chajewski OS, Rutland C, Smith K, Woodham P, Skipper D, Lindsey KG. Myeloid sarcoma diagnosed on pleural effusion cytology: A case report and literature review. Diagn Cytopathol 2021; 49:E316-E319. [PMID: 33751858 DOI: 10.1002/dc.24739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 11/06/2022]
Abstract
Myeloid sarcoma (MS) is a mass-forming, extramedullary infiltration of myeloid blasts rarely presenting in cases of acute myeloid leukemia (AML). These tumoral masses rarely occur at any and multiple anatomic sites, precedent or coincident with bone marrow evidence of AML. We report a case of MS that presented as pancreatic and cardiac masses where subsequent evaluation of pleural effusion cytology rendered the diagnosis. Primary MS diagnosed via pleural effusion cytology is not yet reported in literature. Herein, we report the case of a 45-year-old man who presented with abdominal pain. An infiltrative mass was identified in the pancreatic head, suspicious for pancreatic adenocarcinoma. Despite multiple attempts, Fine needle aspiration cytology of the pancreatic mass failed to render a definitive diagnosis. Subsequent thoracentesis of a right pleural effusion revealed cytologically malignant cells, identified as myeloid blasts after immunohistochemical and flow cytometric evaluation. Although rare, MS should be considered as a diagnostic possibility in the evaluation of malignancy with an unknown primary.
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Affiliation(s)
- Ashley Cross
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Olga S Chajewski
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cooper Rutland
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Keenen Smith
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paige Woodham
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Daniel Skipper
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kathryn G Lindsey
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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13
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Zhou X, Li C. Long-term survival in an acute promyelocytic leukemia patient with recurrent granulocytic sarcomas: A case report. Medicine (Baltimore) 2021; 100:e25257. [PMID: 33832087 PMCID: PMC8036079 DOI: 10.1097/md.0000000000025257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/04/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Granulocytic sarcoma (GS) is an extramedullary myeloid tumor composed of immature cells of the granulocytic series. It rarely occurs in acute promyelocytic leukemia (APL). No case of long-term survival in an APL patient with recurrent GS has been reported. PATIENT CONCERNS A 54-year-old female patient was diagnosed with APL in 1995 and has been in complete remission (CR) of bone marrow morphology for 24 years; however, recurrent GS occurred successively in ovary, breast, spine, body of sternum, lymph nodes, soft tissues from 2004 to 2019. DIAGNOSES The immunohistochemistry confirmed the diagnosis of GS, and fluorescence in situ hybridization (FISH) revealed its origin from APL. INTERVENTIONS She received surgery, and had an excellent response to all-trans retinoic acid (ATRA), DA (daunorubicin combined with cytarabine) regimens, and arsenic trioxide (ATO). OUTCOMES The patient achieved CR in March 2020 after radiotherapy followed by ATO and ATRA. So far, she is still in follow-up. LESSONS It is rare that recurrent GS at multiple sites is involved in APL patient with bone marrow morphology in CR. It is interesting to observe a long-term excellent response to ATRA, chemotherapy and ATO. Although multiple recurrence of GS in patients with APL is rare, the data in this case highlight the need for individualized treatment when such conditions occur.
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Affiliation(s)
- Xuehui Zhou
- Department of Hematology, PLA Strategic Support Force Medical Center, Beijing
| | - Chengwen Li
- Department of Pathology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
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14
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Abstract
A 5-year-old boy presented with right testicular swelling for 1 week. Ultrasonography revealed a right testicular hypoechoic mass with increased blood flow. A malignant tumor was suspected, and further investigation with F-FDG PET/CT showed a soft tissue mass with increased FDG uptake in the right testis. Biopsy of the mass confirmed a diagnosis of myeloid sarcoma.
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Affiliation(s)
- Junhao Wu
- From the Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; and Academician (Expert) Workstation of Sichuan Province, Luzhou, Sichuan, China
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15
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Akyol S, Oz Atalay F. Primary Myeloid Sarcoma of Ovary: A Case Report and Review of the Literature. Turk Patoloji Derg 2021; 37:249-253. [PMID: 33432557 PMCID: PMC10510606 DOI: 10.5146/tjpath.2020.01517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/02/2020] [Indexed: 11/18/2022] Open
Abstract
Myeloid sarcoma (granulocytic sarcoma or chloroma) is a tumor formed by myeloid precursor cells in any localization other than the bone marrow. It can occur without underlying acute myeloid leukemia (AML) or other myeloid neoplasms. Herein, we present a forty-two-year-old female patient who underwent surgery because of a left adnexal mass. Microscopic examination of the specimen revealed cord-like arrangement of the tumor cells with a diffuse growth of small blue cells effacing the ovarian stroma. Adult granulosa cell tumor was in the differential given the scanty cytoplasm of the tumor and in fact was the diagnosis of the referring institution. Further microscopic evaluation with immunohistochemical analysis at our institution revised the diagnosis to myeloid sarcoma. Myeloid sarcoma is a difficult tumor to diagnose due to its rarity, especially in the absence of a history of leukemia, and correct tissue diagnosis is essential for its treatment.
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Affiliation(s)
- Sevda Akyol
- Department of Pathology, Hakkari Yuksekova State Hospital, Hakkari, Turkey
| | - Fatma Oz Atalay
- Department of Bursa Uludag University Medicine Faculty, Bursa, Turkey
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16
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Wang X, Zhang L, Zhou D, Cai H, Wang X, Jiang X. A case report on concurrent occurrence of systemic mastocytosis and myeloid sarcoma presenting with extensive skin involvements and the results of genetic study. Medicine (Baltimore) 2020; 99:e21948. [PMID: 33327223 PMCID: PMC7738061 DOI: 10.1097/md.0000000000021948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Systemic mastocytosis is a rare disease due to mast cell accumulation in various extracutaneous sites. Systemic mastocytosis with an associated clonal hematologic non-MC lineage disease is the second most common subtype of systemic mastocytosis. The most common mutation associated with both systemic mastocytosis and myeloid sarcoma is mutation in Kit. Here, we identified the novel KIT D816V and ARID1A G1254S mutations co-occurring in systemic mastocytosis with myeloid sarcoma. PATIENT CONCERNS A 33-year old male patient presented multiple skin lesions for 10 years. Symptoms accelerated in 2017 with decreased body weight. Physical examination revealed enlarged lymph nodes in his neck, axilla and inguinal region; conjunctival hemorrhage; gingival hyperplasia. Skin biopsy showed mast cell infiltration. Flow cytometry detected CD2, CD25 and CD117 positive cells in lymph nodes. Codon 816 KIT mutation D816V and codon 1245 ARID1A mutation G1254S were found in peripheral blood. MPO, CD117, CD68 positive cells in lymph nodes indicated co-existing myeloid sarcoma. DIAGNOSIS Systemic mastocytosis with an associated clonal hematologic non-MC lineage disease of myeloid sarcoma INTERVENTIONS:: Cytarabine and daunorubicin for myeloid sarcoma and dasatinib for systemic mastocytosis were initiated. Anti-histamine and anti-leukotrienes therapy were used to prevent NSAIDs-induced shock. Platelets were infused to treat bone marrow suppression. OUTCOMES Patient was discharged after recovered from bone marrow suppression. Dasatinib continued on outpatient. CONCLUSION This is the first case of patient with systemic mastocytosis and myeloid sarcoma simultaneously presenting extensive skin involvements. Mutations of Kit and Arid1a emphasis the importance to notice possibility of various tumors occurring in patients with multiple mutations. In addition, cysteine-leukotrienes-receptor antagonists should always be used to prevent anaphylactic shock due to mast cell activation.
