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Li Y, Xie YD, He SJ, Hu JM, Li ZS, Qu SH. Breast and dorsal spine relapse of granulocytic sarcoma after allogeneic stem cell transplantation for acute myelomonocytic leukemia: A case report. World J Clin Cases 2022; 10:2315-2321. [PMID: 35321182 PMCID: PMC8895194 DOI: 10.12998/wjcc.v10.i7.2315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 10/30/2021] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Granulocytic sarcoma (GS) is a rare malignant tumor, and relapse is even rarer in the breast and dorsal spine following allogeneic hematopoietic stem cell transplantation. Currently, a standard treatment regimen is not available.
CASE SUMMARY A rare case of GS of the right breast and dorsal spine after complete remission of acute myelogenous leukemia is reported here. A 55-year-old female patient presented with a palpable, growing, painless lump as well as worsening dorsal compressive myelopathy. She had a history of acute myelomonocytic leukemia (AML M4) and achieved complete remission after chemotherapy following allogeneic hematopoietic stem cell transplantation. Imaging examinations showed the breast lump and C7-T1 epidural masses suspected of malignancy. Histologic results were compatible with GS in both the right breast and dorsal spine, which were considered extramedullary relapse of the AML treated 4 years earlier.
CONCLUSION A rare case of GS relapse following allogeneic hematopoietic stem cell transplantation and guidelines for treatment are discussed.
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Affiliation(s)
- Yuan Li
- Department of Breast Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510630, Guangdong Province, China
| | - Yu-De Xie
- Department of Breast Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510630, Guangdong Province, China
| | - Shao-Jie He
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou 510630, Guangdong Province, China
| | - Jia-Mei Hu
- Department of Breast Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510630, Guangdong Province, China
| | - Zhi-Sheng Li
- Department of Breast Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510630, Guangdong Province, China
| | - Shao-Hua Qu
- Department of Breast Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510630, Guangdong Province, China
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Khemaphiphat P, Wudhikarn K, Bunworasate U, Chanswangphuwana C. Isolated Extramedullary Relapse After Human Leukocyte Antigen-Matched Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation in Acute Myeloid Leukemia Patients: Case Reports and Literature Review. Transplant Proc 2021; 53:2029-2034. [PMID: 33962773 DOI: 10.1016/j.transproceed.2021.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
Isolated extramedullary relapse (iEMR) of acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare and has a dismal prognosis. Among 67 patients with AML after allo-HSCT, iEMR and bone marrow relapse occurred in 6% and 20.9%, respectively, with a median time to relapse of 11.5 and 6.5 months, respectively. Here, we presented 4 iEMR-AML cases. Common relapse locations occurred in the central nervous system, skin, and lymph nodes. We also report a rare case of cardiac iEMR that responded to chemoradiotherapy. Two cases responded to local/systemic treatments, which resulted in prolonged survival. Another case had iEMR in the presence of chronic graft-versus-host disease. Bone marrow relapse occurring after iEMR was typical and found in three-fourths of the cases. In conclusion, iEMR-AML occurrence after allo-HSCT is not rare in Thai patients. Its unpredictability and lack of graft-versus-leukemia effect highlight the importance of monitoring EMR carefully and promptly providing treatments once it is detected.
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Affiliation(s)
- Photsawee Khemaphiphat
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Kitsada Wudhikarn
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Udomsak Bunworasate
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Chantiya Chanswangphuwana
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand.
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3
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Granulocytic sarcoma: Extramedullary manifestation of chronic myeloproliferative neoplasm in a young African woman. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2020.200462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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4
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Zanetti C, Inciardi RM, Benedetti F, Rossi A. Right Cardiac Chambers' Involvement as the First Manifestation of Recurrent Complex Karyotype Acute Myeloid Leukemia. J Cardiovasc Echogr 2018; 28:185-188. [PMID: 30306024 PMCID: PMC6172891 DOI: 10.4103/jcecho.jcecho_14_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We describe a case of a 21-year-old male, with a history of acute myeloid leukemia (AML) treated with allogeneic hematopoietic cell transplantation, referred to our department for atypical chest pain and dyspnea. Echocardiography revealed an extensive mass involving right cardiac chambers and tricuspid valve annulus, with increased thickness and impairment of right ventricle. Cardiac magnetic resonance confirmed the presence of cardiac mass involving pulmonary artery trunk, pericardial sleeves, and lung parenchyma. These findings were attributed to a manifestation of recurrent AML involving the right heart.
