Unexpected myeloid sarcoma of the tonsil in a patient without a history of hematological neoplasm

Context.—Myeloid sarcoma of the head and neck region can pose diagnostic challenges because of the low frequency of myeloid sarcoma and the potential for tumors of almost any lineage to occur in the head and neck. Objective.—To study the clinicopathologic and immunohistochemical characteristics of myeloid sarcoma in the head and neck region and to review the differential diagnosis. Design.—We searched for cases of myeloid sarcoma involving the head and neck region for a 24-year period at our institution. The medical records and pathology slides were reviewed. Additional immunohistochemical stains were performed. Results.—We identified 17 patients, age 17 to 85 years. Most tumors involved the oral cavity. Myeloid sarcoma was the initial diagnosis in 9 patients (53%); the remaining 8 patients (47%) had a history of bone marrow disease. Immunohistochemical analysis using antibodies specific for lysozyme, CD43, and CD68 were highly sensitive for diagnosis but were not specific. By contrast, assessment for myeloperoxidase in this study was less sensitive but more specific. We also used antibodies specific for CD11c and CD33 in a subset of cases, and these reagents seem helpful as well. Conclusions.—The clinical presentation of myeloid sarcoma involving the head and neck, particularly the mouth, is often nonspecific, and a high degree of suspicion for the possibility of myeloid sarcoma is needed. Immunohistochemistry is very helpful for establishing the diagnosis.

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P.158 Feeling Green

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2021.434 ◽

2021 ◽

Vol 48 (s3) ◽

pp. S65-S65

Author(s):

A Ghare ◽

K Langdon ◽

A Andrade ◽

R Kiwan ◽

A Ranger ◽

...

Keyword(s):

Brain Parenchyma ◽

Myeloid Sarcoma ◽

Cerebellar Hemisphere ◽

Hematologic Neoplasms ◽

Short History ◽

History Of ◽

Immature Myeloid Cells ◽

Long Course ◽

The Right ◽

The Brain

Background: Myeloid sarcoma (MS) is a rare solid tumour made of myeloblasts or immature myeloid cells in an extramedullary site or in bone, associated with systemic hematologic neoplasms. When they occur in the brain parenchyma, they can often be misdiagnosed. Methods: The authors report a case of a 4-year old boy 6 months out of remission from AML, presenting with a short history of headaches and vomiting, and found to have a heterogenous contrast-enhancing lesion in the right cerebellar hemisphere, with differential diagnosis of myeloid sarcoma, astrocytoma, medulloblastoma and ATRT. Preliminary diagnosis was made flow cytometry from an intraoperative biopsy. The patient had a long course of chemotherapy and radiation, but eventually died from the systemic burden of his AML. Results: The authors present a literature review on 178 published cases of CNS myeloid sarcomas, and their radiological presentation and the basis of immunohistochemical and pathological diagnosis is discussed. Conclusions: Diagnosis rests on a combination of immunohistochemistry and histopathology of biopsied tissue. Surgical resection is controversial, especially given the efficacy of chemotherapy and radiation, and prognosis remains unclear. As with all uncommon and rare clinical entities, further investigation is warranted to determine prognosis and optimal management of CNS myeloid sarcomas.

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Therapy-Related Myeloid Sarcoma As a New Diagnostic Entity? A 10-Year Institutional Retrospective Review

Blood ◽

10.1182/blood.v122.21.2656.2656 ◽

2013 ◽

Vol 122 (21) ◽

pp. 2656-2656

Author(s):

Taylor Deal ◽

Uma Borate ◽

Shuko Harada ◽

Vishnu Reddy ◽

Deniz Peker

Keyword(s):

