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Clinical characteristics, treatment options, and prognosis of myeloid sarcoma: analysis using the SEER database. Hematology 2023; 28:2247898. [PMID: 37594298 DOI: 10.1080/16078454.2023.2247898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Myeloid sarcoma (MS) is a very rare hematologic disorder. This study analyzes the early treatment options for patients with different types of MS and explores the prognostic factors of MS. METHODS Patients aged 15 years and older with MS in the SEER database (diagnosed from 2000 to 2018) were selected, excluding those with an unknown first course of treatment, an unknown location of disease, and less than 1 month of follow-up. Statistical methods used a chi-square test to compare clinical characteristics; Kaplan-Meier analysis to compare survival differences; and Cox proportional risk models to identify prognostic factors affecting overall survival (OS). RESULTS Data were collected from 472 patients: 244 patients with isolated myeloid sarcoma (IMS) and 228 patients with non-isolated myeloid sarcoma (non-IMS). IMS patients mostly chose local treatment, while non-IMS patients mostly chose chemotherapy. There was a significant difference in OS between IMS patients treated with combined treatment and those without treatment. For non-IMS, treated patients had longer OS than untreated, but the difference was not statistically significant. Among adult patients, those younger than 60 years had a better prognosis. Patients with the urinary system, digestive system, reproductive system and chest and abdomen as the initial site had a better prognosis. CONCLUSIONS Early combination therapy in IMS patients had a longer OS, and chemotherapy combined with radiotherapy/surgery should be the treatment of choice. For non-IMS patients, early combination therapy did not show a significant advantage. Age and location of first presentation were independent factors affecting MS patients' long-term prognosis.
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Clinico-biological features, treatment and prognosis of primary myeloid sarcoma: A French retrospective multi-centric observational study. Br J Haematol 2023; 202:e50-e53. [PMID: 37403204 DOI: 10.1111/bjh.18961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
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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] [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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[Myeloid sarcomas of the shoulder and testis relapsing 9 years after allogenic stem cell transplantation for acute myeloid leukemia]. [RINSHO KETSUEKI] THE JAPANESE JOURNAL OF CLINICAL HEMATOLOGY 2022; 63:860-864. [PMID: 36058855 DOI: 10.11406/rinketsu.63.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This report describes a 56-year-old man who was diagnosed with myeloid sarcoma (MS) of the testis and right shoulder after receiving allogenic stem cell transplantation (allo-SCT) at the age of 47 for acute myeloid leukemia (AML) with inv (16) (p13.1;q22). Nine years after allo-SCT, he complained of a painful right testicular mass. He underwent orchiectomy, and the pathologic diagnosis was MS. Inv (16) was identified by fluorescence in situ hybridization (FISH) using testicular tumor specimens. 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) revealed FDG accumulation in the right shoulder. FISH analysis of bone marrow aspirate revealed no increase in blasts and ruled out CBFB-MYH11 fusion. Reinduction chemotherapy, consolidation, and local radiation therapy for the left testis and right shoulder were administered to him. After that, he received a second allo-SCT from an unrelated donor who was HLA-matched. As of 2 years after the second allo-SCT, recurrence of neither AML nor myeloid sarcoma has been observed. The recurrence of MSs without bone marrow involvement is frequently reported in single, multiple single organs, or multiple single regions. Even if MSs recur in a distant location, combining systemic and local treatment may be a better treatment strategy.
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Myeloid Sarcoma: Diagnostic and Treatment Tools from a Monocentric Retrospective Experience. Acta Haematol 2021; 145:84-88. [PMID: 34284384 DOI: 10.1159/000517389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/24/2021] [Indexed: 11/19/2022]
Abstract
Myeloid sarcoma (MS) is a very rare disease in both adults and children. Prognosis is poor in adults; in the pediatric age, the prognostic impact of extramedullary disease is controversial. Systemic therapy represents the mainstay of treatment even in isolated MS, but a comparison between different induction regimens is very limited in the literature. To date, it is still not clear if induction treatment should differ from that of other acute myeloid leukemias and stem cell transplant is considered for consolidation in both leukemic patients and in those with isolated disease. Our study describes a retrospective series of 13 cases of MS (adults and children), diagnosed and treated at our institute over 18 years. We report the results of immunophenotypic, cytogenetic and molecular studies, therapeutic approaches, and outcome, in order to establish the best strategy for patients' workup.
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Intracranial myeloid sarcoma presentation in distant acute myeloid leukemia remission. J Clin Neurosci 2021; 89:158-160. [PMID: 34119261 DOI: 10.1016/j.jocn.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/10/2021] [Accepted: 05/01/2021] [Indexed: 12/12/2022]
Abstract
Intracranial myeloid sarcoma (IMS) is a rare central nervous system manifestation of hematopoietic neoplasms of myeloid origin. We report the first case of IMS treatment with an isocitrate dehydrogenase-2 (IDH-2) inhibitor, Enasidenib, following surgical resection, whole-brain radiation, and consolidation Etoposide/Cytarabine therapy. A 42-year-old female was diagnosed with IMS after a 10-year remission of her acute myeloid leukemia (AML). She underwent surgical debulking and had postoperative resolution of her visual symptoms. She received adjuvant radiation and medical management, and continues to show no evidence of recurrence or progression at 17 months postoperatively. This case is notable for an isolated IMS presentation in a patient with a very distant history of AML remission, and without evidence of concurrent bone marrow relapse. The goals of neurosurgical intervention should be symptomatic relief of mass effect and pathological diagnosis, due to the sensitivity of IMS to adjuvant radiation and medical management such as IDH-2 inhibitors.
