Cardiac Myeloid Sarcoma: Review of Literature

Intracranial Myeloid Sarcoma Arising Intra-axially From Acute Myeloid Leukemia: A Case Report and Literature Review

Intracranial myeloid sarcoma is a rare brain tumor and an extramedullary manifestation of malignant hematopoietic neoplasms of myeloid origin. A 76-year-old right-handed male patient was initially diagnosed with acute myeloid leukemia (AML; M4Eo). Three years later, the patient experienced headaches, dizziness, nausea, and gait disturbances. Magnetic resonance imaging of the head revealed a mass lesion that appeared to be extra-axial in the right cerebellum with well-defined borders that did not show contrast enhancement and was in contact with the dura mater. The patient underwent surgical tumor resection using the lateral suboccipital approach. The tumor did not attach to the dura mater, indicating susceptibility of an intra-axial tumor. Complete tumor resection was performed. The intraoperative pathological diagnosis revealed the involvement of AML characterized by small round cells diffusely increasing in size with angiogenesis and invasion of macrophages. In conclusion, we present a rare case of intracranial myeloid sarcoma arising intra-axially and originating from an AML that was treated with surgical tumor resection. Although it is difficult to determine whether the tumor was extra-axial or intra-axial on imaging, intracranial myeloid sarcoma should be considered as a differential disease when the patient has a history of hematological neoplasia, such as AML.

Case report: Clinical features of pediatric acute myeloid leukemia presenting with cardiac tamponade: a case series study and literature review

OBJECTIVE

This study aims to elucidate the clinical features observed in cases of pediatric acute myeloid leukemia (AML) initially presenting with cardiac tamponade and to share treatment experiences.

MATERIALS AND METHODS

Five pediatric patients were initially diagnosed with AML accompanied by cardiac myeloid sarcoma (MS). The diagnosis was established by examining our hospital records and reviewing pertinent literature from 1990 to July 2023, accessible through MEDLINE/PubMed. We comprehensively assessed the clinical characteristics and treatment modalities employed for these patients.

RESULT

Five pediatric patients presented with acute symptoms, including shortness of breath, malaise, cough, and fever, leading to their hospitalization. Physical examination revealed irritability, hypoxia, tachypnea, tachycardia, and hypotension. Initial detection utilized chest X-ray or echocardiogram, leading to subsequent diagnoses based on pericardial effusion and/or bone marrow examination. Two patients received chemotherapy at the time of initial diagnosis, one with cytarabine and etoposide, and the other with cytarabine and cladribine. Post-treatment, their bone marrow achieved remission, and over a 2.5-year follow-up, their cardiac function remained favorable. Unfortunately, the remaining three patients succumbed within two weeks after diagnosis, either due to receiving alternative drugs or without undergoing chemotherapy.

CONCLUSION

This is the first and largest case series of pediatric AML patients with cardiac MS, manifesting initially with cardiac tamponade. It highlights the rarity and high mortality associated with this condition. The critical factors for reducing mortality include identifying clinical manifestations, conducting thorough physical examinations, performing echocardiography promptly, initiating early and timely pericardial drainage, and avoiding cardiotoxic chemotherapy medications.

Isolated cardiac involvement of a primary myeloid sarcoma: a case report of an unusual cause of pulmonary oedema

Background

Myeloid sarcoma, also known as chloroma, is a pathologic diagnosis for an extramedullary proliferation of blasts of one or more of the myeloid lineages. It is an uncommon manifestation of acute myeloid leukaemia (AML), although the diagnosis may occur prior to or after diagnosis of AML. Cardiac infiltration by myeloid sarcoma is extremely rare, and of the few published cases, a diagnosis of leukaemia was almost always already present.

Case summary

This is a 52-year-old patient admitted to the hospital with acute shortness of breath, with a large amorphous mass found on computed tomography scan invading the myocardium and causing heart failure. Echocardiography demonstrated multiple cardiac masses. A bone marrow biopsy was non-diagnostic. An endomyocardial biopsy confirmed a cardiac primary myeloid sarcoma. The patient was successfully treated with chemotherapy with complete resolution of the cardiac infiltration and of the heart failure.

Discussion

We present this rare case of primary cardiac myeloid sarcoma and discuss current literature relevant to this effectively unique presentation. We discuss the use of endomyocardial biopsy in the diagnosis of cardiac malignancy and the advantages of early diagnosis and management of this unusual cause of heart failure.

A Journey Across Oceans With a Heavy Heart: Rare Presentation of a Pediatric Malignancy

Myeloid sarcoma, due to extramedullary deposition of myeloblasts, is one of the rare presentations in acute myeloid leukemia. We present an extremely rare case of a 5-year-old boy with cardiac myeloid sarcoma. Noninvasive mode of diagnosis, timely initiation of chemotherapy and meticulous supportive care are the keys to successful outcome. (Level of Difficulty: Intermediate.)