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[Two cases of myeloid sarcomas with review of literature]. Rev Med Interne 2017; 38:774-777. [PMID: 28668372 DOI: 10.1016/j.revmed.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/01/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Myeloid sarcomas are uncommon proliferations of immature myeloid cells occurring in any extramedullary organ. We report here two cases of myeloid sarcomas in patients with, respectively, a polycythemia vera and a myelodysplastic syndrome. CASE REPORTS The first is an 81-year-old woman who presented with osteolytic lesions. Diagnosis has been highlighted using anatomopathological study after bone marrow biopsy, but it was delayed because of a very localized basin lesion and few positive myeloid markers. The second patient is an 86-year-old man who presented with pancytopenia and several lymph nodes. Lymph node cytology failed because of the rarity of blast cells. Diagnosis was done after anatomopathological study on lymph node biopsy which revealed a localized form of myeloid sarcoma. CONCLUSION The diagnosis of myeloid sarcoma must be considered when unusual tumors occur in patients with a chronic myeloid disease. In that case, therapeutic options are those of an acute myeloid leukemia.
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Abstract
Because of shared histologic and clinical features, granulocytic sarcoma (GS) may be confused with B- and T cell malignant lymphomas. Antibodies to myeloperoxidase, lysozyme, CD 15, and other determinants may correctly identify GS but are usually not part of the standard panels employed to evaluate a suspected non-Hodgkin's lym phoma. At the authors' institutions, these typically include reagents to CD20, CD43, CD45, CD45RO, and MB2. In this analysis, well-documented cases of GS and histologi cally similar lymphomas were assessed using a standard immunohistologic antibody panel employed in evaluation of putative lymphomas. In addition, antibodies to lyso zyme, myeloperoxidase, CD3, CD15, CD34, CD68, and MAC 387 were used in a second tier of analysis. The results were evaluated in a step-wise fashion. All B cell lymphomas and the majority of T cell cases were identified correctly by their reactivity for CD20 and CD45RO, respectively. Using the five standard lymphomas markers, 12 of 19 cases of GS had a phenotype that would be relatively unusual in non-Hodgkin's lymphoma—as reflected by CD43 and MB2 coexpression without CD20 or CD45RO-whereas 7 cases of GS showed a "CD43-only" phenotype and were there fore considered possible T cell lesions. All 19 GS cases were labeled by at least one second-tier marker and 18 exhibited two or more of these determinants at that level of evaluation. All T cell lymphomas failed to express CD 15, CD34, CD68, or MAC 387; however, 3 of 20 B cell tumors were focally positive for CD 15. CD3 labeled 9 of 11 cases of T cell lymphoma but also was seen in 11 of 16 cases of GS. These results indicate that, in suspected lymphoma cases, CD45-positivity, but failure to express CD20 or CD45RO, suggests the possibility of GS. Additional immunohistologic studies, in particular those for lysozyme or myeloperoxidase, can then be used to further define the tumoral lineage. Int J Surg Pathol 2(3):177-186, 1995
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Affiliation(s)
| | - Jon H. Ritter
- washington University Medical Center, St. Louis, Missouri
| | | | - Mark R. Wick
- Ackerman Laboratory ofSurgical Pathology, Barnes Hospital-WUMC, One Barnes Hospital Plaza, St. Louis, MO 63110
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Acute myeloid leukemia in a young girl presenting with mediastinal granulocytic sarcoma invading pericardium and causing superior vena cava syndrome. J Pediatr Hematol Oncol 2009; 31:980-2. [PMID: 19956024 DOI: 10.1097/mph.0b013e3181b86ff3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 1-year-4-month-old girl who presented with pericardial effusion and superior vena cava (SVC) syndrome caused by a mediastinal mass was later proved to be a case of acute myeloid leukemia (AML) with mixed-lineage leukemia-gene translocation. The unusual presentation and the giant blasts with basophilic vacuolated cytoplasm had led to initial misdiagnosis of mediastinal lymphoma. She developed progressive SVC syndrome, unresolved pericardial effusion, and extensive leukemia cutis after initial induction therapy. She died soon after second-course chemotherapy. To our knowledge, this is the first reported case of childhood acute myeloid leukemia presenting with mediastinal granulocytic sarcoma causing pericardium invasion and SVC syndrome.