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Bilateral ovarian granulocytic sarcoma as the primary manifestation of acute myelogenous leukemia treated with allogenic stem cell transplantation: A case report. Medicine (Baltimore) 2019; 98:e18390. [PMID: 31876710 PMCID: PMC6946288 DOI: 10.1097/md.0000000000018390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
RATIONALE Granulocytic sarcoma (GS), also known as chloroma, is a tumor comprising myeloblasts or monoblasts, potentially occurring as an extramedullary mass. Systemic chemotherapy should be used to induce complete remission. However, such patients with chloroma have a poorer treatment outcome than those without extramedullary myeloid sarcomas. PATIENT CONCERNS A 30-year-old woman who initially presented with bilateral ovarian masses and splenomegaly was admitted to hospital. Also, her complete blood cell counts showed pancytopenia and blood smear revealed a few immature cells (3%). DIAGNOSES A bone marrow biopsy demonstrated acute myelomonocytic leukemia, and the chromosomal analysis revealed a 46, XX, del18 (p11) [20] karyotype and cytogenetics and molecular markers showed all negative results. INTERVENTIONS Since this diagnosis, she received remission-inducing chemotherapy comprising anthracycline and cytarabine, which is a standard regimen for acute myeloid leukemia (AML), and followed by allogenic hematopoietic stem cell transplantation from Human leukocyte antigen (HLA)-identical sibling donor. OUTCOMES After transplantation, the bone marrow engrafted successfully without complications. She visited our clinic regularly with no evidence of leukemia relapse or graft-versus host disease. LESSONS This report represents the first case of ovarian GS, wherein treatment was successful with high-dose chemotherapy, followed by allogenic hematopoietic stem cell transplantation without oophorectomy.
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MESH Headings
- Adult
- Antimetabolites, Antineoplastic/therapeutic use
- Cytarabine/therapeutic use
- Female
- Humans
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/therapy
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/etiology
- Ovarian Neoplasms/therapy
- Sarcoma, Myeloid/drug therapy
- Sarcoma, Myeloid/etiology
- Sarcoma, Myeloid/therapy
- Stem Cell Transplantation/methods
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Abstract
BACKGROUND Extramedullary blast crisis (EBC) of T315I BCR-ABL mutated chronic myelogenous leukemia (CML) is extremely rare. METHODS We report an unusual case characterized by fever, right shoulder swelling, pleural effusion, and multiple bone destruction as the first signs of EBC of T315I BCR-ABL mutated CML. RESULTS The patient did not respond to chemotherapy consisting of anthracyclines, cytarabine and etoposide. His condition improved after the treatment with ponatinib combined with allogenic stem cell transplantation (alloHCT), but soon worsened after ponatinib withdrawal. He got slight relief after he continued ponatinib. CONCLUSIONS Ponatinib is an important treatment to control EBC even after allo-HCT.
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MESH Headings
- Adult
- Antineoplastic Agents/therapeutic use
- Blast Crisis/genetics
- Combined Modality Therapy
- Fusion Proteins, bcr-abl/genetics
- Humans
- Imidazoles/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Mutation
- Pyridazines/therapeutic use
- Sarcoma, Myeloid/genetics
- Sarcoma, Myeloid/therapy
- Stem Cell Transplantation/methods
- Transplantation, Homologous
- Treatment Outcome
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Abstract
RATIONALE Primary granulocytic sarcoma of the breast is a rare and poor-prognosis malignancy. Clinicians do not have sufficient knowledge of this disease and often misdirect it as other soft tissue sarcomas or inflammation. PATIENT CONCERNS A 42-year-old female presented with a self-discovered asymptomatic growing and palpable right breast mass that had been present for 4 months. DIAGNOSES The patient was diagnosed as primary myeloid sarcoma. INTERVENTIONS The patient received modified radical mastectomy in the right breast and sentinel lymph node biopsy. Pathological diagnosis is primary granulocytic sarcoma. Then the patient accepted acute myeloid leukemia-induction chemotherapy. OUTCOMES The follow-up of this patient has no evidence of disease progression or spread during 1 year. LESSONS Granulocytic sarcoma in the breast tissue is rare. But it still should be considered in the differential diagnosis of any tumor in the breast. The present study discusses comprehensively the clinical and pathological characteristics to improve the understanding of myeloid sarcoma.
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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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Myeloid Sarcoma: Presentation, Diagnosis, and Treatment. CLINICAL LYMPHOMA, MYELOMA & 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] [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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Long-Term Remission following Autologous Hematopoietic Cell Transplantation in a Patient with Multiple Nonleukemic Myeloid Sarcoma and a Review of the Literature. Acta Haematol 2017; 137:117-122. [PMID: 28301836 DOI: 10.1159/000455998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/09/2017] [Indexed: 12/18/2022]
Abstract
Multiple nonleukemic myeloid sarcoma (MS) is a rare form of MS that is developed in multiple anatomic sites other than bone marrow at diagnosis, without a preceding myeloid neoplasm. The prevalence, prognosis, and optimal management of multiple nonleukemic MS have not been addressed. The role of allogenic or autologous hematopoietic cell transplantation (HCT) for nonleukemic MS is also less well defined. We present a case of MS characterized by systemic lymphadenopathies and multiple effusions, which presumably had a very poor prognosis. The patient was treated with acute myeloid leukemia-type induction chemotherapy and autologous peripheral blood stem cell transplantation, and, unexpectedly, she has remained disease free for more than 6 years. We also reviewed the literature on this rare disease, and found that multiple nonleukemic MS was associated with younger age and a worse prognosis when compared with the overall nonleukemic MS population. We suggest that autologous HCT represents a valid option for young patients with chemosensitive disease and should be performed at the status of minimal residual disease-negative complete remission.