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Affiliation(s)
- Claudia Zanetti
- Department of Medicine, Division of Cardiology, University of Verona, Italy
| | | | - Fabio Benedetti
- Department of Medicine, Bone Marrow Transplant Unit, University of Verona, Italy
| | - Andrea Rossi
- Department of Medicine, Division of Cardiology, University of Verona, Italy
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Gautam A, Jalali GK, Sahu KK, Deo P, Ailawadhi S. Cardiac Myeloid Sarcoma: Review of Literature. J Clin Diagn Res 2017; 11:XE01-XE04. [PMID: 28511492 DOI: 10.7860/jcdr/2017/23241.9499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/23/2017] [Indexed: 11/24/2022]
Abstract
Granulocytic Sarcomas (GS) also called as Myeloid Sarcomas (MS) or chloromas are the representatives of extramedullary infiltrates of immature myeloid cells including myeloblasts, promyelocytes and myelocytes. Primary cardiac malignancies per se are rare and infiltration of cardiac muscles by secondary malignant cells is also an uncommon finding. Out of these cardiac tumors, contribution of Cardiac Myeloid Sarcoma (CMS) is even more smaller thereby limiting our knowledge about this rare entity. Because of its very lower incidence, an exact guideline for diagnosis and management is still missing and usually haematologists around the world are treating CMS based on their clinical acumen. Aim of this review is to briefly discuss the presenting clinical feature, differential diagnosis, diagnostic workup and management based on published articles related to CMS till date.
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Affiliation(s)
- Archana Gautam
- Junior Resident, Department of Internal Medicine, UCMS, New Delhi, India
| | - Ghazal Kooshk Jalali
- Senior Resident, Department of Internal Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Kamal Kant Sahu
- Senior Resident, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Prateek Deo
- Junior Resident, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Sikander Ailawadhi
- Senior Associate Consultant, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida
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6
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Jung MH, Lee YH, Lee KY, Jung HO, Youn HJ. Leukemic infiltration presenting as myocardial hypertrophy after complete remission of acute myeloid leukemia. Echocardiography 2016; 34:136-138. [PMID: 27779355 DOI: 10.1111/echo.13404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Here, we report a rare case of isolated leukemic infiltrate of the myocardium (extramedullary involvement) presenting as restrictive cardiomyopathy in a patient in complete remission of acute myeloid leukemia. It was evaluated with multimodality imaging studies (echocardiography and cardiac MRI) and further confirmed by pathology. The present case highlights the importance of maintaining a high degree of clinical suspicion when evaluating patients with progressive ventricular hypertrophy of unknown cause, including recognition of the potential involvement by recurrent hematologic malignancy.
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Affiliation(s)
- Mi-Hyang Jung
- Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Youn-Ho Lee
- Department of Pathology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kyo-Young Lee
- Department of Pathology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hae Ok Jung
- Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ho-Joong Youn
- Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Yang WC, Yao M, Chen YH, Kuo SH. Complete response of myeloid sarcoma with cardiac involvement to radiotherapy. J Thorac Dis 2016; 8:1323-8. [PMID: 27293853 DOI: 10.21037/jtd.2016.04.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We present a rare case of intracardiac myeloid sarcoma (MS) of acute myeloid leukemia (AML) and who responds completely well to low-dose radiotherapy. This 19-year-old young man initially presented with AML and received standard chemotherapy followed by allogeneic hematopoietic stem cell transplantation (HSCT). However, he developed intracardiac isolated MS relapse with the presentation of exertional dyspnea and superior vena cava (SVC) syndrome 3 years later. He then received radiotherapy with 24 Gy at a 12 daily fractions using forward "field in field" intensity modulated radiotherapy technique. He dramatically had improved clinical symptoms, and complete remission was achieved one month after completing radiotherapy. Our result is in line with anecdotal case reports showed that radiotherapy with 15 Gy in 10 fractions or with 24 Gy in 12 fractions resulted in good response and less toxicity of 2 cases of MS with cardiac involvement. These results indicate that a modest radiotherapy dose, 24 Gy, achieves good local control of MS with cardiac involvement.