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MESH Headings
- Adult
- Antibiotics, Antineoplastic
- Antimetabolites, Antineoplastic/therapeutic use
- CD2 Antigens/metabolism
- Cytarabine/therapeutic use
- DNA-Binding Proteins/genetics
- Dasatinib/therapeutic use
- Daunorubicin/therapeutic use
- Drug Therapy, Combination
- Histamine Antagonists/therapeutic use
- Humans
- Interleukin-2 Receptor alpha Subunit/metabolism
- Leukotriene Antagonists/therapeutic use
- Lymph Nodes/metabolism
- Lymph Nodes/pathology
- Male
- Mastocytosis, Systemic/complications
- Mastocytosis, Systemic/drug therapy
- Mastocytosis, Systemic/genetics
- Mastocytosis, Systemic/pathology
- Mutation
- Platelet Transfusion/methods
- Protein Kinase Inhibitors/therapeutic use
- Proto-Oncogene Proteins c-kit/genetics
- Sarcoma, Myeloid/complications
- Sarcoma, Myeloid/drug therapy
- Sarcoma, Myeloid/genetics
- Sarcoma, Myeloid/pathology
- Skin/pathology
- Transcription Factors/genetics
- Treatment Outcome
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17
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Shao H, Wang W, Song J, Tang G, Zhang X, Tang Z, Srivastava J, Shah B, Medeiros LJ, Zhang L. Myeloid/lymphoid neoplasms with eosinophilia and FLT3 rearrangement. Leuk Res 2020; 99:106460. [PMID: 33166908 DOI: 10.1016/j.leukres.2020.106460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/03/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022]
Abstract
Myeloid/lymphoid neoplasms with eosinophilia and gene rearrangement are a unique category in the WHO classification, and include cases with rearrangement of PDGFRA, PDGFRB, FGFR1, and PCM1-JAK2. We report three patients presented with eosinophilia and FLT3 rearrangement: the first case with chronic eosinophilic leukemia, not otherwise specified and T-lymphoblastic leukemia/lymphoma; the second case with myeloid sarcoma; and the last case with high-grade myelodysplastic syndrome. The first case showed t(13;14)(q12;q32), which encoded FLT3-TRIP11. The patient was treated with intense chemotherapy and subsequently sorafenib with clinical improvement. Unfortunately, the patient showed persistent residual disease and passed away 9 months after the diagnosis from pneumonia. The other two cases both showed ETV6-FLT3. The second patient was treated with local radiation and systemic chemotherapy including sorafenib and was alive. The third patient was treated with chemotherapy but showed transformation to acute myeloid leukemia and died 15 months after diagnosis. These cases are among a growing number of cases with FLT3 rearrangement that all showed similar clinicopathologic features characterized by myeloproliferative neoplasm with eosinophilia and frequent T lymphoblastic leukemia/lymphoma. Therefore, we propose that the myeloid/lymphoid neoplasms with eosinophilia and FLT3 rearrangement be included in the WHO category of myeloid/lymphoid neoplasms with eosinophilia and gene rearrangement.
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MESH Headings
- Abnormal Karyotype
- Aged
- Bone Marrow/pathology
- Chromosomes, Human, Pair 13/genetics
- Chromosomes, Human, Pair 13/ultrastructure
- Chromosomes, Human, Pair 14/genetics
- Chromosomes, Human, Pair 14/ultrastructure
- Disease Progression
- Eosinophilia/complications
- Eosinophilia/genetics
- Eosinophilia/pathology
- Humans
- Hypereosinophilic Syndrome/complications
- Hypereosinophilic Syndrome/genetics
- Hypereosinophilic Syndrome/pathology
- Leukemia/classification
- Lymph Nodes/pathology
- Lymphoma/classification
- Male
- Middle Aged
- Myelodysplastic Syndromes/complications
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/pathology
- Oncogene Proteins, Fusion/genetics
- Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/complications
- Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Proto-Oncogene Proteins c-ets/genetics
- Repressor Proteins/genetics
- Sarcoma, Myeloid/complications
- Sarcoma, Myeloid/genetics
- Sarcoma, Myeloid/pathology
- Translocation, Genetic
- World Health Organization
- fms-Like Tyrosine Kinase 3/genetics
- ETS Translocation Variant 6 Protein
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Affiliation(s)
- Haipeng Shao
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, United States
| | - Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jinming Song
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, United States
| | - Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Xiaohui Zhang
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, United States
| | - Zhenya Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jaya Srivastava
- Adaptive Biotechnologies, 1551 Eastlake Ave E, Ste 200, Seattle, WA, United States
| | - Bijal Shah
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, United States
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ling Zhang
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, United States.
