BACKGROUND The mixed lineage leukemia(MLL)-eleven-nineteen lysine-rich leukemia(ELL)fusion gene is a rare occurrence among the various MLL fusion genes.We present the first case in which myeloid sarcoma(MS)was the onl...BACKGROUND The mixed lineage leukemia(MLL)-eleven-nineteen lysine-rich leukemia(ELL)fusion gene is a rare occurrence among the various MLL fusion genes.We present the first case in which myeloid sarcoma(MS)was the only manifestation of adult MLL-ELL-positive acute myeloid leukemia(AML).CASE SUMMARY We report a case of a 33-year-old male patient who was admitted in June 2022 with a right occipital area mass measuring approximately 7 cm×8 cm.Blood work was normal.The patient underwent right occipital giant subscalp mass excision and incisional flap grafting.Immunohistochemistry was positive for myeloperoxidase,CD43 and CD45 and negative for CD3,CD20,CD34,and CD56.The bone marrow aspirate showed hypercellularity with 20%myeloblasts.Flow cytometry showed that myeloblasts accounted for 27.21%of the nucleated cells,which expressed CD33,CD38,and CD117.The karyotype was 46,XY,t(11,19)(q23;p13.1),-12,+mar/46,XY.Next-generation sequencing showed a fusion of MLL exon 7 to exon 2 of ELL.A diagnosis of MLL-ELL-positive AML(M2 subtype)with subcutaneous MS was made.CONCLUSION MLL-ELL-positive AML with MS is a rare clinical entity.Additional research is needed to elucidate the molecular mechanisms of the pathogenesis of MS.展开更多
BACKGROUND Myeloid sarcoma(MS)rarely occurs in acute promyelocytic leukemia(APL)at onset,but it can develop in relapse cases,especially after APL treated with alltrans retinoic acid(ATRA).Therefore little is known abo...BACKGROUND Myeloid sarcoma(MS)rarely occurs in acute promyelocytic leukemia(APL)at onset,but it can develop in relapse cases,especially after APL treated with alltrans retinoic acid(ATRA).Therefore little is known about the clinical features and suitable treatment for APL related MS due to the rarity of the disease,although this may be different from the treatment and prognosis of MS in the relapse stage.To our best knowledge,this is the second case report of APL initial presentation as colon MS.CASE SUMMARY A 77-year-old woman complained of intermittent right lower abdominal pain,black stool,and difficult defecation for 2 mo.Physical examination showed diffuse tenderness during deep palpation and an anemic appearance.Laboratory findings showed positivity for fecal occult blood testing;white blood cell count:3.84×109/L;hemoglobin:105 g/L;platelet count:174×109/L;and negativity for tumor markers.Abdominal enhanced computed tomography showed a space occupying lesion in the colon(1.9 cm).Fibrocolonoscopy revealed a polypoid and ulcerated mass measuring 2.5 cm.The tumor was removed.To our surprise,MS was confirmed by immunohistochemistry.PML/RARαfusion gene was detected in colon specimens by fluorescent in situ hybridization and real-time reverse transcription polymerase chain reaction,which was consistent with the bone marrow.She was diagnosed as having APL related MS.A smooth and unobstructed intestinal wall was found by fibrocolonoscopy,and continuous molecular remission was confirmed in both the bone marrow and colon after four courses of ATRA+arsenic trioxide(ATO).ATRA+ATO showed a favorable therapeutic response for both APL and MS.CONCLUSION Early use of ATRA can benefit APL patients,regardless of whether MS is the first or recurrent manifestation.展开更多
BACKGROUND Myeloid sarcoma(MS),including isolated and leukaemic MS,is an extramedullary myeloid tumour.MS can involve any anatomical site,but MS of the female genital tract is rare,with the ovaries and uterine body an...BACKGROUND Myeloid sarcoma(MS),including isolated and leukaemic MS,is an extramedullary myeloid tumour.MS can involve any anatomical site,but MS of the female genital tract is rare,with the ovaries and uterine body and cervix being the most commonly seen sites.Involvement of the vagina and vulva is extremely rare.CASE SUMMARY We report a rare case of MS with involvement of the vulva and vagina and massive infiltration of the pelvic floor.A 26-year-old woman presented with a vulvar mass,irregular vaginal bleeding and night sweats.Magnetic resonance imaging demonstrated an ill-defined,irregular vulvovaginal mass with massive involvement of the paravaginal tissue,urethra,posterior wall of the bladder,and pelvic floor.The signal and enhancement of the huge mass was homogeneous without haemorrhage or necrosis.Positron emission tomography/computed tomography showed high fluorodeoxyglucose uptake by the mass.Peripheral blood count detected blast cells.Vulvovaginal mass and bone marrow biopsies were performed,and immunohistochemistry confirmed the diagnosis of acute myeloid leukaemia(M-2 type,FAB classification)and vulvovaginal MS.The patient was treated with induction chemotherapy followed by allogeneic haematopoietic stem cell transplantation,and achieved complete remission.A systemic review of the literature on vulvovaginal MS was conducted to explore this rare entity’s clinical and radiological features.CONCLUSION Vulvovaginal MS is extremely rare.Diagnosis of vulvovaginal MS can only be confirmed histopathologically.Even though its clinical and imaging presentations are nonspecific,MS should be considered in the differential diagnosis of a newly developed T2-hyperintense,homogeneously enhanced vulvovaginal mass,especially in a patient with suspected haematological malignancy.展开更多
