GASTROINTESTINAL MYELOID SARCOMA A CASE PRESENTATION AND CRITICAL REVIEW OF THE LITERATURE GASTROINTESTINAL MYELOID SARCOMA
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Keywords
intestinal, gastric, myeloid sarcoma, trisomy 8, acute myeloid leukemia, granulocytic sarcoma
Abstract
Myeloid sarcomas can be detected in up to 30% of acute myeloid leukemia cases or occur de-novo without bone marrow involvement. The most frequent localization of myeloid sarcomas in the abdominal cavity is the small intestine, and gastric presentations are infrequent, frequently misdiagnosed, and a high level of suspicion should exist when the characteristic histomorphology features are present. The current review features a case report with gastric presentation of myeloid sarcoma in a patient with a diagnosis of acute myeloid leukemia with trisomy 8. In addition, a review of the literature of intestinal type myeloid sarcomas shows that less than 15% of these cases have been reported in the stomach. The most common molecular aberrancy detected in intestinal myeloid sarcomas is the fusion protein CBFB-MYH11. Review of several large studies demonstrates that the presence of myeloid sarcoma does not constitute an independent prognostic factor. The therapeutic approach will be tailored to the specific genetic abnormalities present, and systemic chemotherapy with hematopoietic stem cell transplant are the most efficient strategies.
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References
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4. Fianchi L, Quattrone M, Criscuolo M, Bellesi S, Dragonetti G, Maraglino AME, et al. Extramedullary Involvement in Acute Myeloid Leukemia. A Single Center Ten Years' Experience. Mediterr J Hematol Infect Dis. 2021;13(1):e2021030.
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7. Paydas S, Zorludemir S, Ergin M. Granulocytic sarcoma: 32 cases and review of the literature. Leuk Lymphoma. 2006;47(12):2527-41.
8. Kobayashi R, Tawa A, Hanada R, Horibe K, Tsuchida M, Tsukimoto I, et al. Extramedullary infiltration at diagnosis and prognosis in children with acute myelogenous leukemia. Pediatr Blood Cancer. 2007;48(4):393-8.
9. Muss HB, Moloney WC. Chloroma and other myeloblastic tumors. Blood. 1973;42(5):721-8.
10. Yamauchi K, Yasuda M. Comparison in treatments of nonleukemic granulocytic sarcoma: report of two cases and a review of 72 cases in the literature. Cancer. 2002;94(6):1739-46.
11. Neiman RS, Barcos M, Berard C, Bonner H, Mann R, Rydell RE, et al. Granulocytic sarcoma: a clinicopathologic study of 61 biopsied cases. Cancer. 1981;48(6):1426-37.
12. Chang H, Brandwein J, Yi QL, Chun K, Patterson B, Brien B. Extramedullary infiltrates of AML are associated with CD56 expression, 11q23 abnormalities and inferior clinical outcome. Leuk Res. 2004;28(10):1007-11.
13. Hagen PA, Singh C, Hart M, Blaes AH. Differential Diagnosis of Isolated Myeloid Sarcoma: A Case Report and Review of the Literature. Hematol Rep. 2015;7(2):5709.
14. Menasce LP, Banerjee SS, Beckett E, Harris M. Extra-medullary myeloid tumour (granulocytic sarcoma) is often misdiagnosed: a study of 26 cases. Histopathology. 1999;34(5):391-8.
15. Byrd JC, Edenfield WJ, Shields DJ, Dawson NA. Extramedullary myeloid cell tumors in acute nonlymphocytic leukemia: a clinical review. J Clin Oncol. 1995;13(7):1800-16.
16. Kim NR, Lee WK, Lee JI, Cho HY. Multiple Jejunal Myeloid Sarcomas Presenting with Intestinal Obstruction in a Non-leukemic Patient: A Case Report with Ultrastructural Observations. Korean J Pathol. 2012;46(6):590-4.