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18
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Hu YG, Deng XH, Lei W, Li XL. Clinical characteristics and management of primary granulocytic sarcoma of the oral cavity: A case report and literature review. Medicine (Baltimore) 2020; 99:e22820. [PMID: 33120806 PMCID: PMC7581149 DOI: 10.1097/md.0000000000022820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Granulocytic sarcoma (GS) is a commonly occurring tumor comprising immature myeloid cells, which are usually related to acute or chronic myelocytic leukemia. The tumor rarely precedes leukemia without bone marrow involvement and is called primary GS. Although primary GS can occur in any body part, the involvement of the oral cavity is uncommon. PATIENT CONCERNS A 49-year-old woman hospitalized at the Department of Plastic and Maxillofacial Surgery presented with a growing mass in her left maxillary hard palate dating two months back. No obvious physical findings were noted during general examination. She was diagnosed with an oral ulcer at a local clinic, and received antibiotics. However, the symptoms did not improve; the mass became bigger and painful. DIAGNOSIS An incisional biopsy of the oral mass was performed, the immunohistochemistry showed that the tumor cells tested positive for myeloperoxidase, CD4, BCL-2, KI-67. Bone marrow aspiration was negative for malignant cells, and the laboratory test results revealed only monocytosis. Standard bone marrow cytogenetic analysis showed a normal karyotype and leukemia-related fusion gene detection was normal. Therefore, the final diagnosis was intraoral primary GS. INTERVENTIONS The patient was treated with a chemotherapy regimen based on idarubicin and cytarabine arabinoside. OUTCOMES After 2 cycles of idarubicin and cytarabine arabinoside regimen chemotherapy, the patient achieved complete remission. The tumor was barely visible in the left maxillary hard palate. There has been no evidence of disease spread and progression after 1 year of follow-up. CONCLUSIONS Careful morphological and immunohistochemical analyses, correlating with clinical data are necessary to establish the diagnosis of oral primary GS. Early aggressive systemic chemotherapy can effectively relieve symptoms, significantly reducing primary GS conversion into acute myelocytic leukemia and prolonging overall survival.
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Affiliation(s)
- Yun-Gang Hu
- Department of Plastic and Maxillofacial Surgery, The People's Affiliated Hospital of Nanchang University
| | - Xiao-Hua Deng
- Department of Plastic and Maxillofacial Surgery, The People's Affiliated Hospital of Nanchang University
| | - Wei Lei
- Department of Plastic and Maxillofacial Surgery, The People's Affiliated Hospital of Nanchang University
| | - Xiao-Lin Li
- Key Laboratory of Maxillofacial Plastic and Reconstructive surgery, Jiangxi, People's Republic of China, 92 Aiguo road, Nanchang, Jiangxi, People's Republic of China
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19
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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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20
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Zhang X, Huang P, Chen Z, Bi X, Wang Y, Wu J. Vulvar myeloid sarcoma as the presenting symptom of acute myeloid leukemia: a case report and literature review of Chinese patients, 1999-2018. Diagn Pathol 2019; 14:126. [PMID: 31699112 PMCID: PMC6839179 DOI: 10.1186/s13000-019-0892-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/18/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Myeloid sarcoma (MS), which represents a rare malignancy that comprises of myeloid blasts occurring at extra-medullary sites, closely correlates with the onset and relapse of acute myeloid leukemia (AML) and other hemopoietic neoplasm. Female genital system is an uncommon location of MS, with the vulvar MS being even rarer that only eight cases have been reported in English-written literature. CASE PRESENTATION A 47-year-old woman presented with chronic ulceration on her vulva for one and a half month. Microscopic examination of incisional biopsy revealed dermal infiltration of myeloid precursor cells, which were positive for MPO, lysozyme, CD43, CD68, CD38 and CD117. Bone marrow flowcytometric analysis showed myeloblast count of 74%, which expressed CD13, CD33, CD117 and HLA-DR. A diagnosis of AML (M2 type) was made and vulvar MS was the earliest symptom. The patient achieved complete remission after chemotherapy with no evidence of recurrence in a 27-month follow-up. We reviewed the literature and identified 54 cases of Chinese patients with gynecological MS between 1999 and 2018, and discovered that in Chinese population, MS most frequently involved uterine cervix followed by the ovary and vulva, and ovarian MS onset much earlier than other sites. Remarkably, vulvar MS exhibited a high rate of concurrent AML and secondary myeloid leukemia within a short time of its occurrence. Despite its limited distribution, MS should be tackled aggressively with chemotherapy followed by allogeneic hematopoietic stem cell transplantation if the appropriate donor is available. CONCLUSIONS Female genital MS, especially vulvar MS, should be included in the differential diagnosis of gynecological neoplasm, which will facilitate its early diagnosis and prompt management.
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Affiliation(s)
- Xilin Zhang
- Department of Dermatology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
- Department of Dermatology, Shanghai Skin Disease Hospital, Shanghai, 200433, China
| | - Peichen Huang
- Department of Dermatology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Zhuo Chen
- Department of Dermatology, Shanghai Children's Medical Central, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Xinling Bi
- Department of Dermatology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Ying Wang
- Department of Dermatology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China.
| | - Jianhua Wu
- Department of Dermatology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China.
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21
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Abstract
RATIONALE Granulocytic sarcoma without invasion of bone marrow or blood is very rare. The diagnosis of it is usually overlooked and the treatment has not reached a consensus. Meanwhile, the onset of this kind of disease is not clear. PATIENT CONCERNS Diagnose patients in early stage and help choose the right treatment strategies. DIAGNOSES The ultimate diagnosis was nonleukemic granulocytic sarcoma after blunt trauma. INTERVENTIONS Surgery was the initial treatment option. Chemotherapy including idarubicin (70 mg, D1-D3) and cytosine arabinoside (100 mg, D1-D7) and radiotherapy of total 3,060 cGy were then administered but failed to control the disease. Hematopoietic stem cell transplantation was finally administered. OUTCOMES No evidence of disease progression or spread according to the latest follow-up. LESSONS The etiology of nonleukemic granulocytic still remains unclear, though trauma seems to be a potential predisposing factor and deserves more attention for early diagnosis and timely and proper treatment. Systemic chemotherapy is more effective than radiotherapy or surgery. Hematopoietic stem cell transplantation is an alternative choice after the failure of chemotherapy.
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22
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Collinge E, Tigaud I, Balme B, Gerland LM, Sujobert P, Carlioz V, Salles G, Thomas X, Paubelle E. Case report: Purulent transformation of granulocytic sarcoma: An unusual pattern of differentiation in acute promyelocytic leukemia. Medicine (Baltimore) 2018; 97:e9657. [PMID: 29465554 PMCID: PMC5841987 DOI: 10.1097/md.0000000000009657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Acute promyelocytic leukemia (APL) is a curable subtype of acute myeloid leukemia. APL is currently treated with combination of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) resulting in the induction of apoptosis and differentiation of the leukemic cells. Differentiation syndrome (so-called ATRA syndrome) is the main life-threatening complication of induction therapy with these differentiating agents. PATIENT CONCERNS Herein, we report the case of a 49-year-old woman diagnosed with APL with, concomitantly, a bulky cutaneous lesion of 10 cm diameter with a red-to-purple background and a necrotic center, localized on her abdomen. DIAGNOSES After 10 days of treatment, the cutaneous lesion became purulent. Fluorescence in situ hybridization (FISH) analysis performed on this pus confirmed the presence of malignant features in the involved granulocytes proving their origin from the differentiation of leukemic APL cells, as all the analyzed nuclei showed 2 promyelocytic leukemia (PML)-retinoic acid receptor-a (RARA) fusions signals. INTERVENTION The association by ATRA and ATO was continued. OUTCOME Eventually, the evolution was favorable with healing in three weeks. LESSONS This case report therefore highlights the differentiation phenomenon of promyelocytic blasts within promyelocytic sarcoma with the ATRA-ATO combination and the efficacy of this drug association in resolving both the malignant sarcoma and a secondary local infection.