BACKGROUND Myeloid sarcoma(MS) is relatively rare,occurring mainly in the skin and lymph nodes,and MS invasion of the ulnar nerve is particularly unusual.The main aim of this article is to present a case of MS invadin...BACKGROUND Myeloid sarcoma(MS) is relatively rare,occurring mainly in the skin and lymph nodes,and MS invasion of the ulnar nerve is particularly unusual.The main aim of this article is to present a case of MS invading the brachial plexus,causing ulnar nerve entrapment syndrome,and to further clinical understanding of the possibility of MS invasion of peripheral nerves.CASE SUMMARY We present the case of a 46-year-old man with a 13-year history of well-treated acute nonlymphocytic leukaemia who was admitted to the hospital after presenting with numbness and pain in his left little finger.The initial diagnosis was considered a simple case of nerve entrapment disease,with magnetic resonance imaging showing slightly abnormal left brachial plexus nerve alignment with local thickening,entrapment,and high signal on compression lipid images.Due to the severity of the ulnar nerve compression,we surgically investigated and cleared the entrapment and nerve tissue hyperplasia;however,subsequent pathological biopsy results revealed evidence of MS.The patient had significant relief from his neurological symptoms,with no postoperative complications,and was referred to the haemato-oncology department for further consultation about the primary disease.This is the first report of safe treatment of ulnar nerve entrapment from MS.It is intended to inform hand surgeons that nerve entrapment may be associated with extramedullary MS,as a rare presenting feature of the disease.CONCLUSION MS invasion of the brachial plexus and surrounding tissues of the upper arm,resulting in ulnar nerve entrapment and degeneration with significant neurological pain and numbness in the little finger,is uncommon.Surgical treatment significantly relieved the patient’s nerve entrapment symptoms and prevented further neurological impairment.This case is reported to highlight the rare presenting features of MS.展开更多
BACKGROUND Myeloid sarcoma(MS)is a rare hematologic malignancy defined as an extramedullary tumor of immature granulocytic cells.It can occur as primary or de novo and be associated with myelodysplasia or myeloprolife...BACKGROUND Myeloid sarcoma(MS)is a rare hematologic malignancy defined as an extramedullary tumor of immature granulocytic cells.It can occur as primary or de novo and be associated with myelodysplasia or myeloproliferative neoplasms.The most frequent locations are the skin,lymph nodes and bones.The case of a patient with a diagnosis of primary granulocytic de novo gastric MS is reported.CASE SUMMARY A 19-year-old female patient with MS,whose abdominal computed tomography showed a bulky tumor of 16.5 cm in the gastric chamber with infiltration in the retroperitoneal,pancreatic and bile duct region;the histological study showed gastric mucosa diffusely infiltrated by mononucleated cells and the immunohistochemistry expressed myeloperoxidase.After receiving induction chemotherapy based on the 3+7 regimen(daunorubicin/cytarabine),the patient developed severe hematological toxicity and neutropenic typhlitis which required a prolonged medical treatment.She presented a rapid disease progression.Although she received supportive treatment,the patient died.CONCLUSION Gastric primary de novo MS is a rare and aggressive course neoplasm,fostering knowledge is very important to decide its management and to promote more approaches focused on understanding this pathology and its particularities in our population.展开更多
Granulocytic or myeloid sarcoma (MS) is a rare neoplastic condition consisting of a tumor mass of myeloid blasts with or without maturation occurring at an anatomical site other than the bone marrow the association be...Granulocytic or myeloid sarcoma (MS) is a rare neoplastic condition consisting of a tumor mass of myeloid blasts with or without maturation occurring at an anatomical site other than the bone marrow the association between tuberculosis and MS is extremely rare. A 21-year-old female patient presented cough, sore throat and a suppurative swollen gum for 10 days prior to hospital admission. Physical examination revealed moderate pallor and swollen inferior gum. CBC revealed Hb6.5 g/dL, hematocrit 18.4% MCV 97 fL MCH 34 pg, WBC 18.5 ′ 109/μL (1 My/3 Bt/69 Sg/1 Eo/0 Ba/20 Ly/6 Mo), Platelets 43 ′ 109/μL. The peripheral blood smear presented with 3% blast cells (type 1) and granulocytic dysplasia. Bone marrow biopsy showed 100% cellularity. 