Granulocytic sarcoma of the colon and leukemic infiltration of the liver in a patient presenting with hematochezia and jaundice

Successful Treatment of Pediatric Acute Myeloid Leukemia Presenting with Hyperbilirubinemia Secondary to Myeloid Sarcoma: A Case Report

Myeloid sarcoma (MS), a tumor consisting of myeloid blasts with or without maturation, occurs at anatomical sites other than the bone marrow. MS of the gastrointestinal tract presenting with jaundice in children is rare. We report the case of a 4-year-old boy with a 6-week history of symptoms of obstructive jaundice due to a peripancreatic mass compressing the common bile duct. Six weeks later, blasts were found in a peripheral smear prior to surgical biopsy; bone marrow evaluation and flow cytometry results led to a diagnosis of acute myeloid leukemia (AML) with MS. No further invasive testing or temporary drainage was performed. He was started on induction therapy with full therapeutic doses of cytarabine, dose reductions of etoposide, and escalating doses of daunorubicin. His liver enzymes normalized, and he completed subsequent cycles of chemotherapy with full doses. The abdominal ultrasound showed resolution of the mass after the second cycle of chemotherapy. He is currently in remission three years after completing therapy. AML-directed chemotherapy in patients with obstructive jaundice secondary to MS may be beneficial without requiring invasive testing or temporary drainage procedures. Daily follow-up is crucial for chemotherapy dose modifications. Management plans should be individualized according to the patient’s clinical condition.

Identification of herbal categories active in pain disorder subtypes by machine learning help reveal novel molecular mechanisms of algesia

Chronic pain is highly prevalent and poorly controlled, of which the accurate underlying mechanisms need be further elucidated. Herbal drugs have been widely used for controlling various pain disorders. The systematic integration of pain herbal data resources might be promising to help investigate the molecular mechanisms of pain phenotypes. Here, we integrated large-scale bibliographic literatures and well-established data sources to obtain high-quality pain relevant herbal data (i.e. 426 pain related herbs with their targets). We used machine learning method to identify three distinct herb categories with their specific indications of symptoms, targets and enriched pathways, which were characterized by the efficacy of treatment to the chronic cough related neuropathic pain, the reproduction and autoimmune related pain, and the cancer pain, respectively. We further detected the novel pathophysiological mechanisms of the pain subtypes by network medicine approach to evaluate the interactions between herb targets and the pain disease modules. This work increased the understanding of the underlying molecular mechanisms of pain subtypes that herbal drugs are participating and with the ultimate aim of developing novel personalized drugs for pain disorders.

Myeloid Sarcoma of the Hepatobiliary System: A Case Series and Review of the Literature

Myeloid sarcoma (MS) is a rare extramedullary presentation of myeloid malignancies, most commonly seen in association with acute myeloid leukemia (AML). Although MS can develop in any organ, the involvement of the hepatobiliary system is rare. With clinical manifestations of jaundice, abdominal pain and other gastrointestinal symptoms, MS presenting at this location can be a challenge to diagnose, particularly in patients with no known history of hematologic malignancy. This may cause delay in proper management. Here we report 3 cases from a single institution and a review of the literature concerning the epidemiology, clinical presentation, treatment and outcomes in patients with MS of the liver, biliary tree and pancreas.

Myeloid sarcoma presenting as a colon polyp and harbinger of chronic myelogenous leukemia

Myeloid sarcoma, also known as granulocytic sarcoma or chloroma is an unusual accumulation of malignant myeloid precursor cells in an extramedullary site, which disrupts the normal architecture of the involved tissue. It is known to occur more commonly in patients with acute myelogenous leukemia and less commonly in those with myelodysplastic syndrome and myeloproliferative neoplasm, such as chronic myelogenous leukemia. The most common sites of involvement include bone, skin and lymph nodes. However, rare cases have been reported in the gastrointestinal tract, genitourinary tract, or breast. Most commonly, a neoplastic extramedullary proliferation of myeloid precursors in a patient would have systemic involvement of a myeloid neoplasm, including in the bone marrow and peripheral blood. Infrequently, extramedullary disease may be the only site of involvement. It may also occur as a localized antecedent to more generalized disease or as a site of recurrence. Herein, we present the first case in the English literature of a patient presenting with an isolated site of myeloid sarcoma arising in the form of a colonic polyp which, after subsequent bone marrow biopsy, was found to be a harbinger of chronic myelogenous leukemia.

A rare case of myeloid sarcoma presenting as an anorectal ulcer

Myeloid Sarcoma is a rare tumor composed of myeloblasts occurring at an extramedullary site like bones, or various soft tissues. Myeloid sarcoma may involve the gastrointestinal tract very rarely either solitarily, or occurring simultaneously with acute myeloid leukemia. Its diagnosis is challenging and needs biopsy and immunohistochemical staining. We are describing a case of myeloid sarcoma which presented as a painful anal ulcer mimicking an atypical fissure. Its appearance resembled crohn's disease on sigmoidoscopy. A biopsy of the ulcer along with histochemical staining led to the diagnosis of myeloid sarcoma. Our case demonstrates the need for aggressive evaluation of any common gastrointestinal complaint with an atypical presentation.