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de Arruda Câmara VM, Morais JC, Portugal R, da Silva Carneiro SC, Ramos-e-Silva M. Cutaneous granulocytic sarcoma in myelodysplastic syndrome. J Cutan Pathol 2008; 35:876-9. [PMID: 18494822 DOI: 10.1111/j.1600-0560.2007.00916.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Granulocytic sarcoma is an extramedullary tumor of immature cells of granulocytic series, generally associated to acute myelogenous leukemia. The skin is one of the most commonly affected sites. Granulocytic sarcoma can complicate myelodysplastic syndromes and is considered a sign of poor prognosis. They are often misdiagnosed with non-Hodgkin lymphoma of the lymphoblastic type, Burkitt lymphoma and large cell lymphoma. In children, the differential diagnoses also include small, round cell tumors. It is important to diagnose these lesions early because they can precede peripheral blood and bone marrow transformation to acute myelogenous leukemia. We report a case of an elderly patient with myelodysplastic syndrome who developed multiple cutaneous granulocytic sarcoma lesions and discuss prognostic and treatment implications.
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Affiliation(s)
- Viviane Marins de Arruda Câmara
- Sector of Dermatology and Post Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil
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Mateen FJ, Harding SR, Saxena A. Extensive myocardial infiltration by hemopoietic precursors in a patient with myelodysplastic syndrome. BMC HEMATOLOGY 2006; 6:4. [PMID: 16953890 PMCID: PMC1569821 DOI: 10.1186/1471-2326-6-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Accepted: 09/05/2006] [Indexed: 02/05/2023]
Abstract
Background Although myocardial infiltration with leukemic blasts is a known finding in patients with acute leukemia, this phenomenon in myelodysplasia is not reported in the literature. Cardiac symptoms in patients with myelodysplasia are often due to anemia and may be due to iron overload and side effects of therapy. Case presentation Herein we report the first case of neoplastic infiltration of the heart with associated myocardial necrosis in a patient with myelodysplasia. It was associated with unicellular and multifocal geographic areas of necrosis in the left ventricle and the interventricular septum. It is likely that cardiac compromise in our patient was due to a combination of restrictive cardiomyopathy due to leukemic infiltration, concomitant anemia, cardiac dilatation, conduction blocks and myocardial necrosis. Myocardial necrosis was most likely due to a combination of ischemic damage secondary to anemia and prolonged hypotension and extensive leukemic infiltration. Markedly rapid decrease in ejection fraction from 66% to 33% also suggests the role of ischemia, since leukemic infiltration is not expected to cause this degree of systolic dysfunction over a 24-hour period. The diagnosis was not suspected during life due to concomitant signs and symptoms of anemia, pulmonary infections, and pericardial and pleural effusions. The patient succumbed to cardiac failure. Conclusion Hemopoietic cell infiltration was not considered in the differential diagnosis and contributed to this patient's morbidity and mortality. This case highlights the clinical importance of considering myocardial infiltration in patients with myelodysplasia and cardiac symptoms.
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Affiliation(s)
| | - Sheila R Harding
- Departments of Pathology and Internal Medicine, University of Saskatchewan and Saskatoon Health Region, Saskatoon, Canada
- Department of Pathology, University of Saskatchewan and Saskatoon Health Region, Saskatoon, Canada
| | - Anurag Saxena
- Departments of Pathology and Internal Medicine, University of Saskatchewan and Saskatoon Health Region, Saskatoon, Canada
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Mourad W, Kfoury H, Al Husseini H. The value of CD34, myeloperoxidase and chloroacetate esterase (Leder) stain in the diagnosis of granulocytic sarcoma. Ann Saudi Med 2001; 21:287-91. [PMID: 17261930 DOI: 10.5144/0256-4947.2001.287] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The differentiation of extramedullary myelogenous leukemia/granulocytic sarcoma (GS) from malignant lymphoma can sometimes be difficult. In the current study, we explored the value of CD34, myeloperoxidase and nonspecific esterase (Leder) stains in differentiating GS from lymphomas. MATERIALS AND METHODS Fifteen cases of phenotypically confirmed GS were stained for CD34, myeloperoxidase and Leder stains. The same stains were performed in 16 malignant lymphomas as controls. The GS cases were also immunostained for CD3 and CD20 to detect the incidence of aberrant T and B lymphocyte expression. RESULTS CD34 was expressed in 7 of the 15 cases of GS (46%). Myeloperoxidase was expressed in 10 of the 15 cases (66%), and Leder stain was positive in 9 cases (60%). All 15 cases had expression of at least one marker; 8 cases had expression of two markers and one case had expression of all 3 markers. None of the lymphomas showed expression of any of the three markers. Five cases (35%) of GS showed T cell antigen expression and 2 (14%) showed B cell antigen expression. CONCLUSION Our findings suggest that in cases of GS, the use of the combination of CD34, myeloperoxidase and Leder stains can help reach a definitive diagnosis, especially if lymphoma is difficult to exclude. Expression of B and T cell antigens in such lesions should not rule out the diagnosis of GS.