50% of cells were from granulocytic precursors, diagnosis of granulocytic sarcoma. The diagnosis of AML was established: granulocytic sarcoma with massive gum infiltration (immature granulocytic cells) and 10% of blasts in bone marrow. The patient received induction chemotherapy (3 + 7 daunorubicin 90 mg/m2), and gum tissue culture was positive for Mycobacterium tuberculosis. Simultaneously, a qRT- PCR test confirmed the same bacteria in the gum tissue. Patient treated with isoniazid, rifampicin, pyrazinamide and ethambutol ciprofloxacin and amikacin). Remission was achieved and the patient was submitted for consolidation/ intensification (HiDAC x3) schema and referred to allogeneic HSCT. After induction and full hematological recovery there was no further evidence or recurrence of fever and lytic lesions. Currently patient is under CR and ling follow up (48 months) did not show recurrence of either AML or tuberculosis.展开更多
Myeloid sarcomas(MS)involve extramedullary blast proliferation from one or more myeloid lineages thatreplace the original tissue architecture,and these neoplasias are called granulocytic sarcomas,chloromas or extramed...Myeloid sarcomas(MS)involve extramedullary blast proliferation from one or more myeloid lineages thatreplace the original tissue architecture,and these neoplasias are called granulocytic sarcomas,chloromas or extramedullary myeloid tumors.Such tumors develop in lymphoid organs,bones(e.g.,skulls and orbits),skin,soft tissue,various mucosae,organs,and the central nervous system.Gastrointestinal(GI)involvement is rare,while the occurrence of myeloid sarcomas in patients without leukemia is even rare.Here,we report a case of a 38-year-old man who presented with epigastric pain and progressive jaundice.An upper GI endoscopy had shown extensive multifocal hyperemic fold thickening and the spread of nodular lesions in the body of the stomach.Biopsies from the gastric lesions indicated myeloid sarcoma of the stomach.However,concurrent peripheral blood and bone marrow examinations showed no evidence of acute myeloid leukemia.For diagnosis,the immunohistochemical markers must be checked when evaluating a suspected myeloid sarcoma case.Accurate MS diagnosis determines the appropriate therapy and prognosis.展开更多
Myeloid sarcoma(MS) is a type of extramedullary solid haematological tumour. Myeloid sarcoma is classified into two types based on whether onset of the disease is complicated by haematologic diseases: extramedullary i...Myeloid sarcoma(MS) is a type of extramedullary solid haematological tumour. Myeloid sarcoma is classified into two types based on whether onset of the disease is complicated by haematologic diseases: extramedullary infiltration of leukaemia(leukaemic MS) and isolated myeloid sarcoma. The incidence of isolated myeloid sarcoma is low. In particular, isolated myeloid sarcoma involving the pancreas is extremely rare and prone to misdiagnosis. This case report describes the long and eventful diagnostic process of a case of myeloid sarcoma involving the pancreas and orbit. Due to a lack of typical clinical manifestations and imaging characteristics, the patient underwent several rounds of treatment without a confirmed diagnosis. Eventually, the final diagnosis was pathologically confirmed using several types of biopsies and immunohistochemical detection. To date, this type of disease has not been reported in the literature. This case report describes the detailed diagnostic process and discusses the strategies used for diagnosis, which will facilitate the diagnosis of such diseases in the future.展开更多
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....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.展开更多
Myeloid sarcoma(MS)is a rare hematological neoplasm that develops either de novo or concurrently with acute myeloid leukemia(AML).This neoplasm can also be an initial manifestation of relapse in a previously treated A...Myeloid sarcoma(MS)is a rare hematological neoplasm that develops either de novo or concurrently with acute myeloid leukemia(AML).This neoplasm can also be an initial manifestation of relapse in a previously treated AML that is in remission.A 44-year-old male patient was diagnosed with testis MS in a local hospital in August 2010.After one month,bone marrow biopsy and aspiration confirmed the diagnosis of AML.Allogeneic mobilization peripheral blood stem cell transplantation was performed,with the sister of the patient as donor,after complete remission(CR)was achieved by chemotherapy.Five months after treatment,an adrenal mass was detected by positron emission tomography-computed tomography(PET-CT).Radiotherapy was performed for the localized mass after a multidisciplinary team(MDT)discussion.The patient is still alive as of May 2013,with no evidence of recurrent MS or leukemia.展开更多