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Affiliation(s)
- Elodie Collinge
- Department of Hematology, CHU UCL Namur, Belgium
- Department of Hematology
| | | | | | | | | | - Violette Carlioz
- Department of Dermatology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud
| | | | | | - Etienne Paubelle
- Laboratory of Hematology
- LBMC, ENS, CNRS UMR5239, Faculté de Médecine Lyon Sud, Pierre-Bénite, France
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23
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Goldenberg D, Joshi M, Malysz J, Claxton D, Cottrill EE. Myeloid sarcoma of the thyroid. Ear Nose Throat J 2017; 96:460-461. [PMID: 29236267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
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Wang P, Li Q, Zhang L, Ji H, Zhang CZ, Wang B. A myeloid sarcoma involving the small intestine, kidneys, mesentery, and mesenteric lymph nodes: A case report and literature review. Medicine (Baltimore) 2017; 96:e7934. [PMID: 29049187 PMCID: PMC5662353 DOI: 10.1097/md.0000000000007934] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Myeloid sarcomas (MSs) are rare malignant hematological tumors. They most commonly occur in patients with acute or chronic myeloid leukemia. A de novo MS with no evidence of blood system disease is rare, but may represent the first sign of a systemic illness that precedes a full-blown disease. Herein, we report the computed tomography (CT) findings of an extremely rare case of a nonleukemic MS that progressed to acute myelogenous leukemia (AML) and simultaneously involved the small intestine, kidneys, mesentery, and mesenteric lymph nodes. Moreover, we provide CT findings before and after AML chemotherapy, which have not been reported previously. PATIENT CONCERNS A 25-year-old man with intermittent upper abdominal pain for 6 months was admitted to the hospital on November 28, 2015. Initial CT showed concentric wall thickening of the jejunum with an adjacent mesenteric soft tissue mass and mesenteric lymph nodes enlargement. Both kidneys were involved as indicated by the presence of well-defined mildly dilated lesions. During the laparoscopic surgery, the small intestinal tumor, mesenteric soft tissue mass, and mesenteric lymph nodes were removed. DIAGNOSES The pathological diagnosis was an MS. INTERVENTIONS The patient refused systemic chemotherapy and was rehospitalized with persistently aggravated abdominal distension on February 17, 2016. Follow-up CT showed diffuse small bowel wall thickening, widespread infiltration of the peritoneum, omentum, and mesentery, mesenteric lymph node enlargement, and large amounts of ascites fluid. The lesions in both kidneys were substantially larger and more numerous than on initial CT. Then the patient was treated with conventional AML chemotherapy. OUTCOMES The patient achieved complete hematological remission on bone marrow examination. Follow-up CT in September 4, 2016, showed none of the abnormalities seen on initial CT. Currently, the patient is in complete remission. LESSONS If the radiological examination shows lesions at multiple sites, and these lesions are soft tissue masses with homogenous enhancement, MS should be considered in the differential diagnosis, and an aspiration biopsy should be performed to provide a definitive pathological diagnosis. If MS is diagnosed, systemic chemotherapy is crucial to recovery; otherwise, the disease may progress rapidly. Medical imaging is helpful for diagnosing MS and for monitoring treatment response.
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Affiliation(s)
- Ping Wang
- Shandong Medical Imaging Research Institute, School of Medicine, Shandong University, Jinan
- Department of Radiology
| | | | | | - Hong Ji
- Department of Pathology, The Affiliated Hospital of Binzhou Medical University, School of Medicine, Binzhou Medical University, Binzhou
| | | | - Bin Wang
- Medical Imaging Research Institute, Department of Radiology, School of Medicine, Binzhou Medical University, Yantai, Shandong, China
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25
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Katagiri T, Ushiki T, Masuko M, Tanaka T, Miyakoshi S, Fuse K, Shibasaki Y, Takizawa J, Aoki S, Sone H. Successful 5-azacytidine treatment of myeloid sarcoma and leukemia cutis associated with myelodysplastic syndrome: A case report and literature review. Medicine (Baltimore) 2017; 96:e7975. [PMID: 28885352 PMCID: PMC6392782 DOI: 10.1097/md.0000000000007975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Myeloid sarcoma (MS) and leukemia cutis (LC) are extramedullary tumors comprising myeloid blasts. They can occur de novo or concurrently with hematological disorders, usually acute myeloid leukemia (AML). AML chemotherapy is generally the initial therapy for MS and LC, and hematopoietic stem cell transplantation (HSCT) can be considered as additional therapy. However, treatment for older patients who are unable to continue intensive chemotherapy is not currently standardized. PATIENT CONCERNS A 71-year-old Japanese woman was diagnosed with multiple MSs associated with myelodysplastic syndrome (MDS), using bone marrow aspiration and lymph node biopsy. DIAGNOSES Additionally, LC was diagnosed by skin biopsy. Extramedullary MS and LC lesions were formed by massive infiltration of myeloblastic cells. INTERVENTIONS Twenty courses of 5-azacytidine (5-Aza) were administrated as maintenance therapy after induction therapy with daunorubicin and cytarabine. OUTCOMES Myeloblasts decreased in the bone marrow and the LC disappeared after induction therapy. The MSs completely disappeared, except for the palatine tonsil lesion, after 5-Aza maintenance therapy. 5-Aza treatment provided long-term partial response for more than 21 months. LESSONS 5-Aza was well tolerated and may be a good option for the treatment of MS and LC associated with MDS, especially in older patients who cannot receive HSCT.