Breast Cancer ◽

Myeloid Sarcoma ◽

Prior History ◽

Cell Transplant ◽

Myeloid Neoplasms ◽

Significant Difference ◽

Hematological Cancers ◽

History Of ◽

Group 2 ◽

Group 1

Abstract Therapy-related myeloid neoplasms (t-MN) occur as a complication after chemotherapy (CT) and/or radiation therapy (RT) and account for approximately 10 to 20% of all cases of myeloid neoplasms. t-MN often have a high prevalence of adverse-risk karyotypes. Myeloid sarcoma (MS) is a rare form of extramedullary MN with or without coexisting acute myeloid leukemia (AML). It often has similar molecular/genetic features to AML and myelodysplastic syndrome (MDS). Therapy-related MS (t-MS) is a very rare condition and has not been fully studied. We aim to investigate the features of t-MS in comparison to non-therapy-related MS. A retrospective case review between 2003- 2013 was performed after IRB approval. Cases of MS with or without concurrent bone marrow (BM) disease were included in the study. Based on a prior history of therapy for solid or hematological cancers, patients were divided into two groups. Group 1 consisted of MS cases with a history of preceding treatment (t-MS). The remaining cases were included in Group 2. A survival analysis was performed. A total of fifty-four MS cases were included in the study. The age ranged from 25 - 92 years (median age= 56). Male to female ratio was 1.7:1. Thirty-one cases were diagnosed as leukemia cutis, and the remaining were located in other anatomical sites. Sixteen patients had no concurrent BM disease at the time of diagnosis and 17 cases had no prior MN. Cytogenetic and/or FISH data for MS were available for 28 patients. Nineteen patients had normal cytogenetics 3 of which had abnormality via FISH (PML/RARA and MLL gene rearrangements and -7q). Ten of the 54 cases were found to have a prior history of CT and/or RT for solid or hematological cancers (Table 1; Group 1). Cases with prior AML history were included in group 1 (t-MS) if there was evidence of cytogenetic and/or phenotypic evolution from the original tumor. The remaining AML cases were considered relapsed or recurrent disease and included in group 2. The median age in t-MS group was 57 (39 -88 years) and M:F ratio was 1:1. In 10 cases, the most frequent prior solid malignancy was breast cancer (n=4). Five patients had a previous diagnosis of AML of a different subtype with an interval ranging 24-96 months. The overall interval time between the prior therapy and t-MS in all cases was 41 months (ranging from 6 to 126). Eight of 10 cases had no concurrent BM involvement. Molecular studies were available in 7of the 10 patients, and 3 had detectable genetic abnormalities. The treatment for both groups included intensive induction therapy with 7&3 (anthracycline/Ara-C) with or without radiotherapy and various clinical trials. Overall Survival (OS) analysis revealed a significant difference between the two groups (P-value <0.0395). The OS for t-MS patients was significantly shorter at 10 months (ranging 2 to 32; n=10) while compared to 24 months in the remaining 44 patients (1-55 months)Table 1.Group 1 (t-MS)AgeGenderPrior CancerInitial karyotype/FISHPrior TreatmentInterval to MS (m)Location of MSBone marrow diseaseSurvival (m)CytogeneticsFISH164MAML46,XY / normalCT+ SCT32L4NO7Normal-7q239FAML-MDSN/ACT+SCT63Ethmoid sinusNO6*NormalNormal363MAMLt(8;21)CT52Vocal cordNO32NormalNormal457MAMLN/ACT+SCT46SkinAML-MDS2N/AN/A557MAML46,XYCT6SkinAML10Trisomy, tetrasomy and pentasomy of chromosome 8N/A688MLarynx caN/ASurgery+RT124Lymph node (retroperiton)NON/AN/AN/A751FBreast caN/ACT+RT30L3NO◊29NormalNormal845FBreast caN/ACT+RT23Skin (upper abdomen)NO10NormalMLL+981FBreast caN/ACT54Skin (arm)N/A8NormalN/A1043FBreast caN/ACT+RT11Skin (chest)NO◊7N/AN/AMS: Myeloid sarcoma; CT: Chemotherapy; RT: radiotherapy; SCT: stem cell transplant*Patient alive◊Patient developed AML later in the course The results of the current study demonstrate that the epidemiologic features and cytogenetic abnormalities of t-MS are somewhat similar to other MS. Breast cancer is the most commonly associated solid tumor and AML with or without recurrent cytogenetics is the most common hematologic neoplasm associated with t-MS. Despite the similarities, t-MS appears to have a much worse prognosis regardless of the karyotype. Larger scale studies with more extensive molecular analyses are warranted to understand the pathophysiology of this rare disease and to generate more effective treatments. BRAF and RAS testing are being performed and the results will be available by October 1st. Disclosures: Borate: Seattle Genetics, Inc.: Research Funding; Genoptix: Consultancy.