Myeloid sarcoma occurs in 1% - 9% of patients with myelogenous leukemia. Spinal epidural myeloid sarcoma is particularly rare, and its treatment has not been established. A 27-year-old woman complained of pain on her ...Myeloid sarcoma occurs in 1% - 9% of patients with myelogenous leukemia. Spinal epidural myeloid sarcoma is particularly rare, and its treatment has not been established. A 27-year-old woman complained of pain on her left chest, back around the scapula, and neck. Magnetic resonance imaging (MRI) showed a thoracic epidural tumor. One week after her visit, she developed motor weakness of her lower extremities and dysuria, and she was diagnosed with acute myelogenous leukemia (AML) on peripheral blood analysis. The epidural tumor was strongly suspected to be myeloid sarcoma. The paralysis of the lower extremities and bladder dysfunction were not progressive, and chemotherapy and local radiation therapy to the spine were performed. Improvement of paralysis and complete reduction of tumor volume were achieved by the combination of local low-dose radiation therapy and chemotherapy.展开更多
We are presenting the case of a 42-year-old ?male patient, who was hospitalized due to an acute small bowel obstruction caused by a tissue mass of the mesentery. The patient reported that he had a history of a testicu...We are presenting the case of a 42-year-old ?male patient, who was hospitalized due to an acute small bowel obstruction caused by a tissue mass of the mesentery. The patient reported that he had a history of a testicular tumour. For therapy of intestinal obstruction as well as for diagnostic reasons we decided to perform ?an explorative laparotomy. On histopathological examination the immunohistological staining was positive for myeloperoxidase (MPO) and KP-1 (CD68). Staining was slightly positive for Bcl-2, CD117, CD34, but negative for CD3, CD4, CD5, CD8, CD20, CD30, CD79, Bcl-6 and S-100. This leads to the diagnosis of a myeloid sarcoma. After recovery from surgery and chemotherapy, allogenic bone marrow transplantation was performed. Most intestinal obstructions are caused by postoperative adhesions or hernias and only in rare cases caused by a myeloid sarcoma.展开更多
Myeloid sarcoma(MS)is a rare solid tumor,and the diagnose is ambiguity.On account of the rarity of MS,it is often misdiagnosed.In order to promote clinicians to have a better understanding of the disease,a case of iso...Myeloid sarcoma(MS)is a rare solid tumor,and the diagnose is ambiguity.On account of the rarity of MS,it is often misdiagnosed.In order to promote clinicians to have a better understanding of the disease,a case of isolated myeloid sarcoma of the pancreas has been admitted by the Center for Pancreas,the First Affiliated Hospital of Nanjing Medical University.A 36-year-old male patient presented to our department with recurrent postprandial abdominal distension and pain,and weight loss.The initial radiologic diagnose of the lesion was pancreatic cancer and a pancreatectomy was performed.Eventually,the histopathology result confirmed the final diagnosis:myeloid sarcoma(MS).To date,this type of disease has hardly been reported in the literature.This case report describes the diagnostic and treatment process and discusses the better way for diagnosis,which will guide such diseases in the future.展开更多
Small bowel tumors and Crohn's disease are common causes of small bowel obstruction.Early stage neoplasms can easily be mistaken for Crohn's disease.Therefore,thorough work-ups including imaging studies and en...Small bowel tumors and Crohn's disease are common causes of small bowel obstruction.Early stage neoplasms can easily be mistaken for Crohn's disease.Therefore,thorough work-ups including imaging studies and endoscopic evaluation with biopsies are critical for accurate diagnosis.Here we report a case of an otherwise healthy female with progressive onset of multiple,recurrent obstructive symptoms secondary to terminal ileal narrowing who was referred for management of steroid-dependent Crohn's disease.After thorough evaluation,the diagnosis was revised to myeloid granulocytic sarcoma involving the terminal ileum.In this case,a delay in diagnosis can be detrimental for prognosis,as myeloid granulocytic sarcoma is highly predictive of underlying acute myeloid leukemia and needs urgent referral for chemotherapy and/or resection.展开更多
A25-year-old woman presented with a lump in the vulva associated with progressive difficulty in urination that had persisted for approximately half a year.A diagnosis of Bartholin's abscess had been made in anothe...A25-year-old woman presented with a lump in the vulva associated with progressive difficulty in urination that had persisted for approximately half a year.A diagnosis of Bartholin's abscess had been made in another hospital.Incision revealed no pus and ultrasonography showed a solid lesion in the left vulva.Partial excision of the tumor was implemented and histopathology showed a small round cell tumor.There were no other significant findings in her present or past medical history.She was admitted to our hospital with vulvar cancer.On gynecological examination,a 7 cm × 6 cm firm,hard,painless mass was found in the left labium majora.The right labium was inflamed but painless.Results of hematological investigations were mild anemia,with hemoglobin 84 g/L,red blood cell count 2.7× 109/L,white blood cell count 6.53×109/L and platelet count 195× 109/L.Magnetic resonance imaging revealed vulvar cancer with lymphadenopathy in the pelvic cavity.展开更多