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Management of Hard Palatine Fistula Caused by Granulocytic Sarcoma: Case Report. Gulf J Oncolog 2017; 1:72-76. [PMID: 28272007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2016] [Indexed: 06/06/2023]
Abstract
Granulocytic Sarcoma (GS) is a rare condition with a wide list of differential diagnosis and debatable guidelines of treatment in different cancer centers. Most of literature recommended systemic chemotherapy with or without radiation therapy and small role of surgery. One of the rarest sites for myeloid sarcoma is hard palate, which usually worsen the quality of life of the patient due to difficulty in feeding, drinking and speaking. We are reporting a case of hard palatine fistula caused by granulocytic sarcoma, in which we tried to get local control of disease with 3 dimension conformal radiation therapy 3DCRT and surgery with systemic control with chemotherapy using recommendation of multidisciplinary team and targeting mainly patient quality of life.
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15
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Primary Myeloid Sarcoma of the Small Intestine: Case Report and Literature Review. CONNECTICUT MEDICINE 2016; 80:349-352. [PMID: 27509642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Primary myeloid sarcoma is a rare extramedullary manifestation of acute myeloid leukemia (AML). Typically, myeloid sarcoma presents after a diagnosis of AML or other myeloproliferative disorder. However, primary myeloid sarcoma may present without any preexisting condition, thereby making it extremely difficult to diagnose. We discuss a case of a 22-year-old female who was misdiagnosed initially with acute appendicitis and underwent an appendectomy. Postoperatively, she continued to be symptomatic and eventually developed small bowel obstruction. Diagnostic laparoscopy revealed multiple small bowel masses as well as diffuse abdominal and pelvic lymphadenopathy. After extensive pathological review and additional workup consisting of immunohistochemistry and molecular studies, the correct diagnosis of myeloid sarcoma was made. This review will discuss the presentation, diagnosis, management, and prognosis of primary myeloid sarcoma.
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Myeloid sarcoma of the breast in an aleukemic patient: a rare entity in an uncommon location. THE MALAYSIAN JOURNAL OF PATHOLOGY 2015; 37:63-66. [PMID: 25890617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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Pelvic lesion in a female patient--seventeen years later after thymectomy for myasthenia gravis. BULLETIN OF THE HOSPITAL FOR JOINT DISEASE (2013) 2014; 72:189-192. [PMID: 25150351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Granulocytic sarcoma of pediatric head and neck: an institutional experience. Int J Pediatr Otorhinolaryngol 2013; 77:1364-6. [PMID: 23810551 DOI: 10.1016/j.ijporl.2013.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 06/02/2013] [Accepted: 06/04/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To demonstrate a case series of granulocytic sarcoma of the head and neck found in the pediatric population and review long-term outcomes. METHODS A pathology database at a tertiary hospital was searched for patients with biopsy specimens from the head and neck diagnosed as granulocytic sarcoma. RESULTS There were 6 cases between 1992 and 2004 that met inclusion criteria. Subjects' age ranged from 22 months to 14 years old. In three cases, the patients were diagnosed with acute myeloid leukemia (AML) based on biopsy results; 2 patients were already diagnosed with AML when diagnosed with granulocytic sarcoma, and in 1 case, a relapse of AML was diagnosed. In all cases, patients began induction chemotherapy. Two patients died during induction chemotherapy from infection. The remaining 4 patients underwent bone marrow transplants. One patient had a relapse post-transplant and died. Only one patient was healthy two years post-transplant. CONCLUSION The results of this series suggest granulocytic sarcoma must be on the differential when tumors present in the head and neck region in pediatric patients. In our series, 100% of the patients with granulocytic sarcoma had underlying AML. The long-term prognosis of patients with AML who developed granulocytic sarcoma is quite poor.
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Mediastinal granulocytic sarcoma: poor risk AML? JOURNAL OF THE INDIAN MEDICAL ASSOCIATION 2013; 111:562. [PMID: 24783400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Granulocytic sarcoma (GS), a rare extramedullary manifestation of acute myeloid leukaemia (AML) has been frequently reported in the skin, orbits, gingiva, maxilla and lymph nodes. GS in the mediastinum is often mistaken as lymphoblastic lymphoma or mediastinal germ cell tumour. We presented here three cases of AML with normal cytogenetics who presented with mediastinal masses with superior vena caval (SVC) syndrome. All the three cases summarised in this write-up, received standard AML therapy but had, poor outcome.
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Successful treatment of duodenal myeloid sarcoma with allogeneic bone marrow transplantation and additional radiotherapy. Intern Med 2012; 51:769-72. [PMID: 22466836 DOI: 10.2169/internalmedicine.51.6652] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Myeloid sarcoma (MS) is a tumor consisting of myeloid blasts that occurs at an anatomical site other than the bone marrow. We report the case of a 38-year-old man with duodenal MS who underwent an allogeneic bone marrow transplant in a non-complete remission (CR) state. After the transplant, residual disease was suspected on a fluorodeoxyglucose positron emission tomography (FDG-PET)/CT scan, and additional radiotherapy resulted in CR, which has been maintained for 21 months. FDG-PET/CT scanning is useful for evaluating residual myeloid sarcoma during the peritransplant period.
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Allogeneic hematopoietic stem cell transplantation for isolated and leukemic myeloid sarcoma in adults: a report from the Acute Leukemia Working Party of the European group for Blood and Marrow Transplantation. Haematologica 2011; 96:1391-4. [PMID: 21685467 DOI: 10.3324/haematol.2011.041418] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Donor cell leukemia following unrelated donor bone marrow transplantation for primary granulocytic sarcoma of the small intestine. Am J Hematol 2011; 86:315-8. [PMID: 21328426 DOI: 10.1002/ajh.21938] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Isolated mediastinal myeloid sarcoma successfully treated with chemoradiotherapy followed by unrelated allogeneic stem cell transplantation. Intern Med 2011; 50:3003-7. [PMID: 22185993 DOI: 10.2169/internalmedicine.50.6125] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 22-year-old man was diagnosed with isolated mediastinal myeloid sarcoma which radiologically mimicked primary mediastinal lymphoma. Despite administration of standard remission induction chemotherapy with daunorubicin and cytarabine, and three cycles of intensive high-dose cytarabine-based consolidation, chemo-resistant hypermetabolic lesions were persistently detected in the highest mediastinum and in the supraclavicular area. However, complete remission and long-term survival were achieved by curative radiotherapy followed by unrelated allogeneic stem cell transplantation.