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Acute Myeloid Leukemia Presenting as Acute Bulbar Palsy

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v13i4.16056 ◽

2014 ◽

Vol 13 (4) ◽

pp. 481-483

Author(s):

Kiran Kumar Singal ◽

Ajay Mittal ◽

Rajni Aggarwal ◽

Saurav Aggarwal ◽

Rao Farman Khan ◽

...

Keyword(s):

Brain Stem ◽

Myeloid Leukemia ◽

Medical Science ◽

Granulocytic Sarcoma ◽

Myeloid Sarcoma ◽

History Of ◽

The Central Nervous System ◽

Immature Myeloid Cells ◽

Laboratory Investigations ◽

The Brain

Myeloid Sarcoma1 (also termed as chloroma, granulocytic sarcoma, extra medullary myeloid tumor) is a rare extra medullary tumor composed of immature myeloid cells (myeloblast)2. It is usually associated with leukemia or other myeloproliferative disorder. Myeloid Sarcoma in the central nervous system, around the brain stem is the commonest site of presentation and require high suspicion for diagnosis. We report a forty years male patient with history of dysphagia, dysphonia for last two months. MRI showed chloromas around the brain stem. Laboratory investigations revealed the presence of AML. This is a rare case of Myeloid Sarcoma around the brain stem in a patient of AML. DOI: http://dx.doi.org/10.3329/bjms.v13i4.16056 Bangladesh Journal of Medical Science Vol.13(4) 2014 p.481-483

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Primary Myeloid Sarcoma of the Prostate: A Case Report and Literature Review

Case Reports in Hematology ◽

10.1155/2018/3604298 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Ryan Nguyen ◽

Hamid Sayar

Keyword(s):

Myeloid Leukemia ◽

Bone Marrow Examination ◽

Myeloid Sarcoma ◽

Remission Induction ◽

Prior History ◽

Conventional Chemotherapy ◽

Hematologic Disorders ◽

History Of ◽

One Year ◽

Acute Myeloid

We report the case of a 73-year-old male with primary myeloid sarcoma (MS) of the prostate. He underwent remission-induction chemotherapy followed by conventional consolidation for acute myeloid leukemia (AML). One year after initial diagnosis, he was without evidence of AML, the longest reported period of time in the literature for a case of primary MS of the prostate. From 1985 to 2017, fifteen other cases of MS of the prostate have been reported and are reviewed here. Five cases occurred as primary MS, without evidence of AML on bone marrow examination or prior history of hematologic disorders, and progressed to AML within a range of three weeks to seven months. None of these cases were started on conventional chemotherapy for AML prior to progression. Due to its rarity, primary MS of the prostate is often diagnosed incidentally, but prompt AML-targeted treatment is crucial to delaying the progression to AML.

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Monoblastic Sarcoma- A Rare Case Report of Myeloid Sarcoma Variant

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/48969.14951 ◽

2021 ◽

Author(s):

Nupur Kaushik ◽

Lalit Kumar ◽

Pooja Agarwal ◽

Harendra Kumar ◽

Brijesh Sharma

Keyword(s):

Rare Case ◽

Histopathological Examination ◽

Granulocytic Sarcoma ◽

Myeloid Sarcoma ◽

Cervical Region ◽

Rare Manifestation ◽

Rare Case Report ◽

History Of ◽

Immature Myeloid Cells ◽

Normal Architecture

Myeloid sarcoma, also known as chloroma, granulocytic sarcoma, extramedullary Acute Myeloid Leukaemia (AML), myeloblastoma or extramedullary myeloid tumour, is a rare manifestation, characterised by the proliferation of immature myeloid cells, myeloblasts or monoblasts occurring as one or more tumour at an extramedullary site. It is associated with disruption of normal architecture of tissue in which it is found. Monoblastic sarcoma is a rare variant of myeloid sarcoma. Hereby, the authors report a rare case of primary monoblastic sarcoma in a 64-year-old male patient presented with complaint of swelling over right side lower cervical region. He had no history of AML. On physical examination, the swelling was over medial one-third of right clavicle measuring 6×5.8×3 cm. The swelling was excised and sent for histopathological examination, which was diagnosed as monoblastic sarcoma, and confirmed on immunohistochemistry.