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Affiliation(s)
- W Mourad
- Department of Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Murakami Y, Nagae S, Matsuishi E, Irie K, Furue M. A case of CD56+ cutaneous aleukaemic granulocytic sarcoma with myelodysplastic syndrome. Br J Dermatol 2000; 143:587-90. [PMID: 10971333 DOI: 10.1111/j.1365-2133.2000.03714.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We describe a 70-year-old man with cutaneous granulocytic sarcoma who presented with numerous cutaneous nodules but without any leukaemic involvement of the peripheral blood. The tumour cells were positive for lysozyme, peroxidase, CD11a, CD11c, CD33 and HLA-DR, and weakly positive for CD4 and CD14, suggesting granulocytic differentiation. The bone marrow at admission showed dysplasia of the erythrocytic and granulocytic lineage and complex chromosomal abnormalities in association with an increase in monocytes. The patient was diagnosed as having granulocytic sarcoma of monocytic lineage with concomitant myelodysplastic syndrome. In this case, tumour cells also expressed the neural cell adhesion molecule (CD56), which has been suggested as a possible risk factor for developing granulocytic sarcoma in acute myelogenous leukaemia.
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Affiliation(s)
- Y Murakami
- Department of Dermatology, Faculty of Medicine, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.
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Sisack MJ, Dunsmore K, Sidhu-Malik N. Granulocytic sarcoma in the absence of myeloid leukemia. J Am Acad Dermatol 1997. [DOI: 10.1016/s0190-9622(97)80378-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Byrd JC, Edenfield WJ, Dow NS, Aylesworth C, Dawson N. Extramedullary myeloid cell tumors in myelodysplastic-syndromes: not a true indication of impending acute myeloid leukemia. Leuk Lymphoma 1996; 21:153-9. [PMID: 8907283 DOI: 10.3109/10428199609067593] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this report is to record a patient with myelodysplastic syndrome (MDS) associated acute myelogenous leukemia (AML) and leukemia cutis who had blast expression of the neural cell adhesion molecule (NCAM) and to review the world literature on prognostic implications of extramedullary myeloid cell tumors (granulocytic sarcoma, myeloblastoma, chloroma and leukemia cutis) in MDS and MDS associated AML. Case report and world literature from January 1965-January 1994 for all cases of MDS-associated extramedullary myeloid cell tumors (EMT) is reviewed, and the first patient with EMT, MDS associated AML and blast expression of NCAM is described. There have been 46 cases of MDS associated EMT previously reported. 32 cases occurred in the absence of AML. AML developed in 47% of these patients at a mean of 38 weeks from initial EMT. Of the patients not developing AML, median survival from initial EMT was 11 weeks. Nine patients received chemotherapy at the time of EMT and had a median survival of 36 weeks. The median survival for patients receiving conservative therapy for EMT was 48 weeks. Patients (n = 15) with EMT and MDS associated AML had a poor outcome regardless of therapy with a median survival of 11 weeks. Unlike other forms of isolated EMT, MDS associated EMT is not always a forerunner of AML. Premature induction therapy for MDS associated EMT does not appear to prolong survival. EMT in the setting of MDS associated AML is associated with a poor prognosis despite aggressive chemotherapy. Blast expression of NCAM may prove to be a risk factor for EMT in MDS associated AML.
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Affiliation(s)
- J C Byrd
- Division of Hematology-Oncology, Department of Internal Medicine, Walter Reed Army Medical Center and the Uniformed Services University of the Health Sciences, Washington, DC 20307, USA
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Abstract
We report a rare case of central nervous system granulocytic sarcoma (GS) in a patient with essential thrombocythemia (ET). The diagnosis of GS was established by morphological and cytochemical findings (peroxidase and naphthol-AS-D-chloroacetate esterase positivity) of neoplastic cells. GS was detected as an intracranial frontal mass 7 months before the transformation of ET in acute myeloid leukemia and relapsed as two extradural spinal masses during the course of leukemic evolution.
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Affiliation(s)
- M Grande
- Second Institute of Medical Clinics, University of Bari, Italy
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Abstract
A patient presenting with cutaneous vasculitis was noted to be pancytopenic. Subsequent investigation showed a myelodysplastic syndrome (MDS)--refractory anaemia with excess of blasts. Within 3 months her MDS progressed to acute myeloid leukaemia.
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Affiliation(s)
- B F O'Donnell
- St John's Institute of Dermatology, UMDS, London, UK
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List AF, Gonzalez-Osete G, Kummet T, Doll DC. Granulocytic sarcoma in myelodysplastic syndromes: clinical marker of disease acceleration. Am J Med 1991; 90:274-6. [PMID: 1996602 DOI: 10.1016/0002-9343(91)90559-g] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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