Atypical presentation of acute myeloid leukemia: cardiac myeloid sarcoma

Rigamonti, Fabio; Beris, Photis; Sanchez-Pareja, Andrea; Meyer, Philippe; Ashrafpoor, Golmehr; Zaza, Stéphane; Passweg, Jakob; Chalandon, Yves

doi:10.1007/s12185-009-0313-6

Cited by 16 publications

(13 citation statements)

References 28 publications

(36 reference statements)

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“…Five cases had non-promyelocytic [7,9,10,13,15,16], two had acute promyelocytic leukemia [8,20] and one had AML secondary to pre-existing MDS [11]. In the cases reviewed by us, we found that apart from our case there were four cases with biopsy proven myeloid sarcoma and malignant pleural effusion without concurrent acute myeloid leukemia.…”

Section: Discussionmentioning

confidence: 51%

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Myeloid Sarcoma: An Unusual Case of Mediastinal Mass and Malignant Pleural Effusion with Review of Literature

Sahu

Tyagi

Law

et al. 2015

Indian J Hematol Blood Transfus

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Myeloid sarcoma is an extramedullary tumor seen most commonly in patients with acute myeloid leukemia and less frequently in chronic myeloid leukemia, myelodysplastic syndrome and rarely, in an isolated form without any other underlying malignancy. Malignant pleural effusion in hematological malignancies is rare when compared with solid tumors. We present an unusual case of myeloid sarcoma in which a mediastinal mass with pleural effusion was the initial presentation. A 27 year old gentleman presented with complaints of fever, chest pain and swelling in the anterior chest wall for 6 months. Examination revealed a lump measuring 5 9 5 cm on the left side of the chest wall. Hematological evaluation showed hemoglobin-14.2 g/dL, platelet count-233 9 10 9 /L, TLC-117 9 10 6 /L with normal differential counts. Contrast enhanced computerised tomography (CECT) confirmed the presence of a soft tissue mass in the superior mediastinum abutting against the chest wall. Core biopsy was suggestive of myeloid sarcoma and immunohistochemistry was positive for myeloperoxidase and negative for CD3, CD 20 and CD 23. Pleural fluid analysis showed the presence of malignant cells. Bone marrow examination did not show an excess of blasts. A final diagnosis of extramedullary myeloid sarcoma with malignant pleural effusion was made. The patient was given induction chemotherapy (3 ? 7 regimen) with daunorubicin and cytosine arabinoside. Repeat CECT done on day 28 showed complete resolution of pleural effusion and significant reduction in the size of mediastinal mass. The patient has successfully completed three cycles of consolidation therapy following which there has been complete resolution of the mass. He remains asymptomatic on close follow up. Keywords Myeloid sarcoma Á Malignant cytology Á Acute myeloid leukemia Case ReportA 27-year old gentleman presented with complaints of fever, chest pain and swelling in the anterior chest wall for 6 months. Examination showed presence of a non-tender lump (5 9 5 cm) on the left chest wall which was fixed to overlying skin. Laboratory investigations showed hemoglobin-14.2 g/dL, platelet count-233 9 10 9 /L and TLC-11.7 9 10 9 /L with differential count of 65 % neutrophils, 13 % lymphocytes, 6 % monocytes, 16 % eosinophils with normal RBC indices and peripheral blood smear. Chest X ray showed mediastinal widening with left sided moderate pleural effusion (Fig. 1). CECT chest showed soft tissue mass in superior mediastinum abutting against the chest wall (Fig. 2). Positron emission tomography (PET) scan showed increased FDG avid uptake in the superior mediastinum (Fig. 3). A core biopsy from the mass was suggestive of myeloid sarcoma. Immunohistochemistry confirmed the presence of tumor cells that were positive for myeloperoxidase stain and negative for CD3, CD 20 and CD 23 (Fig. 4). Pleural fluid staining showed scattered population of hematopoietic cells intermixed with reactive cells while high power view showed increased cellularity with abundant blasts, myelocytes, metamyelocytes, eo...

