Myeloid sarcoma and extramedullary hematopoiesis expand the spectrum of ERG-positive proliferations: an ancillary tool in the diagnosis

Vargas, Ana Cristina; Turner, Jennifer; Burchett, Ivan; Ho, Lye Lin; Zumbo, Rosalba; Gill, Anthony J.; Maclean, Fiona

doi:10.1016/j.humpath.2022.03.001

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…Histologically, the diagnosis generally aligns with typical Kikuchi disease, but additional caution is warranted due to the coexistence of acute leukaemia. Immunohistochemical staining for CD34, CD117, TdT and ERG should be performed to exclude extramedullary leukaemic infiltrates 21 . Additionally, as HSV lymphadenitis can mimic Kikuchi disease 1,3,4 and HSV reactivation is common in acute leukaemia, 22 it is crucial to search for viral inclusions and consider HSV immunohistochemical staining to rule out HSV lymphadenitis.…”

Section: Discussionmentioning

confidence: 99%

Kikuchi disease in acute leukaemia: a distinct clinical syndrome with HLA association

Yu,

Lin

2024

Histopathology

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AimsTo report the clinicopathological features of Kikuchi disease in patients with acute leukaemia, emphasising similarities among cases.Methods and resultsIn a cohort of 454 Kikuchi disease patients, we identified three cases of concurrent acute leukaemia. These patients shared similar clinical traits, with Kikuchi disease emerging approximately a month after induction chemotherapy onset, featuring neck‐region lymphadenopathy. Notably, two patients were middle‐aged, deviating from the typical age distribution of Kikuchi disease. Histologically, these cases aligned with typical Kikuchi disease. Negative immunohistochemical stains (CD34, CD117, ERG, TdT) indicated the absence of extramedullary leukaemic infiltration. Herpes simplex virus immunohistochemical staining was also negative. Significantly, a human leucocyte antigen (HLA) association was observed in these three cases. HLA‐B*15:01, C*04:01, and DRB1*04:06 were more prevalent in these patients compared to the general population (compared with three independent control cohorts: Taiwanese Han Chinese (n = 504), Tzu Chi Taiwanese bone marrow donors (n = 364) and Hong Kong Chinese (n = 5266)).ConclusionsOur study underscores the unique link between Kikuchi disease and acute leukaemia, characterised by specific features and HLA associations. This underlines Kikuchi disease as a possible differential diagnosis in pertinent clinical scenarios. Furthermore, this syndrome offers insights into postchemotherapy immunology in acute leukaemia, enhancing comprehension.

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Section: Discussionmentioning

confidence: 99%

Kikuchi disease in acute leukaemia: a distinct clinical syndrome with HLA association

Yu,

Lin

2024

Histopathology

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“…Although ERG is not perfect, as it is not a marker of immaturity like CD34 and CD117 and will stain all stages of granulocytic maturation, it has also been demonstrated in other studies [15]. This is important as it limits the utility of ERG to situations where a pathologist is confident of blast cell morphology and has ancillary tests such as cytogenetics, flow cytometry, or molecular aberrations helping to confirm AML diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, four previous studies have looked at ERG IHC in myeloid malignancy [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Erythroblastosis Transformation-Specific Regulated Gene 1 (ERG) Immunohistochemistry in the Diagnosis of Acute Myeloid Leukemia

Lucas,

Neal,

Hsu

et al. 2024

Cureus

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Introduction: The erythroblastosis transformation-specific regulated gene 1 (ERG) is a transcription factor that can be used as an immunohistochemical (IHC) marker in the diagnosis and prognostication of malignancy. ERG was initially used in prostate cancer; however, it is a useful marker in extramedullary myeloid disease. Patients with acute myeloid leukemia (AML), dry bone marrow aspirate, and CD34, CD117negative blast cells can be in a diagnostic dilemma. This audit aimed to (a) validate ERG IHC in bone marrow trephine samples, (b) quantify ERG IHC positivity in an AML cohort, and correlate concordance with CD34 and CD117 IHC, when available, and (c) to see whether ERG is a useful adjunct in the diagnosis of cases of AML.Methods: A retrospective audit was completed of all new and relapsed cases of AML over one year at a single center. For inclusion, patients needed a trephine specimen at presentation, and all had a hematoxylin and eosin (H&E) specimen, ERG IHC, and at least one or both of CD34 and CD117 IHC. Four pathologists independently assessed the stains quantitatively and qualitatively in comparison to the morphology seen on the H&E sample. The kappa value was used to assess agreement.Results: Seventeen patients with AML met the inclusion criteria. All specimens had H&E, CD34, and ERG stains; 9/17 (53%) had CD117 IHC. ERG demonstrated high concordance with blast cells on H&E morphology, with a high agreement among pathologists. Qualitatively, pathologists recognized that ERG spared lymphoid nodules; however, it also stained granulocytes at various maturation stages. Conclusion: ERG is a sensitive marker for the diagnosis of AML. ERG can help visualize blast cells that have been confirmed by ancillary tests. More research into the utility of ERG in AML diagnostics is recommended.

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Myeloid sarcoma: a poorly recognised but important differential diagnosis of epithelioid angiosarcoma

Wong¹,

Amanuel²,

Chua³

et al. 2023

Pathology

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Myeloid sarcoma and extramedullary hematopoiesis expand the spectrum of ERG-positive proliferations: an ancillary tool in the diagnosis

Cited by 4 publications

References 27 publications

Kikuchi disease in acute leukaemia: a distinct clinical syndrome with HLA association

Kikuchi disease in acute leukaemia: a distinct clinical syndrome with HLA association

Erythroblastosis Transformation-Specific Regulated Gene 1 (ERG) Immunohistochemistry in the Diagnosis of Acute Myeloid Leukemia

Myeloid sarcoma: a poorly recognised but important differential diagnosis of epithelioid angiosarcoma

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