17. Benet C, Gomez A, Aguilar C, Delattre C, Vergier B, Beylot-Barry M, et al. Histologic and immunohistologic characterization of skin localization of myeloid disorders: a study of 173 cases. Am J Clin Pathol. 2011;135(2):278-90.
18. Al-Khateeb H, Badheeb A, Haddad H, Marei L, Abbasi S. Myeloid sarcoma: clinicopathologic, cytogenetic, and outcome analysis of 21 adult patients. Leuk Res Treatment. 2011;2011:523168.
19. Sen F, Zhang XX, Prieto VG, Shea CR, Qumsiyeh MB. Increased incidence of trisomy 8 in acute myeloid leukemia with skin infiltration (leukemia cutis). Diagn Mol Pathol. 2000;9(4):190-4.
20. Byrd JC, Weiss RB, Arthur DC, Lawrence D, Baer MR, Davey F, et al. Extramedullary leukemia adversely affects hematologic complete remission rate and overall survival in patients with t(8;21)(q22;q22): results from Cancer and Leukemia Group B 8461. J Clin Oncol. 1997;15(2):466-75.
21. Shan M, Lu Y, Yang M, Wang P, Lu S, Zhang L, et al. Characteristics and transplant outcome of myeloid sarcoma: a single-institute study. Int J Hematol. 2021;113(5):682-92.
22. Dalland JC, Meyer R, Ketterling RP, Reichard KK. Myeloid Sarcoma With CBFB-MYH11 Fusion (inv(16) or t(16;16)) Prevails in the Abdomen. Am J Clin Pathol. 2020;153(3):333-41.
23. Antic D, Elezovic I, Bogdanovic A, Vukovic NS, Pavlovic A, Jovanovic MP, et al. Isolated myeloid sarcoma of the gastrointestinal tract. Intern Med. 2010;49(9):853-6.
24. Derenzini E, Paolini S, Martinelli G, Campidelli C, Grazi GL, Calabrese C, et al. Extramedullary myeloid tumour of the stomach and duodenum presenting without acute myeloblastic leukemia: a diagnostic and therapeutic challenge. Leuk Lymphoma. 2008;49(1):159-62.
25. El H, II, Easler JJ, Ceppa EP, Shahda S. Myeloid sarcoma of the sigmoid colon: An unusual presentation of a rare condition. Dig Liver Dis. 2017;49(11):1280.
26. Gajendra S, Gogia A, Das P, Gupta R, Tanwar P. Acute myeloid leukemia presenting as "bowel upset": a case report. J Clin Diagn Res. 2014;8(7):FD09-10.
27. Goor O, Goor Y, Konikoff F, Trejo L, Naparstak E. Common malignancies with uncommon sites of presentation: case 3. Epigastric distress caused by a duodenal polyp: a rare presentation of acute leukemia. J Clin Oncol. 2003;21(23):4458-9.
28. Jeong SH, Han JH, Jeong SY, Kang SY, Lee HW, Choi JH, et al. A case of donor-derived granulocytic sarcoma after allogeneic hematopoietic stem cell transplantation. Korean J Hematol. 2010;45(1):70-2.
29. Le Beau MM, Larson RA, Bitter MA, Vardiman JW, Golomb HM, Rowley JD. Association of an inversion of chromosome 16 with abnormal marrow eosinophils in acute myelomonocytic leukemia. A unique cytogenetic-clinicopathological association. N Engl J Med. 1983;309(11):630-6.
30. Mrad K, Abid L, Driss M, Ben Abid H, Ben Romdhane K. Granulocytic sarcoma of the small intestine in a child without leukemia: report of a case with cytologic findings and immunophenotyping pitfalls. Acta Cytol. 2004;48(5):641-4.
31. Narayan P, Murthy V, Su M, Woel R, Grossman IR, Chamberlain RS. Primary myeloid sarcoma masquerading as an obstructing duodenal carcinoma. Case Rep Hematol. 2012;2012:490438.