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Primary granulocytic sarcoma of the breast: a case report and review of the literature. EUR J GYNAECOL ONCOL 2011; 32:435-438. [PMID: 21941971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Primary granulocytic sarcoma is an uncommon entity that rarely presents in the breast. It is frequently misdiagnosed as carcinoma or lymphoma and a broad panel of immunohistochemical markers including epithelial and haematological markers are essential for an accurate diagnosis. We reviewed all the cases of granulocytic sarcoma reported in the English literature since 1970 and present a new case of granulocytic sarcoma of the breast. Systemic chemotherapy for acute myeloid leukemia (AML) appears to be superior to surgery or radiotherapy. Granulocytic sarcoma should be in the pathologic differential diagnosis of a breast mass.
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Cardiac chloroma: novel presentation and subsequent diagnosis with cardiac magnetic resonance imaging. Tex Heart Inst J 2010; 37:242-243. [PMID: 20401306 PMCID: PMC2851436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Abstract
The breast continues to be reported as a site of resistant leukemia despite current curative protocols. To characterize disease behavior and potential for lengthy survival after breast relapse, a study was undertaken of 153 cases reported between 1969 and 2005. Authors were contacted for follow-up. There were 105 AML and 48 ALL cases identified. Ninety percent of female patients were younger than 50 and leukemia was temporally related to pregnancy in 13. Eight cases were males. Remissions were typically of short duration, principally due to further extramedullary relapses, in 3 main sites in both AML and ALL: contralateral breast, gynecologic organs, and CNS. However, there are cases of disease-free survival up to 26+ years after intensive treatment. Leukemia growing in the breast may follow a distinctive pattern, and prompt initiation of intensive multi-cycle treatment, assuming occult site involvement, with consideration of CSF prophylaxis, should increase the potential for disease eradication.
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Myeloid (granulocytic) sarcoma of epididymis as rare manifestation of recurrent acute myelogenous leukemia. Urology 2008; 73:1163.e1-3. [PMID: 18602141 DOI: 10.1016/j.urology.2008.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 04/01/2008] [Accepted: 04/08/2008] [Indexed: 11/19/2022]
Abstract
Myeloid sarcoma involving the genitourinary system is a rare complication associated with acute myelogenous leukemia or other myeloproliferative disorders. The diagnosis is made by pathologic findings of diffuse infiltration of intermediate-size neoplastic cells and fibrosis of the affected organ. Immunohistochemically, the cells stain positive for myeloperoxidase, CD45, and CD117 but negative for CD34. Treatment involves local surgical extirpation, radiotherapy, and chemotherapy. We report the second known case of myeloid sarcoma involving the epididymis in a patient with a history of acute myelogenous leukemia.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy, Needle
- Bone Marrow Transplantation/methods
- Combined Modality Therapy
- Diagnosis, Differential
- Epididymis/pathology
- Humans
- Immunohistochemistry
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Neoplasm Staging
- Recurrence
- Risk Assessment
- Sarcoma, Myeloid/diagnosis
- Sarcoma, Myeloid/pathology
- Sarcoma, Myeloid/therapy
- Testicular Neoplasms/diagnosis
- Testicular Neoplasms/pathology
- Testicular Neoplasms/therapy
- Transplantation, Homologous
- Treatment Outcome
- Ultrasonography, Doppler
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29
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[From chloroma to acute promyelocytic leukemia--a historical perspective]. VNITRNI LEKARSTVI 2008; 54:686-700. [PMID: 18780570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The progressing knowledge on chloroma and chloroleukemia is reviewed. However, it is uneasy to identify with certainty the cases of acute promyelocytic leukemia (APL) among the historical descriptions ofchloroma since 1823. In part, this is due to confusion produced by the historical cytological nomenclature--in practice, the leukemic promyelocytes were regarded, quite inaccurately, as a subtype of paramyeloblasts until early 1960's. The term promyelocytic leukemia first appeared in Naegeli's text-book in 1931. However, no clinical associations of the morphological description were then given. As a clinico-pathological entity, APLwas defined by Hillestad in Norway in 1957 and on a more detailed level, by Bernard et al in France in 1959. However, the descriptions of chloroma by Butterfield in 1909 and of leukemia with panmyelophthisis and defibrination by Risak in 1935 in the German-written literature and the case of chloroma described by Libánský in Czech in 1939 were cases of APL with high probability. Further on, experimental studies leading to the postulation of possible differentiation-inducing therapy of leukemia are reviewed--the importance of introducing of clonal culture of hematopoietic cells in the 1960's and the proof of the possibility of bypassing the maturation block in the works of Sachs's group in Rehovot, Israel, is stressed, as well as the later experiments with differentiation inducers in the cell line models in the 1970's and 1980's. The first trials with retinoids in therapy of APL are mentioned, along with the interesting background of the French-Chinese collaboration (under the auspices of professors Degos and Wang) in the introduction of retinoids into practice in the second half of the 1980's. It is discussed how the success of the clinical trials led to enormous progression in the field of molecular genetics of APL, which, in turn, led to development of a new generation of remedies, i.e. to the renaissance of arsenic in the treatment of APL in the 1990's, among others thanks to the current Chinese minister of health, Chen Zhu.
