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Ramia de Cap M, Chen W. Myeloid sarcoma: An overview. Semin Diagn Pathol 2023; 40:129-139. [PMID: 37149396 DOI: 10.1053/j.semdp.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 05/08/2023]
Abstract
Myeloid Sarcoma (MS) is a high grade, hematological malignancy defined as an extramedullary tumor mass of myeloid blasts with or without maturation that effaces tissue architecture. It is a highly heterogenous condition that represents a variety of myeloid neoplasms. This heterogeneity of MS, together with its rarity, have greatly hampered our understanding of the condition. Diagnosis requires tumor biopsy, which should be accompanied by bone marrow evaluation for medullary disease. It is presently recommended that MS be treated similar to AML. Additionally, ablative radiotherapy and novel targeted therapies may also be beneficial. Genetic profiling has identified recurrent genetic abnormalities including gene mutations associated with MS, supporting its etiology similar to AML. However, the mechanisms by which MS homes to specific organs is unclear. This review provides an overview of pathogenesis, pathological and genetic findings, treatment, and prognosis. Improving the management and outcomes of MS patients requires a better understanding of its pathogenesis and its response to various therapeutic approaches.
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Affiliation(s)
- Maximiliano Ramia de Cap
- North Bristol NHS Trust, Southmead Hospital, Pathology Sciences Building, Westbury on Trym, Bristol BS10 5NB, UK.
| | - Weina Chen
- UT Southwestern Medical Center, Dallas, TX, USA
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Ramia de Cap M, Wu LP, Hirt C, Pihan GA, Patel SS, Tam W, Bueso-Ramos CE, Kanagal-Shamanna R, Raess PW, Siddon A, Narayanan D, Morgan EA, Pinkus GS, Mason EF, Hsi ED, Rogers HJ, Toth L, Foucar K, Hurwitz SN, Bagg A, Rets A, George TI, Orazi A, Arber DA, Hasserjian RP, Weinberg OK. Myeloid sarcoma with NPM1 mutation may be clinically and genetically distinct from AML with NPM1 mutation: a study from the Bone Marrow Pathology Group. Leuk Lymphoma 2023:1-9. [PMID: 36960680 DOI: 10.1080/10428194.2023.2185091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Myeloid sarcoma (MS) is currently considered equivalent to de novo acute myeloid leukemia (AML); however, the relationship between these entities is poorly understood. This retrospective multi-institutional cohort study compared 43 MS with NPM1 mutation to 106 AML with NPM1 mutation. Compared to AML, MS had more frequent cytogenetic abnormalities including complex karyotype (p = .009 and p = .007, respectively) and was enriched in mutations of genes involved in histone modification, including ASXL1 (p = .007 and p = .008, respectively). AML harbored a higher average number of gene mutations (p = .002) including more frequent PTPN11 mutations (p < .001) and mutations of DNA-methylating genes including DNMT3A and IDH1 (both p < .001). MS had significantly shorter overall survival (OS) than AML (median OS: 44.9 vs. 93.2 months, respectively, p = .037). MS with NPM1 mutation has a unique genetic landscape, and poorer OS, compared to AML with NPM1 mutation.
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Affiliation(s)
- Maximiliano Ramia de Cap
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- North Bristol NHS Trust, Bristol, UK
| | - Leo P Wu
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christian Hirt
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - German A Pihan
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Wayne Tam
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - Philipp W Raess
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | | | - Damodaran Narayanan
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Elizabeth A Morgan
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Geraldine S Pinkus
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Emily F Mason
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric D Hsi
- Wake Forest Baptist Health, Winston-Salem, NC, USA
| | | | - Laura Toth
- Department of Pathology, The University of New Mexico, Albuquerque, NM, USA
| | - Kathryn Foucar
- Department of Pathology, The University of New Mexico, Albuquerque, NM, USA
| | | | - Adam Bagg
- Department of Pathology, University of Pennsylvania, Philadelphia, PA, USA
| | - Anton Rets
- ARUP Laboratories, Salt Lake City, UT, USA
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Tracy I George
- ARUP Laboratories, Salt Lake City, UT, USA
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Attilio Orazi
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Robert P Hasserjian
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
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Ramia de Cap M, Jou D, Chen Y, Hecht JL, VanderLaan PA, Chen AL. Impact of a Modified HistoGel Method for Processing Endocervical Curettage Specimens on Diagnostic Yield. Am J Clin Pathol 2021; 155:141-147. [PMID: 33009570 DOI: 10.1093/ajcp/aqaa125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Endocervical curettage (ECC) specimens may be limited by scant tissue. We evaluated whether a cellular concentration processing method could improve their diagnostic quality. METHODS Between October 2018 and June 2019, ECC specimens were assigned chronologically to one of two groups: nonconcentrated ECC (NECC) or concentrated ECC (CECC). NECC specimens underwent routine histologic processing. CECC specimens were processed using a published HistoGel-based cell block method. We reviewed diagnoses for ECCs, concurrent cervical biopsies and/or loop electrosurgical excision procedures (LEEPs), and preceding Papanicolaou (Pap) smears. We performed multivariate logistic regression analyses to evaluate the impact of processing method on ECC adequacy and discordance between Pap smear and worst tissue diagnoses. RESULTS NECC and CECC adequacy was 88.2% and 84.7% (P = .06). ECC adequacy was greater if concurrent biopsy/LEEP was performed (odds ratio [OR] = 1.76, P < .01). Discordance between Pap smear and worst tissue diagnoses was 9.5% and 13.3% (P = .04) for cases with NECC and CECC processing, although processing method was not significant in multivariate analysis (OR = 0.74, P = .11). Adequate ECC sampling and concurrent biopsy/LEEP were independently associated with concordance between Pap smear and worst tissue diagnosis (OR = 0.46, P < .01 and OR = 0.65, P = .02). CONCLUSIONS ECC processing method did not significantly affect either specimen adequacy (P = .06) or diagnostic discordance (P = .11) when controlled for other factors.
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Affiliation(s)
| | - David Jou
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Yigu Chen
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Athena L Chen
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
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