32. Sun R, Samie AA, Theilmann L. A patient with a tumor of the ileocecal valve. Gastroenterology. 2011;141(6):1977, 2278.
33. Toubai T, Kondo Y, Ogawa T, Imai A, Kobayashi N, Ogasawara M, et al. A case of leukemia of the appendix presenting as acute appendicitis. Acta Haematol. 2003;109(4):199-201.
34. Shimizu H, Saitoh T, Hatsumi N, Takada S, Yokohama A, Handa H, et al. Clinical significance of granulocytic sarcoma in adult patients with acute myeloid leukemia. Cancer Sci. 2012;103(8):1513-7.
35. Almond LM, Charalampakis M, Ford SJ, Gourevitch D, Desai A. Myeloid Sarcoma: Presentation, Diagnosis, and Treatment. Clin Lymphoma Myeloma Leuk. 2017;17(5):263-7.
36. Ibrahim M, Chen R, Vegel A, Panse K, Bhyravabhotla K, Harris K, et al. Treatment of myeloid sarcoma without bone marrow involvement with gemtuzumab ozogamicin-containing regimen. Leuk Res. 2021;106:106583.
37. Chevallier P, Labopin M, Cornelissen J, Socie G, Rocha V, Mohty M, et al. Allogeneic hematopoietic stem cell transplantation for isolated and leukemic myeloid sarcoma in adults: a report from the Acute Leukemia Working Party of the European group for Blood and Marrow Transplantation. Haematologica. 2011;96(9):1391-4.
38. Chen WY, Wang CW, Chang CH, Liu HH, Lan KH, Tang JL, et al. Clinicopathologic features and responses to radiotherapy of myeloid sarcoma. Radiat Oncol. 2013;8:245.
39. Wada A, Kobayashi N, Asanuma S, Matsuoka S, Kosugi M, Fujii S, et al. Repeated donor lymphocyte infusions overcome a myeloid sarcoma of the stomach resulting from a relapse of acute myeloid leukemia after allogeneic cell transplantation in long-term survival of more than 10 years. Int J Hematol. 2011;93(1):118-22.
40. Vedy D, Muehlematter D, Rausch T, Stalder M, Jotterand M, Spertini O. Acute myeloid leukemia with myeloid sarcoma and eosinophilia: prolonged remission and molecular response to imatinib. J Clin Oncol. 2010;28(3):e33-5.
41. Gadage V, Zutshi G, Menon S, Shet T, Gupta S. Gastric myeloid sarcoma--a report of two cases addressing diagnostic issues. Indian J Pathol Microbiol. 2011;54(4):832-5.
42. Huang XL, Tao J, Li JZ, Chen XL, Chen JN, Shao CK, et al. Gastric myeloid sarcoma without acute myeloblastic leukemia. World J Gastroenterol. 2015;21(7):2242-8.
43. Kini S, Amarapurkar A, Balasubramanian M. Small Intestinal Obstruction with Intussusception due to Acute Myeloid Leukemia: A Case Report. Case Rep Gastrointest Med. 2012;2012:425358.
44. Koehler M. Granulocytic sarcoma of the stomach. Gastrointest Endosc. 1998;48(2):190.
45. Sekaran A, Darisetty S, Lakhtakia S, Ramchandani M, Reddy DN. Granulocytic Sarcoma of the Stomach Presenting as Dysphagia during Pregnancy. Case Rep Gastrointest Med. 2011;2011:627549.
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Oct 29, 2021
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Kheirkhah, P. (2021) “GASTROINTESTINAL MYELOID SARCOMA A CASE PRESENTATION AND CRITICAL REVIEW OF THE LITERATURE: GASTROINTESTINAL MYELOID SARCOMA”, Mediterranean Journal of Hematology and Infectious Diseases, 13(1), p. e2021067. doi: 10.4084/MJHID.2021.067.
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