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Affiliation(s)
- Wen-Chi Yang
- 1 Division of Radiation Oncology, Department of Oncology, 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 3 Cancer Research Center, 4 Graduate Institute of Oncology, National Taiwan University College of Medicine and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Ming Yao
- 1 Division of Radiation Oncology, Department of Oncology, 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 3 Cancer Research Center, 4 Graduate Institute of Oncology, National Taiwan University College of Medicine and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Yu-Hsuan Chen
- 1 Division of Radiation Oncology, Department of Oncology, 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 3 Cancer Research Center, 4 Graduate Institute of Oncology, National Taiwan University College of Medicine and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Sung-Hsin Kuo
- 1 Division of Radiation Oncology, Department of Oncology, 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 3 Cancer Research Center, 4 Graduate Institute of Oncology, National Taiwan University College of Medicine and National Taiwan University Cancer Center, Taipei, Taiwan
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8
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CT and MRI evaluation of cardiac complications in patients with hematologic diseases: a pictorial review. Int J Cardiovasc Imaging 2015; 31 Suppl 2:159-67. [PMID: 25651878 DOI: 10.1007/s10554-015-0610-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/29/2015] [Indexed: 12/12/2022]
Abstract
Cardiac complications with hematologic diseases are not uncommon but it is difficult to diagnose, due to non-specific clinical symptoms. Prompt recognition of these potentially fatal complications by cardiac computed tomography (CT) or cardiac magnetic resonance imaging (MRI) may help to direct clinicians to specific treatments according to causes. Thrombosis is often related to central venous catheter use and is usually located at the catheter tip near the atrial wall. Differentiation of thrombosis from normal structure is possible with CT and, distinction of a thrombus from a tumor is possible on a delayed enhancement MRI with a long inversion time (500-600 ms). Granulocytic sarcoma of the heart is indicated by an infiltrative nature with involvement of whole layers of myocardium on CT and MRI. MRI with T2* mapping is useful in evaluating myocardial iron content in patients with hemochromatosis. Diffuse subendocardial enhancement is typically observed on delayed MRIs in patients with cardiac amyloidosis. T1 mapping is an emerging tool to diagnose amyloidosis. Myocardial abscess can occur due to an immunocompromised status. CT and MRI show loculated lesions with fluid density and concomitant rim-like contrast enhancement. Awareness of CT and MRI findings of cardiac complications of hematologic diseases can be helpful to physicians for clinical decision making and treatment.
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Huang Q, Reddi D, Chu P, Snyder DS, Weisenburger DD. Clinical and pathologic analysis of extramedullary tumors after hematopoietic stem cell transplantation. Hum Pathol 2014; 45:2404-10. [PMID: 25294373 DOI: 10.1016/j.humpath.2014.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/14/2014] [Accepted: 07/18/2014] [Indexed: 10/24/2022]
Abstract
Clinical and pathologic analyses of 41 extramedullary biopsy/resection specimens of extramedullary tumors (EMTs) after hematopoietic stem cell transplantation (HSCT) were performed. The 41 EMT specimens were from 28 patients, with 11 having more than 1 consecutive EMT in different anatomic locations at different times post-HSCT. The median age at EMT diagnosis was 45 years (range, 17-73 years), and the male/female ratio was 17:11. The most common initial diagnosis was acute myeloid leukemia (21), followed by chronic myeloid leukemia with myeloid blast phase (2), primary myelofibrosis with acute leukemic transformation (1), acute lymphoblastic leukemia (2), mixed lineage T/myeloid leukemia (1), and plasma cell myeloma (1). All initial presentations were limited to bone marrow-only disease. Twenty patients had abnormal chromosomal karyotypes, whereas 6 had normal cytogenetics with their original disease. All patients received standard chemotherapy followed by allogeneic (27) or autologous (1) HSCT. The EMTs occurred 2 to 177 months (median, 16.5 months) after HSCT and were diagnosed as solid mass lesions as follows: skin and soft tissue (10), central nervous system and paraspinal tissue (9), breast (7), gastrointestinal tract (4), lymph node (4), genitourinary system (4), and mediastinum (3). Interestingly, all but 3 patients had negative bone marrows at the time their EMT was diagnosed, indicating that most EMTs presented as sole lesion of relapsed disease. The overall outcome was dismal for patients with EMT, with 20 (71%) of 28 patients deceased at 1 to 26 months after EMT diagnosis, with a median overall survival of only 6.5 months.
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Affiliation(s)
- Qin Huang
- Department of Pathology, City of Hope National Medical Center, Duarte, CA 91010; Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical, Los Angeles, CA 90048.
| | - Deepti Reddi
- Department of Pathology, City of Hope National Medical Center, Duarte, CA 91010
| | - Peiguo Chu
- Department of Pathology, City of Hope National Medical Center, Duarte, CA 91010
| | - David S Snyder
- Department of Hematology & Hematopoietic Stem Cell Transplantation, City of Hope National Medical Center, Duarte, CA 91010
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11
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Abstract
Myeloid sarcomas are rare extramedullary tumors composed of immature myeloid cells. Most cases are seen in childhood acute myelogenous leukemia (AML). They can develop at many sites, but cardiac involvement is a rare finding. We report the case of a 24-year-old woman who, after being in remission from AML for 10 years, developed an isolated cardiac myeloid sarcoma.