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MESH Headings
- History, 19th Century
- History, 20th Century
- History, 21st Century
- Humans
- Leukemia, Promyelocytic, Acute/diagnosis
- Leukemia, Promyelocytic, Acute/history
- Leukemia, Promyelocytic, Acute/therapy
- Sarcoma, Myeloid/diagnosis
- Sarcoma, Myeloid/history
- Sarcoma, Myeloid/therapy
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30
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Orbital tumour as initial manifestation of acute myeloid leukemia: granulocytic sarcoma: case report. Pathol Oncol Res 2008; 14:209-11. [PMID: 18431695 DOI: 10.1007/s12253-008-9028-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Accepted: 03/05/2008] [Indexed: 12/13/2022]
Abstract
We report orbital involvement as an initial manifestation of acute myeloid leukemia in a 57-year-old woman. The patient presented with painful proptosis and limited ocular motility. Orbital computed tomography revealed bilateral homogeneous masses. Orbital biopsy was performed on the right side; and histopathology disclosed a myelocytic tumour. Despite treatment using irradiation and chemotherapy, the patient died eleven months after presentation. There appear to be only a few previous reports of acute myeloid leukemia cases presenting with orbital involvement, and most cases occurred in children. This very rare condition has a poor survival prognosis, even with radiation treatment and chemotherapy.
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MESH Headings
- Acute Disease
- Diagnosis, Differential
- Exophthalmos/etiology
- Fatal Outcome
- Female
- Humans
- Immunohistochemistry
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/therapy
- Middle Aged
- Orbital Neoplasms/diagnosis
- Orbital Neoplasms/therapy
- Prognosis
- Sarcoma, Myeloid/diagnosis
- Sarcoma, Myeloid/therapy
- Tomography, X-Ray Computed
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31
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Precursor B lymphoblastic leukemia 32 months after local therapy for a primary extramedullary myeloid cell tumor. Pediatr Blood Cancer 2007; 49:1039-46. [PMID: 16572408 DOI: 10.1002/pbc.20789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A primary extramedullary myeloid cell tumor (pEMT) of an inguinal lymph node was completely excised without subsequent anti-tumor therapy in a 6-year-old child. Clinical observation and monitoring of blood and bone marrow (BM) did not reveal any pathologic results before 32 months, when a precursor B lymphoblastic leukemia was diagnosed. Identical T-cell receptor gamma rearrangement in nodal pEMT and in precursor B lymphoblastic leukemia in BM indicates a clonal relationship of these two tumors.
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MESH Headings
- Acute Disease
- Antigens, Neoplasm/biosynthesis
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/biosynthesis
- Bone Marrow/pathology
- Child
- Cytogenetic Analysis
- Female
- Flow Cytometry
- Follow-Up Studies
- Humans
- Immunophenotyping
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/immunology
- Neoplasms, Second Primary/therapy
- Polymerase Chain Reaction/methods
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/diagnosis
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Receptors, Antigen, T-Cell, gamma-delta/biosynthesis
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Remission Induction
- Sarcoma, Myeloid/diagnosis
- Sarcoma, Myeloid/immunology
- Sarcoma, Myeloid/therapy
- Time Factors
- Treatment Outcome
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32
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Abstract
Myeloid sarcoma is an unusual manifestation of acute leukemia. These leukemic tumors have been described in multiple organ systems. Leukemia is almost always present, but may be undiagnosed when the myeloid sarcoma comes to medical attention. We present a clinicopathologic report of a previously healthy young woman with conjunctival myeloid sarcomas of all 4 eyelids without evidence of an underlying hematologic disorder over 15 months' follow-up, despite refusal of consolidation chemotherapy. Isolated, multifocal myeloid sarcoma of the periorbital region is a very rare manifestation of acute leukemia.
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MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Combined Modality Therapy
- Conjunctival Neoplasms/chemistry
- Conjunctival Neoplasms/pathology
- Conjunctival Neoplasms/therapy
- Eyelid Neoplasms/chemistry
- Eyelid Neoplasms/pathology
- Eyelid Neoplasms/therapy
- Female
- Humans
- Leukemia, Monocytic, Acute/metabolism
- Leukemia, Monocytic, Acute/pathology
- Leukemia, Monocytic, Acute/therapy
- Sarcoma, Myeloid/metabolism
- Sarcoma, Myeloid/pathology
- Sarcoma, Myeloid/therapy
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33
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Long-term remission of extramedullary relapse from acute promyelocytic leukemia after treatment with arsenic trioxide, intrathecal chemotherapy, and brain irradiation. CLINICAL ADVANCES IN HEMATOLOGY & ONCOLOGY : H&O 2007; 5:320-3; discussion 323-4. [PMID: 17607291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Arsenic Trioxide
- Arsenicals/administration & dosage
- Cranial Irradiation
- Daunorubicin/administration & dosage
- Ear Neoplasms/cerebrospinal fluid
- Ear Neoplasms/diagnostic imaging
- Ear Neoplasms/genetics
- Ear Neoplasms/secondary
- Ear Neoplasms/therapy
- Humans
- Injections, Spinal
- Leukemia, Myelomonocytic, Acute/complications
- Leukemia, Myelomonocytic, Acute/diagnosis
- Leukemia, Myelomonocytic, Acute/drug therapy
- Leukemia, Myelomonocytic, Acute/genetics
- Leukemia, Myelomonocytic, Acute/pathology
- Male
- Oxides/administration & dosage
- Radiography
- Remission Induction
- Sarcoma, Myeloid/cerebrospinal fluid
- Sarcoma, Myeloid/diagnostic imaging
- Sarcoma, Myeloid/etiology
- Sarcoma, Myeloid/genetics
- Sarcoma, Myeloid/therapy
- Tretinoin/administration & dosage
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34
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Myeloid sarcoma presenting as an isolated nodule in a patient with acute myelogenous leukemia. J Drugs Dermatol 2007; 6:447-50. [PMID: 17668545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
We report a case of an elderly female in remission from acute myelogenous leukemia that presented with a nonhealing enlarging asymptomatic nodule on her right thigh. A wide excision of the nodule and histological examination revealed myeloid sarcoma without evidence or overlap of leukemia cutis, which had been suspected from nodules that had developed early in the course of the disease. The patient subsequently underwent radiation therapy to the area with sustained clearance.