Granulocytic sarcoma is an uncommon and localized extramedullary tumor composed of immature granu-locytic cells.It may present in association with acute myeloid leukaemia,myelodysplastic syndrome and chronic myelogeno...Granulocytic sarcoma is an uncommon and localized extramedullary tumor composed of immature granu-locytic cells.It may present in association with acute myeloid leukaemia,myelodysplastic syndrome and chronic myelogenous leukaemia.Granulocytic sarcoma may occur in any anatomical site but involvement of the gastrointestinal tract is rare,especially in the rectum.We report on the case of a 17 year old female who presented with rectal bleeding,abdominal pain and weight loss one mo prior to admission.Recto-sigmoidoscopy revealed a rectal polypoid and ulcerated mass.The histological examination of the mass showed granulocytic sarcoma.Bone marrow examination was compatible with acute promyelocytic leukaemia(FABtype M3).This case report is a reminder of this peculiar sign of tumoral syndrome in acute myeloid leukaemia.We also discuss diagnostic methods and analyze the disease course.展开更多
IntroductionIn this paper we present a case of monocytic sarcoma of the vertebralcanal with a review of relevant literature references.According to the extensive morphological
基金Supported by Scientific Research Project of Anhui Provincial Health Commission,No.AHWJ2021b005.
文摘BACKGROUND The mixed lineage leukemia(MLL)-eleven-nineteen lysine-rich leukemia(ELL)fusion gene is a rare occurrence among the various MLL fusion genes.We present the first case in which myeloid sarcoma(MS)was the only manifestation of adult MLL-ELL-positive acute myeloid leukemia(AML).CASE SUMMARY We report a case of a 33-year-old male patient who was admitted in June 2022 with a right occipital area mass measuring approximately 7 cm×8 cm.Blood work was normal.The patient underwent right occipital giant subscalp mass excision and incisional flap grafting.Immunohistochemistry was positive for myeloperoxidase,CD43 and CD45 and negative for CD3,CD20,CD34,and CD56.The bone marrow aspirate showed hypercellularity with 20%myeloblasts.Flow cytometry showed that myeloblasts accounted for 27.21%of the nucleated cells,which expressed CD33,CD38,and CD117.The karyotype was 46,XY,t(11,19)(q23;p13.1),-12,+mar/46,XY.Next-generation sequencing showed a fusion of MLL exon 7 to exon 2 of ELL.A diagnosis of MLL-ELL-positive AML(M2 subtype)with subcutaneous MS was made.CONCLUSION MLL-ELL-positive AML with MS is a rare clinical entity.Additional research is needed to elucidate the molecular mechanisms of the pathogenesis of MS.
基金Supported by the National Natural Science Foundation of China(General Program),No.81170519.
文摘BACKGROUND Myeloid sarcoma(MS)rarely occurs in acute promyelocytic leukemia(APL)at onset,but it can develop in relapse cases,especially after APL treated with alltrans retinoic acid(ATRA).Therefore little is known about the clinical features and suitable treatment for APL related MS due to the rarity of the disease,although this may be different from the treatment and prognosis of MS in the relapse stage.To our best knowledge,this is the second case report of APL initial presentation as colon MS.CASE SUMMARY A 77-year-old woman complained of intermittent right lower abdominal pain,black stool,and difficult defecation for 2 mo.Physical examination showed diffuse tenderness during deep palpation and an anemic appearance.Laboratory findings showed positivity for fecal occult blood testing;white blood cell count:3.84×109/L;hemoglobin:105 g/L;platelet count:174×109/L;and negativity for tumor markers.Abdominal enhanced computed tomography showed a space occupying lesion in the colon(1.9 cm).Fibrocolonoscopy revealed a polypoid and ulcerated mass measuring 2.5 cm.The tumor was removed.To our surprise,MS was confirmed by immunohistochemistry.PML/RARαfusion gene was detected in colon specimens by fluorescent in situ hybridization and real-time reverse transcription polymerase chain reaction,which was consistent with the bone marrow.She was diagnosed as having APL related MS.A smooth and unobstructed intestinal wall was found by fibrocolonoscopy,and continuous molecular remission was confirmed in both the bone marrow and colon after four courses of ATRA+arsenic trioxide(ATO).ATRA+ATO showed a favorable therapeutic response for both APL and MS.CONCLUSION Early use of ATRA can benefit APL patients,regardless of whether MS is the first or recurrent manifestation.