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Matkowskyj KA, Wiseman WR, Robin JC, Norvell JP, Puthumana J, Nelson B, Peterson L, McGarry TJ, Tourtellotte WG. Therapy-related myelodysplastic syndrome presenting as fulminant heart failure secondary to myeloid sarcoma. J Hematop 2010; 3:41-6. [PMID: 21544187 DOI: 10.1007/s12308-010-0058-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 04/13/2010] [Indexed: 10/19/2022] Open
Abstract
Rapidly progressive heart failure is commonly caused by an extensive myocardial infarction, a mechanical complication of infarction, myocarditis, or acute valvular insufficiency. We present an unusual case that was caused by a diffuse infiltration of the myocardium with leukemic cells (myeloid sarcoma). The patient presented with episodic shortness of breath, he was anemic and thrombocytopenic, and his bone marrow biopsy revealed myelodysplastic syndrome from treatment for oligodendroglioma. His clinical course was characterized by a chronic leak of cardiac enzymes, a new right bundle branch block, and a large pericardial effusion causing tamponade and death from fulminant heart failure and ventricular arrhythmias within 2 weeks. At autopsy, the heart was massively infiltrated with myeloblasts and other immature myeloid cells. There was no evidence of acute leukemia in the bone marrow or peripheral blood. Cardiac infiltration in a patient with myelodysplastic syndrome is extremely rare, especially in the absence of bone marrow involvement by blasts. The recognition of this entity is becoming increasingly important as the incidence of cardiac myeloid sarcoma may be on the rise as the number of patients receiving chemotherapy increases.
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Jeong SH, Han JH, Jeong SY, Kang SY, Lee HW, Choi JH, Park JS. A case of donor-derived granulocytic sarcoma after allogeneic hematopoietic stem cell transplantation. THE KOREAN JOURNAL OF HEMATOLOGY 2010; 45:70-2. [PMID: 21120167 PMCID: PMC2982999 DOI: 10.5045/kjh.2010.45.1.70] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 03/09/2010] [Accepted: 03/09/2010] [Indexed: 01/22/2023]
Abstract
The occurrence of granulocytic sarcoma as a pattern of relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare. In this paper, we report a rare case of acute myeloid leukemia (AML) relapsed as a granulocytic sarcoma of the donor type. The patient was diagnosed as having AML and underwent an allo-HSCT from his matched sibling donor. Fifty-seven months after allo-HSCT, he developed granulocytic sarcomas of duodenum, jejunum, and left sterno-cleido-mastoid muscle. The bone marrow was normal with 100% donor chimerism. A Y chromosome PCR was performed on the patient's duodenum specimen as well as bone marrow aspirate in order to check the patient-origin cells. The duodenal specimen was found to contain 41.2% SRY-positive cells (from the donor). Repeat endoscopy on day 2 of chemotherapy showed that the granulocytic sarcoma had shrunk dramatically. The patient died of sepsis during the nadir state 35 days after starting salvage chemotherapy.
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Affiliation(s)
- Seong Hyun Jeong
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
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Lu Y, Huang Q. Primary myelofibrosis relapsed with duodenal myeloid sarcoma after allogeneic stem cell transplantation. Leuk Lymphoma 2010; 50:1879-81. [PMID: 19860605 DOI: 10.3109/10428190903207555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abstract
Chloromas are not frequently seen in patients with acute myelogenous leukemia and chloromas involving cardiac structures have only been rarely reported in the literature. We report a complete radiographic response to low-dose fractionated radiotherapy in a patient with an intracardiac chloroma.
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Koželj M, Zorman D, Mrevlje B, Černelč P, Zver S. Cardiac granulocytic sarcoma diagnosed by intracardiac echocardiography-guided biopsy. Int J Hematol 2008; 88:101-103. [PMID: 18498027 DOI: 10.1007/s12185-008-0104-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2007] [Revised: 02/16/2008] [Accepted: 04/15/2008] [Indexed: 12/31/2022]
Abstract
A 52-year-old man presented with clinical and echocardiographic signs of cardiac tamponade. A transthoracic echocardiogram revealed a large right atrial mass that obstructed the superior vena cava flow. Cardiac magnetic resonance imaging and computed tomography demonstrated extracardiac tumour invasion of the free atrial wall extending to the right pulmonary hilus. Intracardiac echocardiography-guided biopsy of the tumour revealed the tissue diagnosis-granulocytic sarcoma of the heart. The patient was effectively treated with radiotherapy, chemotherapy and allogeneic haematopoietic stem cell transplantation. He has remained free of the disease for 12 months after treatment.