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Affiliation(s)
| | - Takashi Ushiki
- Department of Hematology
- Department of Transfusion Medicine and Regenerative Medicine, Niigata University Medical and Dental Hospital
| | | | | | | | | | | | | | - Sadao Aoki
- Department of Pathophysiology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata, Japan
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Almond LM, Charalampakis M, Ford SJ, Gourevitch D, Desai A. Myeloid Sarcoma: Presentation, Diagnosis, and Treatment. Clinical Lymphoma Myeloma and Leukemia 2017; 17:263-267. [PMID: 28342811 DOI: 10.1016/j.clml.2017.02.027] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/13/2017] [Accepted: 02/28/2017] [Indexed: 12/22/2022]
Abstract
Myeloid sarcoma is an extramedullary tumor of immature granulocytic cells. It is a rare condition, most often associated with acute myeloid leukemia (AML), although in some rare cases it may present in nonleukemic patients. It should therefore be considered as a differential diagnosis of any atypical cellular infiltrate. It may occur at any site, leading to very varied clinical presentations. Diagnosis is challenging and relies on a high index of suspicion as well as radiology, histology, immunophenotyping, and molecular analyses, which also are essential for risk stratification and treatment planning. Systemic chemotherapy using AML-like regimens should be commenced early, even in nonleukemic disease. Surgery and/or radiotherapy may be indicated for symptomatic lesions or tumors causing local organ dysfunction or obstruction. Allogeneic hematopoietic stem cell transplantation has demonstrated promising results, particularly in patients who achieved complete remission with AML-induction protocols, and recent advances in genetic profiling may enable the development of novel targeted therapies. Prospective multicenter controlled trials are required to further refine management decisions and investigate the role of novel targeted therapies.
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Affiliation(s)
- L Max Almond
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
| | - Maria Charalampakis
- Department of Haematology and Stem Cell Transplantation, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Samuel J Ford
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - David Gourevitch
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Anant Desai
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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27
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Seracchioli R, Geraci E, Paradisi R, Montanari G, Zannoni L, Tabanelli V, Pileri SA, Carloni S, Sartor C, Martinelli G. Pelvic myeloid sarcoma: a multidisciplinary approach. EUR J GYNAECOL ONCOL 2017; 38:476-478. [PMID: 29693897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Myeloid sarcoma (MS) is a rare tumor mass derived from the extramedullary proliferation of blasts of one or more of myeloid lineages. It usually occurs at an anatomical site other than the bone marrow (BM). Among the anatomical site which may be involved, female genital tract is a rare localization. When MS follows a previous history of myeloid pathology it is usually associated to a poor prognosis. To date this disease was managed with exploratory laparotomy or with surgical debulking. The authors report a case of laparosc6pic diagnosis of a pelvic myeloid sarcoma in a patient previously affected by acute mycloid leukemia, evidencing the importance of minimally invasive diagnosis and subsequent multidisciplinary management.
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28
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Abstract
RATIONALE Granulocytic sarcoma (GS) is defined as leukemia infiltration in any organ other than the bone marrow. GS rarely occurs in the pancreas. Here, we present the first report of GS in the pancreas on F-fluorodexyglucose positron emission tomography/computed tomography (F-FDG PET/CT). PATIENT CONCERNS A 19-year-old male patient with acute myeloid leukemia received a human leukocyte antigen-haploidentical stem cell transplant as a second transplant while in second complete remission. INTERVENTIONS After a second stem cell transplant, obstructive pancreatitis accompanied by a mass in the pancreatic head was observed. FDG-PET/CT revealed abnormal activity in the head of the pancreas and the skin in the patient's left breast area. DIAGNOSES Pathological examination demonstrated relapsed acute myeloid leukemia in both the lesions. OUTCOMES This is the first report showing the F-FDG PET/CT findings of GS in the pancreas. LESSONS F-FDG PET/CT may help determine the stage of GS.
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Affiliation(s)
| | | | | | - Yuji Nakamoto
- Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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29
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Affiliation(s)
- Ishfaq Bhat
- University of Nebraska Medical Center, Omaha, Nebraska, USA
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30
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Dörfel D, Häntschel M, Federmann B, Haen S, Fend F, Müller II, Salih HR, Vogel W, Kanz L, Horger M. Cardiac Myeloid Sarcoma: Multimodality Radiologic Imaging Features and Pathologic Correlation. Am J Med 2016; 129:e117-20. [PMID: 27103046 DOI: 10.1016/j.amjmed.2016.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 11/13/2022]
Affiliation(s)
- Daniela Dörfel
- Department of Medical Oncology, Hematology, Immunology, Rheumatology and Pulmology, University Hospital Tübingen, Germany; Clinical Collaboration Unit, Translational Immunology, German Cancer Consortium and German Cancer Research Center, Partner Site Tübingen, Germany
| | - Maik Häntschel
- Department of Medical Oncology, Hematology, Immunology, Rheumatology and Pulmology, University Hospital Tübingen, Germany
| | - Birgit Federmann
- Institute of Pathology and Neuropathology, University of Tübingen, Germany
| | - Susanne Haen
- Institute of Pathology and Neuropathology, University of Tübingen, Germany
| | - Falko Fend
- Institute of Pathology and Neuropathology, University of Tübingen, Germany
| | - Iris I Müller
- Department of Cardiology and Cardiovascular Medicine, University Hospital Tübingen, Germany
| | - Helmut R Salih
- Department of Medical Oncology, Hematology, Immunology, Rheumatology and Pulmology, University Hospital Tübingen, Germany; Clinical Collaboration Unit, Translational Immunology, German Cancer Consortium and German Cancer Research Center, Partner Site Tübingen, Germany
| | - Wichard Vogel
- Department of Medical Oncology, Hematology, Immunology, Rheumatology and Pulmology, University Hospital Tübingen, Germany
| | - Lothar Kanz
- Department of Medical Oncology, Hematology, Immunology, Rheumatology and Pulmology, University Hospital Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Germany.
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Mirochnik R, Araida S, Yaffe V, Yanga S, Abu EN. [Rare presentation of acute myeloid leukemia in head and neck area, differential diagnosis and a case presentation]. Refuat Hapeh Vehashinayim (1993) 2016; 33:16-70. [PMID: 30699483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Differential diagnosis of lateral neck masses is vast, it may be one of many possible pathologies, it may appear in any age group and could be a presentation of a congenital, inflamed or a reactive structure, salivary gland pathology and of a traumatic or an latrogenic origin. Neck mass in adults of 40 years old or older require an immediate attention, the primary concern is of a metastatic dissemination of a local or a distant primary malignancy, in 74% the primary is local and in 11% distant. A 43 years old male, otherwise healthy, was admitted to the ER with a chief complain of a right submandibular mass, presenting over 3 weeks. Prior to addmition he was initially mistreated for odontogenic abscess by extraction of inflamed teeth in right posterior mandibular segment and an antibiotic regime by augmentin and metronidazole, with no resolution. On admission he presented an abnormal blood count, with a severe leukopenia, thrombocytopenia and neutropenia. A bone marrow biopsy has shown a massive infiltration of myeloid blast cells, consequently he was diagnosed with Acute Myeloid Leukemia, and the lateral neck mass was clinically diagnosed as a Chloroma.