文摘BACKGROUND Myeloid sarcoma(MS),including isolated and leukaemic MS,is an extramedullary myeloid tumour.MS can involve any anatomical site,but MS of the female genital tract is rare,with the ovaries and uterine body and cervix being the most commonly seen sites.Involvement of the vagina and vulva is extremely rare.CASE SUMMARY We report a rare case of MS with involvement of the vulva and vagina and massive infiltration of the pelvic floor.A 26-year-old woman presented with a vulvar mass,irregular vaginal bleeding and night sweats.Magnetic resonance imaging demonstrated an ill-defined,irregular vulvovaginal mass with massive involvement of the paravaginal tissue,urethra,posterior wall of the bladder,and pelvic floor.The signal and enhancement of the huge mass was homogeneous without haemorrhage or necrosis.Positron emission tomography/computed tomography showed high fluorodeoxyglucose uptake by the mass.Peripheral blood count detected blast cells.Vulvovaginal mass and bone marrow biopsies were performed,and immunohistochemistry confirmed the diagnosis of acute myeloid leukaemia(M-2 type,FAB classification)and vulvovaginal MS.The patient was treated with induction chemotherapy followed by allogeneic haematopoietic stem cell transplantation,and achieved complete remission.A systemic review of the literature on vulvovaginal MS was conducted to explore this rare entity’s clinical and radiological features.CONCLUSION Vulvovaginal MS is extremely rare.Diagnosis of vulvovaginal MS can only be confirmed histopathologically.Even though its clinical and imaging presentations are nonspecific,MS should be considered in the differential diagnosis of a newly developed T2-hyperintense,homogeneously enhanced vulvovaginal mass,especially in a patient with suspected haematological malignancy.
文摘BACKGROUND Myeloid sarcoma(MS) is relatively rare,occurring mainly in the skin and lymph nodes,and MS invasion of the ulnar nerve is particularly unusual.The main aim of this article is to present a case of MS invading the brachial plexus,causing ulnar nerve entrapment syndrome,and to further clinical understanding of the possibility of MS invasion of peripheral nerves.CASE SUMMARY We present the case of a 46-year-old man with a 13-year history of well-treated acute nonlymphocytic leukaemia who was admitted to the hospital after presenting with numbness and pain in his left little finger.The initial diagnosis was considered a simple case of nerve entrapment disease,with magnetic resonance imaging showing slightly abnormal left brachial plexus nerve alignment with local thickening,entrapment,and high signal on compression lipid images.Due to the severity of the ulnar nerve compression,we surgically investigated and cleared the entrapment and nerve tissue hyperplasia;however,subsequent pathological biopsy results revealed evidence of MS.The patient had significant relief from his neurological symptoms,with no postoperative complications,and was referred to the haemato-oncology department for further consultation about the primary disease.This is the first report of safe treatment of ulnar nerve entrapment from MS.It is intended to inform hand surgeons that nerve entrapment may be associated with extramedullary MS,as a rare presenting feature of the disease.CONCLUSION MS invasion of the brachial plexus and surrounding tissues of the upper arm,resulting in ulnar nerve entrapment and degeneration with significant neurological pain and numbness in the little finger,is uncommon.Surgical treatment significantly relieved the patient’s nerve entrapment symptoms and prevented further neurological impairment.This case is reported to highlight the rare presenting features of MS.
文摘BACKGROUND Myeloid sarcoma(MS)is a rare hematologic malignancy defined as an extramedullary tumor of immature granulocytic cells.It can occur as primary or de novo and be associated with myelodysplasia or myeloproliferative neoplasms.The most frequent locations are the skin,lymph nodes and bones.The case of a patient with a diagnosis of primary granulocytic de novo gastric MS is reported.CASE SUMMARY A 19-year-old female patient with MS,whose abdominal computed tomography showed a bulky tumor of 16.5 cm in the gastric chamber with infiltration in the retroperitoneal,pancreatic and bile duct region;the histological study showed gastric mucosa diffusely infiltrated by mononucleated cells and the immunohistochemistry expressed myeloperoxidase.After receiving induction chemotherapy based on the 3+7 regimen(daunorubicin/cytarabine),the patient developed severe hematological toxicity and neutropenic typhlitis which required a prolonged medical treatment.She presented a rapid disease progression.Although she received supportive treatment,the patient died.CONCLUSION Gastric primary de novo MS is a rare and aggressive course neoplasm,fostering knowledge is very important to decide its management and to promote more approaches focused on understanding this pathology and its particularities in our population.
