Myeloid Sarcoma of the Paranasal Sinuses in a Patient with Acute Myeloid Leukemia

Abstract

Myeloid sarcoma (MS) is an uncommon extramedullary malignant tumor, and often represents a subgroup of acute myeloid leukemia (AML). MS of paranasal sinus origin is extremely rare. We report an uncommon case of sinonasal MS associated with AML, who was successfully treated with hematopoietic stem-cell transplantation. A 39-year-old male was admitted with complaints of left nasal obstruction and proptosis. Computed tomography and magnetic resonance imaging identified a left ethmoidal mass involving the maxillary sinus, the orbit, and the skull base. Nasal endoscopic examination detected a whitish homogeneous mass occupying the left nasal cavity. Although accumulation of atypical lymphocytes was suspected based on initial pathological inspection, immunohistochemical analysis showed myeloperoxidase-positive myeloid cells. Together with concomitant leukocytosis (149,000/µL) composed of myeloid blast cells and excess of myeloblasts in the bone marrow, the patient was diagnosed as sinonasal MS with AML with maturation (French-American-British Classification M2). The patient was treated by chemotherapy (remission induction therapy with daunorubicin and cytarabine; salvage chemotherapy with high-dose cytarabine), radiotherapy (30 Gy in 10 fractions) and allogeneic hematopoietic stem-cell transplantation, and followed up for 12 months with no recurrence. Early diagnosis is critical for the best improvement of MS. MS of the paranasal sinuses may easily be misdiagnosed as malignant lymphoma or poorly differentiated carcinoma. Prompt hematological and immunohistological investigations with suspicion of MS are essential for correct diagnosis. Furthermore, we concisely review nine previously reported patients with MS and indicate the importance of hematopoietic stem-cell transplantation for good prognosis.

Nasal Lymphoma Presenting With Contralateral Proptosis and Vision Changes: A Case Report and Literature Review

“…We present a literature review of proptosis secondary to sinonasal masses in Table 1 [11][12][13][14][15][16]. To the best of our knowledge, the present case report is the first documented instance of a sinonasal mass causing ocular symptoms exclusively on the contralateral side.…”

Myeloid sarcoma of the nasal cavity in a 15-month-old child

“…Although MS represents an extramedullary proliferation and may occur at nearly any anatomic site, MS involvement in the sinonasal area is rare. Suzuki et al [ 5 ] summarized 10 sinonasal MS cases that had been reported between 2000 and 2018, including 9 adults and 1 child. Holsinger et al [ 6 ] found 2 pediatric sinonasal MS cases recorded between 1955 and 1999 at university-based, tertiary care referral centers in Houston.…”

“…[ 4 ] However, the sinonasal area may be a predilection site of isolated MS occupied 20% of sinonasal MS cases. [ 5 ] MS has a wide age distribution and pediatric population is a preference age group. [ 3 ] Nevertheless, some retrospective series suggested the main age range of onset of MS is connected with tumor site to some extent.…”

“…[ 2 , 3 ] MS may occur in isolation, or more commonly in patients with acute myeloid leukemia (AML), myeloproliferative neoplasm, myelodysplastic syndrome, or myeloproliferative neoplasm/myelodysplastic syndrome. [ 4 ] The sinonasal area may be a predilection site of isolated MS. [ 5 ] Although MS had been described in 1853, the number of the disease is still rare, resulted in the limitation of literatures that define clinical features, diagnosis, treatment and outcomes. Thus, case reports and retrospective series are essential for study and management of MS.…”

Self‐Assemble Polymeric Nanoparticle with GSH Exhaustion for SPECT Imaging–Guided Enhanced Radioisotope Therapy

“…Radiotherapy (RT) including radioisotope therapy (RIT) and external beam radiotherapy (EBRT) have been widely applied in clinic for cancer treatment . In order to improve the therapeutic efficiency of cancer, RT usually combines other therapies such as chemotherapy, photothermal therapy, or surgery for cancer treatment, further increasing the cure rate . In recent years, various nanomaterials with radioisotope labeling/doping have been used for tumor imaging and combination of RIT and photothermal therapy, realizing great well cancer treatment .…”