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35
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36
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Acute myeloid leukaemia presenting with mediastinal myeloid sarcoma: report of three cases and review of literature. Leuk Lymphoma 2007; 48:290-4. [PMID: 17325888 DOI: 10.1080/10428190601059803] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although myeloid sarcomas (MS) are frequently associated with acute myeloid leukaemia (AML), the occurrence of mediastinal MS is a much rarer event. The authors describe a distinct group of three AML patients with mediastinal MS and complex cytogenetics presenting at their centre over a 7-year period. Clinical features consistent with superior vena caval obstruction were noted at presentation in two of the three patients. Mediastinal mass was detected on routine chest radiography, and biopsies confirmed the diagnosis of MS. One patient relapsed after consolidation chemotherapy and died from progressive disease. Two patients underwent allogeneic haemopoietic stem cell transplant, but succumbed to transplant related complications. Review of mediastinal MS over the last 20 years shows that a significant proportion of patients have complex cytogenetic abnormalities and a poor long-term prognosis. Early and accurate diagnosis is essential and patients should be managed along the lines of high risk AML.
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MESH Headings
- Adult
- Chromosome Aberrations
- Female
- Humans
- Leukemia, Monocytic, Acute/diagnosis
- Leukemia, Monocytic, Acute/genetics
- Leukemia, Monocytic, Acute/therapy
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/therapy
- Male
- Mediastinal Neoplasms/diagnosis
- Mediastinal Neoplasms/genetics
- Mediastinal Neoplasms/therapy
- Neoplasms, Second Primary/diagnosis
- Sarcoma, Myeloid/diagnosis
- Sarcoma, Myeloid/genetics
- Sarcoma, Myeloid/therapy
- Superior Vena Cava Syndrome/pathology
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37
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How can we help patients with refractory chronic graft versus host disease- single centre experience. Neoplasma 2007; 54:431-6. [PMID: 17688373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Chronic graft-versus-host disease (cGVHD) is a major cause of morbidity and mortality in long-term survivors of allogeneic haematopoietic stem cell transplantation (alloHSCT). Ocular involvement as well as dermal sclerosis, joint contractures and pathological changes in oral cavity are often refractory to treatment. This kind of patients require complex aggressive immunosuppressive therapy. We are still waiting for drugs against cGVHD, characterized by decreased infectious complications, encouraging efficacy and rare and reversible side effects. We describe eight patients who developed extensive chronic graft versus host disease with eye involvement after alloHSCT. All had ocular manifestations, which were refractory to the first and second line of systemic immunosuppressive therapy. All patients responded to the topical cyclosporine therapy, but clinical improvement was seen only since the fifth month of starting treatment. Topical cyclosporine was well tolerated. Other four patients with sclerodermoid type of skin changes, refractory to second line systemic immunosuppressive therapy, were treated with clofazimine. Clofazimine is a drug used to treat leprosy. Because of its anti-inflammatory effects, clofazimine is used also as a second or third line therapy for various skin disorders including: pyoderma gangrenosum, lupus erythematosus, palmoplantar pustulosis and chronic graft versus host disease. All patients,who received clofazimine due to dermal sclerosis, joint contractures and oral manifestations, achieved partial or complete responses and were able to reduce other immunosuppressive drugs. Clofazimine was generally well tolerated.
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38
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Abstract
A 59-year-old woman was diagnosed with essential thrombocythemia in 1988 and had been treated with hydroxyurea, mitobronitol, busulfan, and ranimustine, in that order. Hepatosplenomegaly, low-grade fever, and body weight loss manifested, and a few blasts were noted in the peripheral blood studied in March 2002. A biopsied specimen of the bone marrow showed myelofibrosis but not a leukemia in August 2004. An abnormal karyotype with der(1; 13) appeared for the first time. She was treated with low-dose prednisolone. In January 2005, she experienced left hip joint pain, and magnetic resonance scanning showed a tumoral lesion in the femoral head. Histological diagnosis of the biopsied mass revealed that it was a granulocytic sarcoma, and radiotherapy was performed. In April 2005, bone scintigraphy showed multiple lesions. She became febrile and red blood cell transfusion-dependent with hepatosplenomegaly and a small number of circulating blasts. Intravenous cytarabine (low dose) and etoposide relieved the fever and hepatosplenomegaly; however, she developed a pathologic fracture of the right humerus. An additional karyotypic abnormality (7q22 deletion) was noted. She subsequently died of infection. Granulocytic sarcoma is very rare in essential thrombocythemia, and this patient may be the first reported case of essential thrombocythemia that developed multiple lesions and a pathologic fracture without transformation to overt leukemia.
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39
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Abstract
Granulocytic sarcoma is an extramedullary tumor of myeloblasts and/or immature myeloid cells, which can develop at any anatomic site and is often a forerunner to the development of acute myelogenous leukemia. Granulocytic sarcoma of the gastrointestinal tract most frequently involves the small intestine and most often presents with abdominal pain and obstruction. Pathologists must consider granulocytic sarcoma in any mass of unknown origin with a diffusely infiltrating population of tumor cells, as the diagnosis is often initially unrecognized, especially in nonleukemic patients. Multiple ancillary modalities are available to assist pathologists in making the correct diagnosis so that appropriate therapy can be initiated.
