Myeloid Sarcoma: The Other Side of Acute Leukemia

Abstract

Myeloid sarcomas are extramedullary myeloid masses with associated tissue damage. Myeloid sarcomas usually arise before, during or after diagnosis of acute leukemia, most often AML. Majority of the patients with myeloid sarcoma respond to upfront systemic chemotherapy and sometimes bone marrow transplant, but it is unclear which patients will benefit from which treatments. This is primarily due to the paucity of knowledge on myeloid sarcoma. At present, there are no prognostic biomarkers for myeloid sarcoma, which can help in risk stratification in patients with myeloid sarcoma. Several studies have suggested that myeloid sarcoma is more likely to occur with certain translocations such as CBF and MLL rearrangements. In addition, sequencing analysis has identified several mutations in genes such as FLT3, NPM1, EZH2, and KIT. Nevertheless, there is still lack of knowledge to understand why particular leukemia migrates to the skin and soft tissues and becomes refractory to systemic therapy.

Infiltration of thyroid papillary cancer tissue with myeloid leukemic cells: a case report

“…In cytogenetic examinations performed in MS patients, various cytogenetic abnormalities have been detected in more than half of the cases. MS is well-described in patients with recurrent genetic abnormalities, including t(8;21), inv(16), t(16;16), MLL rearrangements, trisomy 8, monosomy 7, FLT3-ITD, and NPM-1 mutation [21,22]. MLL gene amplification and trisomy 17 detected in our patient support the role of cytogenetic abnormalities in the pathophysiology of MS.…”

“…In the bone marrow aspiration smear and biopsy, megaloblastic changes, severe erythroid dysplasia, and blastic infiltration (18%) were detected. In the genetic examination performed with real-time polymerase chain reaction, t (8,21) and inv (16) were found to be negative. Cytogenetic analysis performed by fluorescent in situ hybridization revealed 21% amplification of mixed lineage leukemia (MLL) gene at chromosome 11q23 and 10% trisomy 17.…”

Isolated Myeloid Sarcoma: A Diagnostic Dilemma

“…Immunohistochemistry of MS is frequently positive for myeloperoxidase expressed in 66-96% cases. In addition, CD43, CD34, CD45, CD56, CD68, lysozyme, CD117, CD11c, CD13, CD33, and B and T cell markers can also be observed [ 3 , 8 ].…”

Myeloid sarcoma: an uncommon presentation of myeloid neoplasms; a case series of 4 rare cases reported in a tertiary care institute

“…5 In patients of AML with MS, an important element accountable for the migration of AML cells into the non-myeloid regions is the interaction between the matrix metalloproteinase (MMP) -9 and leukocyte β2 integrin along with some unidentified protein complexes, known as 'invadosomes'. 6 MS occurrence has a mild predisposition for males (M:F = 2:1), with 60% of patients younger than 15 years of age. 6 However, it is known to show a varied age distribution ranging from 1 year to 81 years of age.…”

“…6 MS occurrence has a mild predisposition for males (M:F = 2:1), with 60% of patients younger than 15 years of age. 6 However, it is known to show a varied age distribution ranging from 1 year to 81 years of age. 7 The most common anatomic sites of involvement are the skin (26%), lymph node (15%), testis (6%), and intestine (6%).…”