Acute Megakaryoblastic Leukemia Simulating Carcinoma

Ashfaq, Raheela; Weinberg, Arthur G.; Argyle, Craig

doi:10.1093/ajcp/98.1.55

Cited by 19 publications

(8 citation statements)

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“…Some rather unusual findings in this study were skeletal pains from multiple osteolytic lesions [22,33,55], the presence of soft-tissue tumor [56] as in other types of AML M2, M5 [57], and of cohesive scanty clusters of 7-10 primitive-looking blast cells in BM aspirates, that may mimic metastatic solid tumors in the BM [58,59]. The presence of PDGF, TGF ␤, and fibronectin in extramedullary tumors suggests that specific expression of growth factor proteins by the leukemic cells may also selectively regulate tumor formation [60,61]. One form of differentiating the clusters of primitive-looking blast cells from the syncytial arrangement of cells of metastatic solid tumors in this study, was the finding of pseudo-rosettes consisting of megakaryoblasts, where all cells contained scant or moderate blue-gray cytoplasm, some showing central or peripheral platelet shedding.…”

Section: Discussionmentioning

confidence: 99%

Biology, clinical, and hematologic features of acute megakaryoblastic leukemia in children

et al. 2003

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To assess the incidence, clinical features at presentation, hematologic, immunophenotypic, and cytogenetic characteristics of AMKL in children we prospectively studied 834 consecutive non selected children with newly diagnosed acute leukemia (AL) admitted to the Hematology Department at the Instituto Nacional de Pediatría (INP), Mexico, D.F. We found 682 cases (81.8%) with a typical ALL immunophenotype, and the remaining 152 (18.2%) were considered to have AML. In 29 of the 152 patients with AML studied, a diagnosis of AMKL was established. These 29 cases represented 19.1% of the cases of AML and 3.48% of the total cases of AL during the time span covered by the study. Twenty-four percent of the cases occurred in infants 2 years old or younger and 41.4% occurred in children 41 months of age or younger. In contrast, in only 18.6% of the patients with AML (M0-M6), the diagnosis was established before 42 months of age and in 17% before their second year of life. Clinical presentation was not strikingly different than that observed in patients with other types of AML, and the time interval from onset of symptoms to diagnosis was also similar, though in a small subset of patients, the clinical course was characterized by a chronic slowly progressive disorder extending over weeks or months resembling smoldering leukemia or chronic myelofibrosis with agnogenic myeloid metaplasia. Bone marrow (BM) fibrosis was a constant features in our patients; 75% of the patients studied showed this complication at the time of diagnosis. Some rather unusual findings in this study were intense skeletal pains from multiple osteolytic lesions, the presence of soft-tissue tumor, and the presence of cohesive scanty clusters of primitive-looking blast cells in BM aspirates. Several interesting cytogenetic findings in our study were t(1;22)(p13;q13) in a 14-year-old boy, t(9;22)(q34;q11) in one patient, and monosomy 7 in two patients. Another important finding in our study was the clinical association with colonic adenocarcinoma in one patient, an association that to our knowledge has not been reported previously. In conclusion, our data suggest that the incidence of AMKL in Mexico might be higher than those reported in Caucasian white pediatric population, and that biologic and cytogenetic profile may differ from those of western countries, but more studies are needed to corroborate cytogenetic heterogeneity, ethnic and geographic diversity. Early onset of the disease, low WBC counts, slight thrombocytopenia or normal platelet counts, and BM fibrosis were characteristic distinctive features of at least half of the patients with this subtype of AML. Am. J. Hematol. 73:71-80, 2003.

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Section: Discussionmentioning

confidence: 99%

Biology, clinical, and hematologic features of acute megakaryoblastic leukemia in children

et al. 2003

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“…Penchansky et al reported three cases of AMKL in children with cohesive clusters of blast cell infiltration in bone marrow biopsy simulating metastatic carcinoma (7). Ashfaq et al reported an additional case of AMKL in an infant with an abdominal mass resembling epithelial malignant neoplasm (5). The exact mechanism that causes clumping of blast cells and the appearance of metastatic tumor in bone marrow aspiration and biopsy is not yet clear.…”

Section: Discussionmentioning

confidence: 99%

Acute megakaryoblastic leukemia mimicking small round cell tumor with novel t(1;5)(q21;p13). Case report

Bozkurt

Berrak

Tuğtepe

et al. 2008

APMIS

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Acute megakaryoblastic leukemia is a relatively rare form of acute leukemia that has heterogeneous blast morphology and karyotypic abnormalities. An 8-month-old boy with a retroperitoneal mass was diagnosed as having acute megakaryoblastic leukemia that initially presented as small round cell tumor of childhood. Bone marrow aspiration showed syncytial groups of atypical medium sized cells with scant cytoplasm and fine nuclear chromatin. Retroperitoneal mass biopsy showed several lymph nodes with cohesive clusters of neoplastic cells that demonstrated expression of Factor VIII. Flow cytometric analysis of the second bone marrow aspiration showed CD 61 positivity. Karyotypic analysis of bone marrow cells showed a novel translocation, (1;5)(q21;p13).

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“…Several case studies demonstrated that megakaryocytic leukemia revealed the tumor‐forming nature of blastic cells 14,15 . Some adhesion molecules could possibly be ascribed to the feature 10,16–17 . The nature of blastic cells to adhere to each other may prevent them from entering peripheral blood circulation, resulting in difficulty in clinical diagnosis of blastic transformation.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 Some adhesion molecules could possibly be ascribed to the feature. 10,[16][17] The nature of blastic cells to adhere to each other may prevent them from entering peripheral blood circulation, resulting in difficulty in clinical diagnosis of blastic transformation. Blastic transformation in our patient was not diagnosed while she was alive; however, biopsy of her bone marrow, magnetic resonance imaging (MRI) and Ga scintigram were not performed.…”

Section: Discussionmentioning

confidence: 99%

Megakaryoblastic transformation of chronic myelomonocytic leukemia presenting with severe bone pain

Sahara¹,

Inoue²,

Sunaga

et al. 2002

Geriatrics Gerontology Int

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A 77‐year‐old woman, who had suffered from osteoporosis with compression fractures of vertebrae, was admitted to our hospital because of increasing bone pain. She had anemia and monocytosis, and was diagnosed as chronic myelomonocytic leukemia (CMML). Although chemotherapy was initiated, she died from pneumonia. Autopsy revealed multiple tumors composed of megakaryoblastic cells in her bone marrow and extramedullary organs and, therefore, the pathological diagnosis was made as megakaryoblastic transformation of CMML. Severe bone pain was considered to be a symptom of megakaryoblastic transformation of CMML.

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Acute Megakaryoblastic Leukemia Simulating Carcinoma

Cited by 19 publications

References 0 publications

Biology, clinical, and hematologic features of acute megakaryoblastic leukemia in children

Biology, clinical, and hematologic features of acute megakaryoblastic leukemia in children

Acute megakaryoblastic leukemia mimicking small round cell tumor with novel t(1;5)(q21;p13). Case report

Megakaryoblastic transformation of chronic myelomonocytic leukemia presenting with severe bone pain

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