文摘Granulocytic or myeloid sarcoma (MS) is a rare neoplastic condition consisting of a tumor mass of myeloid blasts with or without maturation occurring at an anatomical site other than the bone marrow the association between tuberculosis and MS is extremely rare. A 21-year-old female patient presented cough, sore throat and a suppurative swollen gum for 10 days prior to hospital admission. Physical examination revealed moderate pallor and swollen inferior gum. CBC revealed Hb6.5 g/dL, hematocrit 18.4% MCV 97 fL MCH 34 pg, WBC 18.5 ′ 109/μL (1 My/3 Bt/69 Sg/1 Eo/0 Ba/20 Ly/6 Mo), Platelets 43 ′ 109/μL. The peripheral blood smear presented with 3% blast cells (type 1) and granulocytic dysplasia. Bone marrow biopsy showed 100% cellularity. 50% of cells were from granulocytic precursors, diagnosis of granulocytic sarcoma. The diagnosis of AML was established: granulocytic sarcoma with massive gum infiltration (immature granulocytic cells) and 10% of blasts in bone marrow. The patient received induction chemotherapy (3 + 7 daunorubicin 90 mg/m2), and gum tissue culture was positive for Mycobacterium tuberculosis. Simultaneously, a qRT- PCR test confirmed the same bacteria in the gum tissue. Patient treated with isoniazid, rifampicin, pyrazinamide and ethambutol ciprofloxacin and amikacin). Remission was achieved and the patient was submitted for consolidation/ intensification (HiDAC x3) schema and referred to allogeneic HSCT. After induction and full hematological recovery there was no further evidence or recurrence of fever and lytic lesions. Currently patient is under CR and ling follow up (48 months) did not show recurrence of either AML or tuberculosis.
基金Supported by the National Natural Science Foundation of China,No.81370511the Natural Science Foundation of Guangdong Province,No.S2011020002348Fundamental Research Funds for the Central Universities,No.82000-3281901
文摘Myeloid sarcomas(MS)involve extramedullary blast proliferation from one or more myeloid lineages thatreplace the original tissue architecture,and these neoplasias are called granulocytic sarcomas,chloromas or extramedullary myeloid tumors.Such tumors develop in lymphoid organs,bones(e.g.,skulls and orbits),skin,soft tissue,various mucosae,organs,and the central nervous system.Gastrointestinal(GI)involvement is rare,while the occurrence of myeloid sarcomas in patients without leukemia is even rare.Here,we report a case of a 38-year-old man who presented with epigastric pain and progressive jaundice.An upper GI endoscopy had shown extensive multifocal hyperemic fold thickening and the spread of nodular lesions in the body of the stomach.Biopsies from the gastric lesions indicated myeloid sarcoma of the stomach.However,concurrent peripheral blood and bone marrow examinations showed no evidence of acute myeloid leukemia.For diagnosis,the immunohistochemical markers must be checked when evaluating a suspected myeloid sarcoma case.Accurate MS diagnosis determines the appropriate therapy and prognosis.
文摘Myeloid sarcoma(MS) is a type of extramedullary solid haematological tumour. Myeloid sarcoma is classified into two types based on whether onset of the disease is complicated by haematologic diseases: extramedullary infiltration of leukaemia(leukaemic MS) and isolated myeloid sarcoma. The incidence of isolated myeloid sarcoma is low. In particular, isolated myeloid sarcoma involving the pancreas is extremely rare and prone to misdiagnosis. This case report describes the long and eventful diagnostic process of a case of myeloid sarcoma involving the pancreas and orbit. Due to a lack of typical clinical manifestations and imaging characteristics, the patient underwent several rounds of treatment without a confirmed diagnosis. Eventually, the final diagnosis was pathologically confirmed using several types of biopsies and immunohistochemical detection. To date, this type of disease has not been reported in the literature. This case report describes the detailed diagnostic process and discusses the strategies used for diagnosis, which will facilitate the diagnosis of such diseases in the future.
文摘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.
文摘Myeloid sarcoma(MS)is a rare hematological neoplasm that develops either de novo or concurrently with acute myeloid leukemia(AML).This neoplasm can also be an initial manifestation of relapse in a previously treated AML that is in remission.A 44-year-old male patient was diagnosed with testis MS in a local hospital in August 2010.After one month,bone marrow biopsy and aspiration confirmed the diagnosis of AML.Allogeneic mobilization peripheral blood stem cell transplantation was performed,with the sister of the patient as donor,after complete remission(CR)was achieved by chemotherapy.Five months after treatment,an adrenal mass was detected by positron emission tomography-computed tomography(PET-CT).Radiotherapy was performed for the localized mass after a multidisciplinary team(MDT)discussion.The patient is still alive as of May 2013,with no evidence of recurrent MS or leukemia.