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40
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Recurrent extramedullary relapse of acute promyelocytic leukemia after allogeneic stem cell transplantation: successful treatment by arsenic trioxide in combination with local radiotherapy. Int J Hematol 2006; 83:337-40. [PMID: 16757435 DOI: 10.1532/ijh97.05167] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Isolated extramedullary relapse is rare in patients with acute promyelocytic leukemia (APL) after allogeneic stem cell transplantation (SCT), and an optimal therapy for it has not been established. We describe a patient with APL who developed serially occurring extramedullary disease (EMD) after SCT. We confirmed that EMD had arisen from the recipient's APL blasts by detecting t(15;17) and PML/RARalpha from the tumor cell suspension. The patient displayed EMD 4 times at different sites. Administration of all-trans retinoic acid with local radiotherapy and with chemotherapy for the first to third EMDs resulted in regression of the tumors. However, these regimens did not prevent the subsequent occurrence of new EMD. For the fourth EMD, intravenous administration of arsenic trioxide followed by local radiotherapy resulted in the disappearance of EMD, and no further EMD has developed to date. In the present case, the bone marrow was in morphologic and molecular remission during the course of recurrent EMD. The accumulation of detailed cases is needed to elucidate the pathogenesis, predisposing factors, and optimal therapy for EMD in APL after SCT.
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MESH Headings
- Antineoplastic Agents/administration & dosage
- Arsenic Trioxide
- Arsenicals/administration & dosage
- Chromosomes, Human, Pair 15/genetics
- Chromosomes, Human, Pair 17/genetics
- Combined Modality Therapy
- Female
- Humans
- Leukemia, Promyelocytic, Acute/diagnostic imaging
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/therapy
- Middle Aged
- Neoplasm Proteins/genetics
- Oncogene Proteins, Fusion/genetics
- Oxides/administration & dosage
- Radiography
- Recurrence
- Remission Induction
- Sarcoma, Myeloid/diagnostic imaging
- Sarcoma, Myeloid/genetics
- Sarcoma, Myeloid/therapy
- Stem Cell Transplantation/adverse effects
- Translocation, Genetic/genetics
- Transplantation, Homologous
- Tretinoin/administration & dosage
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41
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Abstract
Pre-leukemic granulocytic sarcoma (GS) may pose an initial diagnostic problem and its therapeutic approach has never been formally established. To our knowledge, non-myeloablative stem cell transplantation has been reported in cases of leukemic GS, but not in primary GS. We report a case of primary GS with extensive and aggressive presenting features and successfully treated with intensive chemotherapy followed by non-myeloablative allogeneic stem cell transplant. This resulted in complete remission with minimal complications. Our case demonstrates the potential of graft-vs.-tumour effect in the treatment of GS and suggests that non-myeloablative allogeneic stem cell transplant may be a feasible therapeutic approach for primary GS.
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42
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Granulocytic sarcoma giant in chronic myeloid leukemia during imatinib mesylate therapy. Am J Hematol 2006; 81:76-7. [PMID: 16369975 DOI: 10.1002/ajh.20451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
MESH Headings
- Adult
- Antineoplastic Agents/administration & dosage
- Benzamides
- Combined Modality Therapy
- Fatal Outcome
- Female
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnostic imaging
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Neoplasms, Second Primary/blood
- Neoplasms, Second Primary/diagnostic imaging
- Neoplasms, Second Primary/therapy
- Piperazines/administration & dosage
- Pyrimidines/administration & dosage
- Radiography
- Sarcoma, Myeloid/diagnostic imaging
- Sarcoma, Myeloid/therapy
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43
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Abstract
Orbital granulocytic sarcoma is a localized tumor consisting of malignant cells of myeloid origin. This tumor may present in association with acute myelogenous leukemia. Granulocytic sarcoma may be found in a variety of locations throughout the body including the orbit and typically affects children and young adults. There is a slight male predominance in these cases. This is an uncommon case report of a 33-year-old Latin-American woman who was admitted to the Hospital for rapidly progressive orbital proptosis. There was no systemic manifestation of leukemia. The occurrence of orbital granulocytic sarcoma before the development of systemic leukemia in children and young adults is not uncommon and these cases frequently develop hematological evidence within 2 months after initial orbital disease. In this case report, there was no systemic manifestation of leukemia in the last 30 months, even in the presence of orbital tumors. Granulocytic sarcoma is most frequently confused with malignant lymphoma, rhabdomyosarcoma and neuroblastoma. The differential diagnosis of these cases can be challenging, particularly when there is no evidence of systemic leukemia, when imaging features are not sufficiently specific to distinguish granulocytic neoplasms from other tumors. To establish the diagnosis often a biopsy is required. The treatment in such cases (orbital granulocytic sarcoma) is not standardized. Orbital granulocytic sarcoma may be suspected in cases of orbital tumors even in the absence of systemic manifestations of leukemia at any age.
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Abstract
CONTEXT Myeloid sarcoma is a neoplasm of immature myeloid cells involving an extramedullary anatomic site that is usually, although not always, associated with acute myeloid leukemia. Any extramedullary site can be involved by myeloid sarcoma, but involvement of the cecal appendix is uncommon, and symptoms mimicking acute appendicitis as a result of appendiceal involvement are rare. OBJECTIVE To describe the clinicopathologic features of 2 patients with myeloid sarcoma involving the appendix who presented with right lower quadrant pain suggestive of acute appendicitis and prompting appendectomy. DESIGN Clinical information for both patients was obtained from the medical record. Routine hematoxylin-eosin-stained slides, naphthol-ASD-chloroacetate stain, and immunohistochemical stains for myeloid, B-cell, and T-cell antigens were prepared. RESULTS Peripheral blood and bone marrow were infiltrated by coexistent acute myeloid leukemia in case 1 but were negative for leukemia in case 2. In case 2, the patient had a history of acute myeloid leukemia that had been treated by an allogenic bone marrow transplant 7 months earlier. Histologic examination of the appendix revealed poorly differentiated myeloid sarcoma in both cases. Each neoplasm was positive for chloroacetate esterase, myeloperoxidase, lysozyme, and CD43 and was negative for CD3 and CD20. CONCLUSIONS Myeloid sarcoma involving the appendix can rarely cause pain or other symptoms mimicking acute appendicitis. A high index of suspicion combined with the use of cytochemical and immunohistochemical studies are helpful in establishing the diagnosis.