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32
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Aleem A, Aziz S, Hussain S, Algahtani F, Alsaleh K. Isolated Uterine Myeloid Sarcoma Preceding the Diagnosis of Acute Myeloid Leukemia. J Coll Physicians Surg Pak 2016; 26:S52-S55. [PMID: 27376223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/29/2015] [Indexed: 06/06/2023]
Abstract
Myeloid sarcoma (MS) is an extramedullary solid tumor composed of leukemic myeloid cells. MS is an uncommon tumor complicating acute myeloid leukemia (AML), or less often myelodysplestic syndrome (MDS) and myeloproliferative disorders. Rarely, MS may precede the systemic onset of AML, which usually follows within months. We report a 36 year-old lady who presented with a cervical-uterine mass, which proved to be MS. Initially, she had no systemic AMLand was treated with hysterectomy and systemic chemotherapy. She developed bilateral-flank pain and renal impairment after 9 months. Imaging revealed a soft-tissue mass in the para-aortic and peri-sacral region with bilateral hydronephrosis. Biopsy from the mass confirmed recurrence of MS. Bone marrow (BM) biopsy revealed 20% blasts consistent with AML. She was treated with aggressive chemotherapy and local radiotherapy. Despite these measures, she died of progressive disease. MS should be considered and treated as systemic AML, rather than an isolated mass; and we discuss management issues in such patients.
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Affiliation(s)
- Aamer Aleem
- Department of Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Shahid Aziz
- Department of Division Hematology - Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Sajjad Hussain
- Department of Emergency Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Fatmah Algahtani
- Department of Radiology and Pathology, Division of Hematopathology,College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Alsaleh
- Department of Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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33
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Russo MP, Andresik D, Perusini MA. [Granulocytic Sarcoma: Two cases with Lymph Node Presentation]. Rev Fac Cien Med Univ Nac Cordoba 2016; 73:202-204. [PMID: 27805558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Two cases of granulocytic sarcoma (GS) with lymph node presentation without marrow involvement are presented because it is a rare presentation of acute myeloid leukemia (AML) that can coexist with or precede it and as initial symptom (case 1) or disease relapse (case 2). The most common differential diagnoses are lymphoma or solid tumor. Biopsy is essential for definitive diagnosis. Imaging studies such as positron emission tomography (PET) are very useful for staging and monitoring. The prognosis and treatment according to the literature is not different from AML. The two cases presented were diagnosed with lymph node biopsy with a bone marrow that did not meet criteria for AML.
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Abstract
Myeloid sarcoma is a tumor composed of myeloblasts occurring at an extramedullary site. It may develop in patients with acute myeloid leukemia, myeloproliferative or myelodysplastic syndrome, sometimes preceding onset of the systemic disease. Frequent sites of myeloid sarcoma are bones or various soft tissues. Gastrointestinal involvement is very rare. We report a unique case of myeloid sarcoma presenting as a painful anal fissure, in a patient with a history of acute myeloid leukemia. The diagnosis was achieved by a surgical excisional biopsy and immunoistochemical staining.
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35
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Grantham JT, Howell DM, Bacaj PJ, Coad JE, Vos JA. Myeloid Sarcoma of the Bladder in the Setting of Refractory Anemia with Excess Blasts-2 (RAEB-2). W V Med J 2015; 111:34-36. [PMID: 26665895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Myeloid sarcoma is an extramedullary tumor consisting of immature hematopoietic cells of granulocytic or monocytic differentiation. While rare, it can be seen in a variety of clinical settings and is most commonly associated with acute myeloid leukemia (AML), myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN). We present a rare case of myeloid sarcoma occurring in the bladder of a 56 year old male. Myeloid sarcoma may be difficult to recognize due to its rarity and clinical and morphologic similarity to many other conditions; however, swift diagnosis is necessary as it is considered equivalent to AML. Prognostic indicators for myeloid sarcoma have not been well established, but survival may be improved by undergoing chemotherapy designed to treat AML.
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36
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Pan Y, Tao Y, Fu C, Jia J, Liu S, Xiao D. Assessment of PET/CT in multifocal myeloid sarcomas with loss of TET2: a case report and literature review. Int J Clin Exp Pathol 2015; 8:13630-13634. [PMID: 26722587 PMCID: PMC4680532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/22/2015] [Indexed: 06/05/2023]
Abstract
Myeloid sarcoma is a rare solid tumor consisting of leukemic myeloblasts and/or myeloid precursors occurring outside the blood or bone marrow. The unique site with myeloid sarcoma has been reported, the multiple sites of myeloid sarcoma have rarely been cited in the medical literature. Here we report that the unusual clinical presentation and management of myeloid sarcoma in multiple sites with PET-CT, highlighting the utility of PET-CT was useful in detecting and monitoring myeloid sarcoma. We also found that loss of TET2 and gain of 5 hmC in the case of myeloid sarcoma, indicating the mechanism for myeloid sarcoma is totally different with other hematopoietic malignancies.
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Affiliation(s)
- Yu Pan
- Department of Pathology, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
- Department of Pathology, School of Basic Medicine, Central South UniversityChangsha 410078, Hunan, China
| | - Yongguang Tao
- Department of Pathology, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
- Cancer Research Institute, Central South UniversityChangsha 410078, Hunan, China
- Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of EducationChangsha 410078, Hunan, China
- Key Laboratory of Carcinogenesis, National Health and Family Planning CommissionChangsha 410078, Hunan, China
- Center for Molecular Imaging, Central South UniversityChangsha 410078, Hunan, China
| | - Chunyan Fu
- Department of Pathology, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
- Department of Pathology, School of Basic Medicine, Central South UniversityChangsha 410078, Hunan, China
| | - Jiantao Jia
- Cancer Research Institute, Central South UniversityChangsha 410078, Hunan, China
- Department of Pathophysiology, Changzhi Medical CollegeChangzhi 046000, Shanxi, China
| | - Shuang Liu
- Center for Medicine Research, Xiangya Hospital, Central South UniversityChangsha 410008, Hunan, China
| | - Desheng Xiao
- Department of Pathology, Xiangya Hospital, Central South UniversityChangsha 410078, Hunan, China
- Department of Pathology, School of Basic Medicine, Central South UniversityChangsha 410078, Hunan, China
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Dhandapani E. Acute Myeloid Leukemia Presenting as Intracerebral Granulocytic Sarcoma. J Assoc Physicians India 2015; 63:70-71. [PMID: 27608697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The CNS involvement of acute myeloid leukemia (AML) is more commonly manifest as meningeal involvement. Rarely it may present as intravascular tumor aggregates called granulocytic sarcoma which presents as intracranial hemorrhage. We are presenting a case of intracranial, intra-parenchymal granulocytic sarcoma (other names: chloroma, extramedullary myeloblastoma), presenting as acute hemiplegia without cerebral hemorrhage.