文摘Myeloid sarcoma occurs in 1% - 9% of patients with myelogenous leukemia. Spinal epidural myeloid sarcoma is particularly rare, and its treatment has not been established. A 27-year-old woman complained of pain on her left chest, back around the scapula, and neck. Magnetic resonance imaging (MRI) showed a thoracic epidural tumor. One week after her visit, she developed motor weakness of her lower extremities and dysuria, and she was diagnosed with acute myelogenous leukemia (AML) on peripheral blood analysis. The epidural tumor was strongly suspected to be myeloid sarcoma. The paralysis of the lower extremities and bladder dysfunction were not progressive, and chemotherapy and local radiation therapy to the spine were performed. Improvement of paralysis and complete reduction of tumor volume were achieved by the combination of local low-dose radiation therapy and chemotherapy.
文摘We are presenting the case of a 42-year-old ?male patient, who was hospitalized due to an acute small bowel obstruction caused by a tissue mass of the mesentery. The patient reported that he had a history of a testicular tumour. For therapy of intestinal obstruction as well as for diagnostic reasons we decided to perform ?an explorative laparotomy. On histopathological examination the immunohistological staining was positive for myeloperoxidase (MPO) and KP-1 (CD68). Staining was slightly positive for Bcl-2, CD117, CD34, but negative for CD3, CD4, CD5, CD8, CD20, CD30, CD79, Bcl-6 and S-100. This leads to the diagnosis of a myeloid sarcoma. After recovery from surgery and chemotherapy, allogenic bone marrow transplantation was performed. Most intestinal obstructions are caused by postoperative adhesions or hernias and only in rare cases caused by a myeloid sarcoma.
文摘Myeloid sarcoma(MS)is a rare solid tumor,and the diagnose is ambiguity.On account of the rarity of MS,it is often misdiagnosed.In order to promote clinicians to have a better understanding of the disease,a case of isolated myeloid sarcoma of the pancreas has been admitted by the Center for Pancreas,the First Affiliated Hospital of Nanjing Medical University.A 36-year-old male patient presented to our department with recurrent postprandial abdominal distension and pain,and weight loss.The initial radiologic diagnose of the lesion was pancreatic cancer and a pancreatectomy was performed.Eventually,the histopathology result confirmed the final diagnosis:myeloid sarcoma(MS).To date,this type of disease has hardly been reported in the literature.This case report describes the diagnostic and treatment process and discusses the better way for diagnosis,which will guide such diseases in the future.
文摘Small bowel tumors and Crohn's disease are common causes of small bowel obstruction.Early stage neoplasms can easily be mistaken for Crohn's disease.Therefore,thorough work-ups including imaging studies and endoscopic evaluation with biopsies are critical for accurate diagnosis.Here we report a case of an otherwise healthy female with progressive onset of multiple,recurrent obstructive symptoms secondary to terminal ileal narrowing who was referred for management of steroid-dependent Crohn's disease.After thorough evaluation,the diagnosis was revised to myeloid granulocytic sarcoma involving the terminal ileum.In this case,a delay in diagnosis can be detrimental for prognosis,as myeloid granulocytic sarcoma is highly predictive of underlying acute myeloid leukemia and needs urgent referral for chemotherapy and/or resection.
文摘A25-year-old woman presented with a lump in the vulva associated with progressive difficulty in urination that had persisted for approximately half a year.A diagnosis of Bartholin's abscess had been made in another hospital.Incision revealed no pus and ultrasonography showed a solid lesion in the left vulva.Partial excision of the tumor was implemented and histopathology showed a small round cell tumor.There were no other significant findings in her present or past medical history.She was admitted to our hospital with vulvar cancer.On gynecological examination,a 7 cm × 6 cm firm,hard,painless mass was found in the left labium majora.The right labium was inflamed but painless.Results of hematological investigations were mild anemia,with hemoglobin 84 g/L,red blood cell count 2.7× 109/L,white blood cell count 6.53×109/L and platelet count 195× 109/L.Magnetic resonance imaging revealed vulvar cancer with lymphadenopathy in the pelvic cavity.
文摘Granulocytic sarcoma is an uncommon and localized extramedullary tumor composed of immature granu-locytic cells.It may present in association with acute myeloid leukaemia,myelodysplastic syndrome and chronic myelogenous leukaemia.Granulocytic sarcoma may occur in any anatomical site but involvement of the gastrointestinal tract is rare,especially in the rectum.We report on the case of a 17 year old female who presented with rectal bleeding,abdominal pain and weight loss one mo prior to admission.Recto-sigmoidoscopy revealed a rectal polypoid and ulcerated mass.The histological examination of the mass showed granulocytic sarcoma.Bone marrow examination was compatible with acute promyelocytic leukaemia(FABtype M3).This case report is a reminder of this peculiar sign of tumoral syndrome in acute myeloid leukaemia.We also discuss diagnostic methods and analyze the disease course.
文摘IntroductionIn this paper we present a case of monocytic sarcoma of the vertebralcanal with a review of relevant literature references.According to the extensive morphological