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Sino-orbital chloroma presenting as unilateral proptosis in a boy. Int J Pediatr Otorhinolaryngol 2005; 69:1595-8. [PMID: 15939484 DOI: 10.1016/j.ijporl.2005.03.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Accepted: 03/26/2005] [Indexed: 11/23/2022]
Abstract
Granulocytic sarcoma or chloroma is an unusual localized tumor composed of cells of myeloid origin. Involvement of the orbit and the ethmoid sinuses and presenting as proptosis is rare. Diagnosis could be difficult and delayed when there are no other systemic manifestations, especially with normal peripheral blood and bone marrow picture. We present one such case with unilateral proptosis as the sole presenting sign that posed a diagnostic challenge to us. Orbital decompression by an otolaryngologist may have a role in managing such a case.
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46
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The Application of Molecular Analyses for Primary Granulocytic Sarcoma with a Specific Chromosomal Translocation. Int J Hematol 2005; 82:210-4. [PMID: 16207593 DOI: 10.1532/ijh97.04151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary granulocytic sarcoma (GS) is a rare disease defined by the absence of antecedent or concomitant leukemic cells in the bone marrow and the peripheral blood. Immunohistochemical staining for myeloperoxidase is necessary for a definite diagnosis. Otherwise, primary GS is often misdiagnosed as a malignant lymphoma or other malignancies. Primary GS is well known to frequently develop into acute myeloid leukemia (AML). Here we describe a 28-year-old woman with primary GS manifesting as an epidural tumor in the sacral region accompanied by meningeal dissemination. Fluorescence in situ hybridization analysis detected the AML1/MTG8 fusion gene in neoplastic cells obtained from her cerebrospinal fluid specimen and the epidural mass. The AML1/MTG8 fusion gene transcript was also detected by a nested reverse transcriptase-polymerase chain reaction analysis of mononuclear cells from the bone marrow, although leukemic cells were not recognized in a microscopical examination of the patient's bone marrow. Systemic chemotherapy with high-dose cytarabine followed by local radiotherapy was performed, and the patient clinically achieved a complete response. These molecular analyses provide a precise method of diagnosis, especially with respect to the French-American-British AML classification, according to the characteristic karyotypic alterations, and a patient consequently can quickly be given appropriate systemic chemotherapy as induction therapy.
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MESH Headings
- Adult
- Antimetabolites, Antineoplastic/administration & dosage
- Chromosomes, Human, Pair 21/genetics
- Chromosomes, Human, Pair 8/genetics
- Combined Modality Therapy
- Core Binding Factor Alpha 2 Subunit/genetics
- Cytarabine/administration & dosage
- DNA Mutational Analysis
- Female
- Hemibody Irradiation
- Humans
- Oncogene Proteins, Fusion/genetics
- RUNX1 Translocation Partner 1 Protein
- Sarcoma, Myeloid/genetics
- Sarcoma, Myeloid/pathology
- Sarcoma, Myeloid/therapy
- Spinal Neoplasms/genetics
- Spinal Neoplasms/pathology
- Spinal Neoplasms/therapy
- Translocation, Genetic
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47
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Abstract
Granulocytic sarcoma is an extramedullary collection of myeloblasts that is usually associated with acute or chronic myeloid leukemia. It can be found in any location throughout the body; however, multifocal skeletal involvement is extremely rare. This report describes a case of granulocytic sarcoma in a 33-year-old man, manifesting as multiple skeletal lesions along with signs of cord compression without any preceding history of myeloid leukemia. Cytogenetic studies revealed t(8,9) translocation, which has never been reported in association with granulocytic sarcoma. The prognostic significance of this finding is unknown. This case report underscores the importance of considering granulocytic sarcoma in the differential diagnosis of spinal tumors, since the tumor may occur before other manifestations of myeloid leukemia are evident.
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48
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Acute myeloid leukemia with concurrent myeloid sarcoma treated with autologous bone marrow transplantation: two illustrative cases and a literature review. Hematol Oncol 2005; 23:133-5. [PMID: 16273593 DOI: 10.1002/hon.759] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Myeloid sarcoma (MS) is an invasive extramedullary solid tumor composed of immature cells of the myeloid series. It complicates the clinical course of a minority of patients with acute myeloid leukemia (AML). Traditionally its presence has been regarded as an indicator of aggressive disease. Currently, the optimal treatment of AML with concurrent MS remains to be determined. We report two cases of autologous bone marrow transplantation (auto-BMT) for AML with concurrent MS followed by a review of the literature.
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49
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50
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Granulocytic sarcoma of the small bowel causing intestinal obstruction. Hong Kong Med J 2005; 11:204-6. [PMID: 15951586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Granulocytic sarcomas of the small bowel are rare. They are discrete tumours of leukaemic myeloblasts and partially matured granulocytes that form in any part of the body. This disease is infrequently seen in patients with acute myeloid leukaemia, and rarely seen in patients without leukaemia. Here we report a case of small bowel obstruction due to granulocytic sarcoma of mid-ileum in a non-leukaemic patient. We also review the literature on treatment and prognosis of this condition.
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