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Ding J, Li H, Qi YK, Wu J, Liu ZB, Huang BC, Chen WX. Ovarian granulocytic sarcoma as the primary manifestation of acute myelogenous leukemia. Int J Clin Exp Pathol 2015; 8:13552-13556. [PMID: 26722572 PMCID: PMC4680517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/20/2015] [Indexed: 06/05/2023]
Abstract
Granulocytic sarcoma (GS) usually occurs concomitantly with or after the onset of acute myeloid leukemia (AML) or other myeloproliferative disorders, however, GS of the ovary as the primary manifestation of AML is exceedingly rare. To the best of our knowledge, eight cases of ovarian GS as the first sign of AML have been reported in the literature. Here, we report the ninth case: a 27-year-old female who presented with an ovarian mass without any underlying hematologic disorder. A high index of suspicion aided by immunohistochemistry established the correct diagnosis of undifferentiated GS that involved the ovary. Simultaneously, laboratory findings indicated that the blood counts continually increased after surgery. Five days after the surgery, bone marrow biopsy confirmed the presence of AML. After establishing the diagnosis, the patient was sent to the hematology department to receive cytosine arabinoside and idarubicin chemotherapy. This report outlines an exceedingly rare case of AML that initially manifested as an ovarian GS. Awareness of this entity will enable earlier diagnosis and appropriate treatment.
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Affiliation(s)
- Jun Ding
- Department of Pathology, Shanghai Gongli Hospital Shanghai, People's Republic of China
| | - Hua Li
- Department of Pathology, Hua Bei Oil Field Total Hospital Hebei, People's Republic of China
| | - Yu-Kai Qi
- Department of Pathology, Shanghai Gongli Hospital Shanghai, People's Republic of China
| | - Jian Wu
- Department of Pathology, Shanghai Gongli Hospital Shanghai, People's Republic of China
| | - Ze-Bin Liu
- Department of Pathology, Fudan University Shanghai Cancer Center Shanghai, People's Republic of China
| | - Bin-Cang Huang
- Department of Radiology, Shanghai Gongli Hospital Shanghai, People's Republic of China
| | - Wei-Xiang Chen
- Department of Pathology, Shanghai Gongli Hospital Shanghai, People's Republic of China
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39
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Nalwa A, Nath D, Suri V, Jamaluddin MA, Srivastava A. Myeloid sarcoma of the breast in an aleukemic patient: a rare entity in an uncommon location. Malays J Pathol 2015; 37:63-66. [PMID: 25890617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Myeloid sarcoma (MS) is an extramedullary solid neoplasm of immature myeloid cells. These tumours usually develop in concurrence with or following acute leukemia. The breast is an uncommon site for presentation of this tumour, where it is often misdiagnosed as lymphoma or carcinoma.A 33- year-old female presented with a right breast lump in a private hospital, which was diagnosed as ductal carcinoma on lumpectomy. Subsequently she developed a lump in the left breast and a similar diagnosis of carcinoma was made on biopsy. A left mastectomy was performed. Histopathological examination revealed a tumour composed of mononuclear cells arranged in sheets and cords with round to oval vesicular nuclei and occasional prominent nucleoli. IHC for CK was very weak and focal. The tumour cells were immunonegative for ER, PR, Her2neu,epithelial membrane antigen, e-cadherin, CD3 and CD20. Diffuse immunopositivity for myeloperoxidase, CD34 and CD117 established a diagnosis of myeloid sarcoma. A histopathological review of the right breast lesion, with immunohistochemistry, also confirmed the diagnosis of myeloid sarcoma. Investigatory workup for acute myeloid leukemia, including bone marrow aspirate and biopsy and karyotypic studies, proved negative. The patient was treated with high dose cytarabine (HDAC) regimen and was disease free during the 12-month follow-up.Although extremely rare, awareness of such a presentation is crucial. This case also illustrates that careful histopathological review along with an expanded panel of immunohistochemistry is extremely important for recognizing such cases as a misdiagnosis can lead to unnecessary surgery and inappropriate therapy.
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Affiliation(s)
- Aasma Nalwa
- All India Institute of Medical Sciences, Department of Pathology, First Floor, Teaching Block, New Delhi. 110029, India.
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40
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Huang XL, Tao J, Li JZ, Chen XL, Chen JN, Shao CK, Wu B. Gastric myeloid sarcoma without acute myeloblastic leukemia. World J Gastroenterol 2015; 21:2242-2248. [PMID: 25717265 PMCID: PMC4326167 DOI: 10.3748/wjg.v21.i7.2242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/10/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
Myeloid sarcomas (MS) involve extramedullary blast proliferation from one or more myeloid lineages that replace the original tissue architecture, and these neoplasias are called granulocytic sarcomas, chloromas or extramedullary myeloid tumors. Such tumors develop in lymphoid organs, bones (e.g., skulls and orbits), skin, soft tissue, various mucosae, organs, and the central nervous system. Gastrointestinal (GI) involvement is rare, while the occurrence of myeloid sarcomas in patients without leukemia is even rare. Here, we report a case of a 38-year-old man who presented with epigastric pain and progressive jaundice. An upper GI endoscopy had shown extensive multifocal hyperemic fold thickening and the spread of nodular lesions in the body of the stomach. Biopsies from the gastric lesions indicated myeloid sarcoma of the stomach. However, concurrent peripheral blood and bone marrow examinations showed no evidence of acute myeloid leukemia. For diagnosis, the immunohistochemical markers must be checked when evaluating a suspected myeloid sarcoma case. Accurate MS diagnosis determines the appropriate therapy and prognosis.