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

Acta Haematologica ◽

10.1159/000444516 ◽

2016 ◽

Vol 135 (4) ◽

pp. 241-251 ◽

Cited By ~ 5

Author(s):

Kelly J. Norsworthy ◽

Bhavana Bhatnagar ◽

Zeba N. Singh ◽

Ivana Gojo

Keyword(s):

Hematologic Malignancy ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Case Series ◽

Biliary Tree ◽

Myeloid Sarcoma ◽

Review Of The Literature ◽

System A ◽

Hepatobiliary System ◽

History Of

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.

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Progressive course of isolated splenic myeloid sarcoma

Open Medicine ◽

10.2478/s11536-013-0161-x ◽

2013 ◽

Vol 8 (4) ◽

pp. 499-502

Author(s):

Darko Antic ◽

Maja Perunicic Jovanovic ◽

Djordje Knezevic ◽

Slavenko Ostojic ◽

Ivo Elezovic

Keyword(s):

Tumor Tissue ◽

Soft Tissue Mass ◽

Lactate Dehydrogenase Level ◽

Myeloid Sarcoma ◽

Pathological Examination ◽

Blood Cell Count ◽

Broad Spectrum Antibiotic ◽

Tissue Mass ◽

Superior Part ◽

History Of

AbstractA previously healthy 40-year-old male presented with a 2-week history of fever and abdominal discomfort that was resistant to empirical broad-spectrum antibiotic treatment. The patient’s blood cell count and complete biochemical panel was normal, except for an increased lactate dehydrogenase level. Ultrasonography and computed tomography of the abdomen showed a large, soft tissue mass had infiltrated superior part of the spleen. Splenectomy with total tumor mass removal were performed. The pathological examination of the tumor tissue confirmed diagnosis of isolated myeloid sarcoma with monoblastic differentiation. Despite intensive antileukemic therapy, patient died four months after diagnosis was established.

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Endovascular biopsy of a sigmoid sinus lesion using a stent retriever and aspiration catheter

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-018121 ◽

2021 ◽

pp. neurintsurg-2021-018121

Author(s):

Kasra Khatibi ◽

Hamidreza Saber ◽

Ramin Javahery ◽

Naoki Kaneko ◽

Lucido Luciano Ponce Mejia ◽

...

Keyword(s):

Sigmoid Sinus ◽

Stent Retriever ◽

Myeloid Sarcoma ◽

Pathologic Finding ◽

Cerebral Angiogram ◽

History Of ◽

Blurry Vision ◽

The Right ◽

Oncologic Treatment ◽

The Brain

A teenager with a history of acute myeloid leukemia presented with headache, nausea and blurry vision over a 2 week period. The MRI of the brain was concerning for the presence of a myeloid sarcoma within the right sigmoid sinus. For evaluation of venous obstruction and the underlying lesion the patient underwent a cerebral angiogram and transvenous biopsy of the sigmoid sinus lesion using a stent retriever and aspiration catheter. The tissue extracted was consistent with myeloid sarcoma. This pathologic finding was consistent with the recurrence of leukemia and guided the targeted oncologic treatment.

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Acute myeloid leukaemia relapse presenting as cardiac myeloid sarcoma

BMJ Case Reports ◽

10.1136/bcr-2018-224419 ◽

2018 ◽

pp. bcr-2018-224419

Author(s):

Alexander Waselewski ◽

Michael Joiner ◽

Steven Raymond Miller

Keyword(s):

Acute Myeloid Leukaemia ◽

Myeloid Leukaemia ◽

Right Atrium ◽

Residual Disease ◽

Vena Cava ◽

Myeloid Sarcoma ◽

Adjuvant Radiation ◽

History Of ◽

The Right ◽

Acute Myeloid

A 50-year-old woman previously diagnosed with acute myeloid leukaemia presented with a 3-month history of shortness of breath and a right-sided facial rash. A chest CT revealed an intracardiac mass in the right atrium extending into her superior and inferior vena cava. Surgery was performed to remove the mass and pathology was consistent with myeloid sarcoma. After surgery, adjuvant radiation therapy was directed to the residual disease. The patient eventually relapsed in other sites not including the right atrium and eventually succumbed to her disease.

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