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Section: Discussionmentioning

confidence: 51%

“…Lo et al [10] reported a patient with granulocytic sarcoma of the mediastinum who presented with esophageal obstruction and compressive symptoms. The involvement of rare sites like gingival [14], peritoneum [11], pericardium [15], spine [6], thymus [16] and the head of pancreas [17] have also been reported in literature.…”

Section: Discussionmentioning

confidence: 99%

Myeloid Sarcoma: An Unusual Case of Mediastinal Mass and Malignant Pleural Effusion with Review of Literature

Sahu

Tyagi

Law

et al. 2015

Indian J Hematol Blood Transfus

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“…It may also present antedating the onset of systemic bone marrow leukemia (6,7), and many such cases are misdiagnosed as lymphoma (8). MS can occur in any organ, with common sites including the bones, lymph nodes, soft tissue and skin (9,10). Spinal epidural MS is not common, and spinal cord compression caused by MS is even more rare (11).…”

Section: Introductionmentioning

confidence: 99%

Acute Myeloid Leukemia Concurrent with Spinal Epidural Extramedullary Myeloid Sarcoma Accompanied by a High CD25 Expression and the <i>FLT3-ITD</i> Mutation

et al. 2014

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Myeloid sarcoma (MS) is an extramedullary myeloid tumor that sometimes presents with antedating systemic leukemia, leading physicians to the misdiagnosis of lymphoma. CD25 is expressed in 13% of patients with acute myeloid leukemia (AML), and its expression is associated with FLT3-ITD mutations, an elevated serum soluble interleukin 2 receptor (sIL-2R) level and a lower survival rate. However, there are no reports concerning the relationship between MS and the CD25 expression. We herein report a case of AML accompanied by thoracic epidural MS with a high CD25 expression, the FLT3-ITD mutation and an extremely elevated serum sIL-2R level in a 59-year-old man who presented with paraplegia.

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“…However, GS can also occur in up CCT cardiac computed tomography, CMRI cardiac magnetic resonance imaging Int J Cardiovasc Imaging to 35 % of cases when there is no evidence of leukemia or bone marrow involvement [12,15]. GS commonly arise in lymph nodes, periosteum, bone, oral mucosa, skin, and other soft tissue; cardiac involvement is very rare [13,[16][17][18]. Leukemia accounts for approximately 4 % of secondary tumors involving the heart [16,17,19].…”

Section: Granulocytic Sarcomamentioning

confidence: 99%

“…GS commonly arise in lymph nodes, periosteum, bone, oral mucosa, skin, and other soft tissue; cardiac involvement is very rare [13,[16][17][18]. Leukemia accounts for approximately 4 % of secondary tumors involving the heart [16,17,19]. In autopsy reports of patients with AML, myocardial involvement was present in less than 1 % [18,20].…”

Section: Granulocytic Sarcomamentioning

confidence: 99%

CT and MRI evaluation of cardiac complications in patients with hematologic diseases: a pictorial review

Kim

Jung

Kim

et al. 2015

Int J Cardiovasc Imaging

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Cardiac complications with hematologic diseases are not uncommon but it is difficult to diagnose, due to non-specific clinical symptoms. Prompt recognition of these potentially fatal complications by cardiac computed tomography (CT) or cardiac magnetic resonance imaging (MRI) may help to direct clinicians to specific treatments according to causes. Thrombosis is often related to central venous catheter use and is usually located at the catheter tip near the atrial wall. Differentiation of thrombosis from normal structure is possible with CT and, distinction of a thrombus from a tumor is possible on a delayed enhancement MRI with a long inversion time (500-600 ms). Granulocytic sarcoma of the heart is indicated by an infiltrative nature with involvement of whole layers of myocardium on CT and MRI. MRI with T2* mapping is useful in evaluating myocardial iron content in patients with hemochromatosis. Diffuse subendocardial enhancement is typically observed on delayed MRIs in patients with cardiac amyloidosis. T1 mapping is an emerging tool to diagnose amyloidosis. Myocardial abscess can occur due to an immunocompromised status. CT and MRI show loculated lesions with fluid density and concomitant rim-like contrast enhancement. Awareness of CT and MRI findings of cardiac complications of hematologic diseases can be helpful to physicians for clinical decision making and treatment.

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Atypical presentation of acute myeloid leukemia: cardiac myeloid sarcoma

Cited by 16 publications

References 28 publications

Myeloid Sarcoma: An Unusual Case of Mediastinal Mass and Malignant Pleural Effusion with Review of Literature

Myeloid Sarcoma: An Unusual Case of Mediastinal Mass and Malignant Pleural Effusion with Review of Literature

Acute Myeloid Leukemia Concurrent with Spinal Epidural Extramedullary Myeloid Sarcoma Accompanied by a High CD25 Expression and the <i>FLT3-ITD</i> Mutation

CT and MRI evaluation of cardiac complications in patients with hematologic diseases: a pictorial review

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