Isolated granulocytic sarcoma of the pancreas: a tricky diagnostic for primary pancreatic extramedullary acute myeloid leukemia

We report two clinical cases of primary granulocytic sarcoma of the pancreas that were diagnosed on the surgical specimen. Atypical clinical and morphological presentations may have lead to pretherapeutic biopsies of the pancreatic mass in order to indicate primary chemotherapy. Literature review of this rare clinical presentation may help physicians to anticipate diagnostic and therapeutic strategies.

Extensive involvement of the gastrointestinal tract by a de novo presentation of the monoblastic type of myeloid sarcoma: a case report of a rare entity that is often misdiagnosed

We present the first known case of the monoblastic type of myeloid sarcoma (also known as extramedullary myeloid tumor, chloroma, and granulocytic sarcoma) with diffuse involvement of the gastrointestinal tract. The patient originally presented with diarrhea and crampy abdominal discomfort. Endoscopically, the disease showed a diffuse inflammatory process mimicking a number of benign conditions, such as inflammatory bowel disease and autoimmune enteropathy. Sequential biopsies of the upper and lower gastrointestinal tract showed a diffuse infiltrate of increasingly atypical cells. The disease progressed to systemic involvement, including widespread lymphadenopathy, splenomegaly, and pulmonary deposits; the patient died 13 months after the development of initial symptoms. The immunohistochemical and histologic profiles of this case are diagnostic of the monoblastic type of myeloid sarcoma.

Isolated myeloid sarcoma of the gastrointestinal tract

Myeloid sarcoma (MS) is a rare disease that presents as an extramedullary tumor of myeloid cells. Most patients subsequently develop acute myelogenous leukemia (AML), and their prognosis is poor. Here, we report the case of a 28-year-old woman with a primary isolated myeloid sarcoma which originated in the gastrointestinal (GI) tract. Two months after initial presentation, bone marrow tests led to a diagnosis of AML. This case is noteworthy because GI tract infiltration with leukemic cells is very rare, and it is even more rare as an occurrence preceding the development of systemic leukemia.

Granulocytic sarcoma of the colon in a child with acute myeloid leukemia presenting as hematochezia

Granulocytic sarcoma (GS), an extramedullary myeloid tumor composed of immature cells of the granulocytic series, can occur in patients with acute myeloid leukemia (AML), myelodysplastic syndrome, or chronic myelogenous leukemia. It can occur in any organ or tissue, but the most common involved areas are the skin, bone/spine, and lymph nodes. However, its occurrence in the gastrointestinal tract is relatively rare, and is especially rare in the colon in adults. No case of GS involving the colon in children has ever been reported. We report here an extremely rare case of GS in the colon of a 10-year-old boy with AML presenting with hematochezia. Colonic GS was diagnosed by colonofiberscopic biopsy. His hematochezia responded rapidly to induction chemotherapy and the patient remained in complete remission after 3-month follow-up. In conclusion, hematochezia may be due to colonic involvement of GS, which should be considered in the differentials in addition to thrombocytopenia, as it is usually encountered in AML patients.

Extramedullary myeloid leukemia mimicking lepromatous leprosy

Granulocytic sarcoma is an extramedullary localized tumoral lesion of myeloid precursors. It is composed of immature cells of the granulocytic series known to occur in patients with myelodysplastic syndrome, chronic myelogenous leukemia or acute myelogenous leukemia. We present a 29-year-old female who was admitted to hospital for lesions that appeared on the face, lips and nose, mimicking lepromatous leprosy. It should be kept in mind that granulocytic sarcoma may mimick lepromatous leprosy.

Radiologic Spectrum of Extramedullary Relapse of Myelogenous Leukemia in Adults

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.

Granulocytic sarcoma of bowel: CT findings

PURPOSE

To evaluate retrospectively the computed tomographic (CT) findings of granulocytic sarcoma of the bowel.

MATERIALS AND METHODS

The institutional review boards of all participating institutions approved this study and waived the requirement for informed consent. CT scans were retrospectively reviewed in eight patients (seven men, one woman; age range, 23-71 years; mean age, 46 years) with pathologically proved granulocytic sarcoma of the small and/or large bowel. CT findings were evaluated with regard to the sites, morphologic characteristics, and contrast material enhancement patterns of the lesions, along with other ancillary findings (ie, peritoneal and mesenteric infiltration, ascites, lymphadenopathy, bowel perforation, and obstruction).

RESULTS

Eight patients had a total of 13 lesions in the bowel (of which eight were pathologically proved), involving the duodenum (n=1), jejunum (n=2), ileum (n=5), sigmoid colon (n=1), and rectum (n=4); multifocal bowel lesions were noted in four patients. The lesion varied in shape, with wall thickening alone in three of 13 lesions, an intraluminal polypoid mass in four, an exophytic mass in one, and a combination of findings in five. Contrast material enhancement, relative to the back musculature, showed isoattenuation in seven lesions, hyperattenuation in four, and hypoattenuation in two. Five of eight patients had multiple peritoneal masses with diffuse mesenteric or peritoneal infiltration. Ascites was present in six of eight patients; lymphadenopathy (especially in the mesentery), in five; bowel perforation, in two; and bowel obstruction, in one.

CONCLUSION

Granulocytic sarcoma of the bowel is characterized by variability in shape and contrast enhancement and has a high predilection for mesenteric and peritoneal spread.