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Affiliation(s)
- Mirta Koželj
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška 7, 1525, Ljubljana, Slovenia.
| | - Darko Zorman
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška 7, 1525, Ljubljana, Slovenia
| | - Blaž Mrevlje
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška 7, 1525, Ljubljana, Slovenia
| | - Peter Černelč
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1525, Ljubljana, Slovenia
| | - Samo Zver
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1525, Ljubljana, Slovenia
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Owonikoko T, Agha M, Balassanian R, Smith R, Raptis A. Gemtuzumab therapy for isolated extramedullary AML relapse following allogeneic stem-cell transplant. ACTA ACUST UNITED AC 2007; 4:491-5. [PMID: 17657254 DOI: 10.1038/ncponc0899] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 06/04/2007] [Indexed: 01/21/2023]
Abstract
BACKGROUND A 19-year-old male with primary refractory acute myeloid leukemia received salvage therapy with mitoxantrone and cytarabine combination. He received consolidation therapy 3 months later with a matched-unrelated-donor stem-cell transplant. The disease relapsed in the bone marrow (BM) 9 months after the initial stem-cell transplant, and was successfully treated by repeat transplant from the same donor. Ten months following repeat transplant, the patient presented with an increasing number of extramedullary sites of biopsy-proven disease relapse (i.e. cranial and peripheral nerves, tongue, abdominal wall and chest wall). Repeated biopsy of the BM and chimera study showed no morphologic evidence of leukemic infiltrate with 100% donor-cell population. INVESTIGATIONS Physical examination, complete blood count, BM biopsy, flow cytometry, cytogenetic analysis, chimera study, tongue biopsy, abdominal-wall biopsy, cytology and immunohistochemistry, CT scan of the chest, abdomen and pelvis, MRI of the brain, and cerebrospinal fluid analysis. DIAGNOSIS Isolated extramedullary relapse of acute myeloid leukemia after stem-cell transplant. MANAGEMENT Primary leukemia treatment with idarubicin, cytarabine, etoposide, dexamethasone, tioguanine on protocol and salvage therapy with mitoxantrone and cytarabine combination for primary refractory disease. A matched-unrelated-donor stem-cell transplant for consolidation and donor-lymphocyte infusions were performed, followed by repeat unrelated-donor transplant for leukemia relapse in the marrow, radiation therapy and gemtuzumab ozogamicin for multiple sites of extramedullary leukemia relapse.
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Affiliation(s)
- Taofeek Owonikoko
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA 15232, USA
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Fritz J, Vogel W, Bares R, Horger M. Radiologic Spectrum of Extramedullary Relapse of Myelogenous Leukemia in Adults. AJR Am J Roentgenol 2007; 189:209-18. [PMID: 17579173 DOI: 10.2214/ajr.06.1500] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Chloroma, also know as granulocytic sarcoma, is a localized extramedullary tumor composed of malignant cells of the myeloid cell line. It occurs most frequently secondary to a history of myelogenous leukemia as extramedullary relapse. New treatment regimens, including allogeneic stem cell transplantation, extensive use of donor lymphocyte infusion, and second transplantation, are associated with increased rates of chloroma of up to 21%. The purpose of this article is to highlight the sites of involvement as well as the morphologic and imaging features of chloroma in patients with myelogenous leukemia. CONCLUSION Allogeneic stem cell transplantation now represents the treatment of choice for leukemia and for patients with leukemia relapse. Therefore, the rate of chloroma is likely to increase. Because clinical and laboratory data are frequently not indicative, radiologic diagnosis of chloroma will become more important.
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Affiliation(s)
- Jan Fritz
- Department of Diagnostic Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
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Pelosini M, Benedetti E, Galimberti S, Caracciolo F, Petrini M, Fazzi R, Andreazzoli F, Papineschi F. Granulocytic sarcoma and subsequent acute leukemia recurrence with different biologic characteristics 5 years after allogeneic bone marrow transplantation for acute myeloid leukemia. Bone Marrow Transplant 2006; 37:897-8. [PMID: 16547489 DOI: 10.1038/sj.bmt.1705344] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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