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41
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Sugiyama A, Ito S, Sugita Y, Shimada JI, Takeuchi M, Hirano S, Kuwabara S. Brachial Plexus Involvement of Myeloid Sarcoma Detected by Reconstruction Magnetic Resonance Neurography. Intern Med 2015; 54:2251-3. [PMID: 26328656 DOI: 10.2169/internalmedicine.54.5095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Myeloid sarcoma is a rare hematological disorder that presents as an extramedullary mass of immature myeloid precursors. We herein present the case of a 57-year-old man with a seven-month history of progressive weakness in the right upper extremity. Reconstruction magnetic resonance neurography showed a marked enlargement of the right brachial plexus. Fluorodeoxyglucose positron emission tomography revealed a radioactive lesion in the sacrum, in addition to the right brachial plexus, and a biopsy of the sacrum revealed myeloid sarcoma. The brachial plexus lesion was also regarded as myeloid sarcoma because of the treatment response. Isolated myeloid sarcoma involving the brachial plexus is very rare and its diagnosis is difficult as there was neither a history of leukemia nor bone marrow involvement in this patient. In this case, reconstructed magnetic resonance neurography was useful for detecting the brachial plexus mass lesion which led to an early diagnosis and good recovery.
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Affiliation(s)
- Atsuhiko Sugiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
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42
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Wang X, Mang R, Zhou Y. [Myeloidleukemia with external auditory canal granulocytic sarcoma: a case report]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 29:91-93. [PMID: 25966566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We describe a 44-year old man who suffered an isolated external auditory canal granulocytic sarcoma in remission of acute myeloid leukemia. The patient confirmed acute promyelocytic leukemia three years ago and the disease was in remission after treatment. Two months ago he presented pain and hearing loss in the left ear and the symptom developed gradually. At otoscopic examination a tumoral lesion was noted in the external auditory canal and computerized tomography scan showed a mass in the left external acoustic meatus without bone erosion.
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43
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Antic D, Bogdanovic A, Perunicic Jovanovic M, Jovanovic J, Elezovic I. Myeloid sarcoma of the skin in a patient with myelodysplastic syndrome. Acta Dermatovenerol Croat 2015; 23:134-137. [PMID: 26228825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report the case of a 76-year-old woman who presented with asymptomatic extensive erythematous. Firm plaques were noted over the right cheek. Complete blood count was normal, as was a peripheral smear. An excision biopsy taken from the cheek showed infiltration of the dermis and hypodermis with atypical cells which were strongly positive for human leukocyte antigen (HLA-DR) and lysozyme and were moderately myeloperoxidase (MPO) enzyme. The results of immunohistochemical staining for CD34, CD117, CD3, CD4, CD8, CD20, CD23, CD56, and ALK-1 were negative. Bone marrow analysis indicated myelodysplastic syndrome RAEB 1 while cytogenetic finding showed tetrasomy 8. It was recommended that the patient undergo local radiotherapy of skin lesions, but she refused and was lost to follow-up.
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Affiliation(s)
- Darko Antic
- Darko Antic, MD, Clinic for Hematology, Clinical Center Serbia, Koste Todorovića 2, 11000 Belgrade, Serbia;
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Tirado-Sánchez A, Equihua-Velázquez M, Rodríguez-Florido MA, Ponce-Olivera RM. What is your diagnosis? Granulocytic sarcoma. Cutis 2014; 94:65-82. [PMID: 25184647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Andrés Tirado-Sánchez
- Department of Dermatology, Hospital General de México, Dr Balmis 148, Doctores, Cuauhtémoc, 06726 Ciudad de México, Distrito Federal, México.
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45
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Kurian CJ, Madhavan I, Krishnankutty PK, Andrews MA. Compressive myelopathy caused by isolated epidural myeloid sarcoma with systemic mastocytosis. Rare presentation of a hematological malignancy. Neurosciences (Riyadh) 2014; 19:238-239. [PMID: 24983289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Cyril J Kurian
- Department of General Medicine, Government Medical College, Thrissur, Kerala State, India. Tel. +91 9497392251. E-mail:
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46
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Robledo J, Maller S, Boyle JS, Higgins RA. Oral and maxillofacial pathology. Case of the month. Myeloid sarcoma with monocytic differentiation. Tex Dent J 2014; 131:350-391. [PMID: 25115124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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47
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Isshiki Y, Ohwada C, Togasaki E, Shimizu R, Hasegawa N, Yamazaki A, Sugita Y, Kawaguchi T, Tsukamoto S, Sakai S, Takeda Y, Takeuchi M, Sakaida E, Shimizu N, Ota S, Yokote K, Iseki T, Nakaseko C. Acute myeloid leukemia concurrent with spinal epidural extramedullary myeloid sarcoma accompanied by a high CD25 expression and the FLT3-ITD mutation. Intern Med 2014; 53:1159-64. [PMID: 24881741 DOI: 10.2169/internalmedicine.53.1137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Myeloid sarcoma (MS) is an extramedullary myeloid tumor that sometimes presents with antedating systemic leukemia, leading physicians to the misdiagnosis of lymphoma. CD25 is expressed in 13% of patients with acute myeloid leukemia (AML), and its expression is associated with FLT3-ITD mutations, an elevated serum soluble interleukin 2 receptor (sIL-2R) level and a lower survival rate. However, there are no reports concerning the relationship between MS and the CD25 expression. We herein report a case of AML accompanied by thoracic epidural MS with a high CD25 expression, the FLT3-ITD mutation and an extremely elevated serum sIL-2R level in a 59-year-old man who presented with paraplegia.
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Affiliation(s)
- Yusuke Isshiki
- Department of Hematology, Chiba University Hospital, Japan
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Gavrilina OA, Bariakh EA, Parovichnikova EN, Troitskaia VV, Zvonkov EE, Kravchenko SK, Sinitsyna MN, Obukhova TN, Gitis MK, Savchenko VG. [Myeloid sarcoma of the small bowel with inversion of chromosome 16: a description of 3 clinical cases]. TERAPEVT ARKH 2014; 86:85-92. [PMID: 25314783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Myeloid sarcoma (MS) is a rare malignant solid tumor presented with myeloid blast cells showing varying degrees of maturation. MS may have an extramedullary site, precede, or develop simultaneously with the clinical manifestations of acute myeloid leukemia (AML); it may also occur as an AML relapse. Besides AML, MS may be a manifestation of chronic myeloid leukemia or other chronic myeloproliferative diseases. Due to the fact that this disease is rare, the bulk of the literature on MS is presented with single descriptions of retrospective studies and clinical cases. The paper describes 3 cases of MS with inversion of chromosome 16 and small bowel lesion.
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49
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Aladag E, Babacan T, Akin S, Uner U, Kars A, Altundag K. Successful treatment of myeloid sarcoma with local treatment modalities: the longest overall survival in published literature. J BUON 2014; 19:316-317. [PMID: 24659682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- E Aladag
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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50
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