Difference between revisions of "Granulocytic sarcoma"

From Libre Pathology
Jump to navigation Jump to search
(+cat.)
 
m (cases can occasionally precede full blown AML)
 
(11 intermediate revisions by 2 users not shown)
Line 1: Line 1:
#redirect [[Soft_tissue_lesions#Granulocytic_sarcoma]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Chloroma_-_very_high_mag.jpg
| Width      =
| Caption    = Chloroma. [[H&E stain]].
| Synonyms  = extramedullary leukemia, myeloid sarcoma and chloroma, myeloblastoma, chloromyeloma, chloromyelosarcoma, granulocytic leukosarcoma, myelosarcoma
| Micro      = atypical small blue cells ~2x resting lymphocyte, infiltrative
| Subtypes  =
| LMDDx      = [[small round cell tumours]]
| Stains    =
| IHC        = CD117 +ve, CD43 +ve, CD34 +ve/-ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[soft tissue lesion]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = rare
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  =
| Other      =
| ClinDDx    = other [[soft tissue lesions]]
| Tx        = see ''[[acute myeloid leukemia]]''
}}
'''Granulocytic sarcoma''' is an uncommon [[malignant]] [[soft tissue lesion]] that really represents a hematologic malignancy; it is a soft tissue manifestation of [[acute myeloid leukemia]]. It is ''not'' a [[sarcoma]]. In a small number of cases, granulocytic sarcoma may precede systemic disease and may show a aleukaemic picture, i.e. there may not be significant numbers of blasts circulating in the blood.
 
Numerous other terms refer to this including '''extramedullary leukemia''',<ref name=pmid21795742>{{Cite journal  | last1 = Bakst | first1 = RL. | last2 = Tallman | first2 = MS. | last3 = Douer | first3 = D. | last4 = Yahalom | first4 = J. | title = How I treat extramedullary acute myeloid leukemia. | journal = Blood | volume = 118 | issue = 14 | pages = 3785-93 | month = Oct | year = 2011 | doi = 10.1182/blood-2011-04-347229 | PMID = 21795742 }}</ref> '''myeloid sarcoma''' and '''chloroma'''.
 
Less common terms include:<ref name=pmid21556238>{{Cite journal  | last1 = Eom | first1 = KS. | last2 = Kim | first2 = TY. | title = Intraparenchymal myeloid sarcoma and subsequent spinal myeloid sarcoma for acute myeloblastic leukemia. | journal = J Korean Neurosurg Soc | volume = 49 | issue = 3 | pages = 171-4 | month = Mar | year = 2011 | doi = 10.3340/jkns.2011.49.3.171 | PMID = 21556238 | PMC = 3085814 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085814/ }}</ref> '''myeloblastoma''', '''chloromyeloma''', '''chloromyelosarcoma''', '''granulocytic leukosarcoma''', and '''myelosarcoma'''.
 
==General==
*Soft tissue manifestation of [[acute myeloid leukemia]].<ref name=pmid21556238/>
*WBC elevated, low or normal range.<ref name=pmid25678833>{{Cite journal  | last1 = Arthur | first1 = C. | last2 = Cermak | first2 = J. | last3 = Delaunay | first3 = J. | last4 = Mayer | first4 = J. | last5 = Mazur | first5 = G. | last6 = Thomas | first6 = X. | last7 = Wierzbowska | first7 = A. | last8 = Jones | first8 = MM. | last9 = Berrak | first9 = E. | title = Post hoc analysis of the relationship between baseline white blood cell count and survival outcome in a randomized Phase III trial of decitabine in older patients with newly diagnosed acute myeloid leukemia. | journal = J Blood Med | volume = 6 | issue =  | pages = 25-9 | month =  | year = 2015 | doi = 10.2147/JBM.S64067 | PMID = 25678833 }}</ref>
 
==Microscopic==
Features:
*Cluster of atypical small blue cells in [[soft tissue lesions|soft tissue]] with scant cytoplasm.
 
DDx:
*[[Small cell carcinoma]]
*Large cell lymphomas ([[DLBCL]], [[ALCL]]).
*Other [[small round cell tumour]]s.
 
===Images===
<gallery>
Image:Chloroma - intermed mag.jpg | Chloroma - intermed. mag. (WC)
Image:Chloroma_-_high_mag.jpg | Chloroma - high mag. (WC)
Image:Chloroma_-_very_high_mag.jpg | Chloroma - very high mag. (WC)
Image:Myeloid sarcoma within a lymph node x40 magnification.jpg | Myeloid sarcoma within a lymph node (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case306/micro.html Granulocytic sarcoma - several crappy images (upmc.edu)].
*[http://path.upmc.edu/cases/case379.html Myeloid sarcoma - several images (upmc.edu)].
 
==IHC==
Features:<ref name=pmid24969631>{{Cite journal  | last1 = Seifert | first1 = RP. | last2 = Bulkeley | first2 = W. | last3 = Zhang | first3 = L. | last4 = Menes | first4 = M. | last5 = Bui | first5 = MM. | title = A practical approach to diagnose soft tissue myeloid sarcoma preceding or coinciding with acute myeloid leukemia. | journal = Ann Diagn Pathol | volume = 18 | issue = 4 | pages = 253-60 | month = Aug | year = 2014 | doi = 10.1016/j.anndiagpath.2014.06.001 | PMID = 24969631 }}</ref>
Markers of immaturity:
*CD34 +ve/-ve (5 of 9 cases).
*CD117 +ve (9 of 9 cases).
*TdT
Myeloid markers:
*CD43 +ve (7 of 7 cases) - sensitive, but not specific
*Myeloperoxidase +ve (8 of 10 cases).
*CD11c (myelomonocytic marker)
*CD13 (granulopoietic marker)
*CD33 (granulopoietic marker, specific but less sensitive)
 
CD34, CD117 and myeloperoxidase are more commonly positive in cases showing granulopoietic differentiation, but can be negative in cases with a myelomonocytic or monocytic differentiation, where CD68, CD163 and lysozyme may be helpful.<ref name=pmid23530613>{{cite journal |vauthors=Zhou J, Bell D, Medeiros LJ |title=Myeloid sarcoma of the head and neck region |journal=Arch Pathol Lab Med |volume=137 |issue=11 |pages=1560–8 |date=November 2013 |pmid=23530613 |doi=10.5858/arpa.2012-0537-OA |url=}}</ref>
 
==Sign out==
*It is prudent to mention ''acute myeloid leukemia'' somewhere in the report to ensure the appropriate referral is made.
 
==See also==
*[[Soft tissue lesions]].
*[[Intravascular lymphoma]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Soft tissue lesions]]

Latest revision as of 22:09, 10 January 2023

Granulocytic sarcoma
Diagnosis in short

Chloroma. H&E stain.
Synonyms extramedullary leukemia, myeloid sarcoma and chloroma, myeloblastoma, chloromyeloma, chloromyelosarcoma, granulocytic leukosarcoma, myelosarcoma
LM atypical small blue cells ~2x resting lymphocyte, infiltrative
LM DDx small round cell tumours
IHC CD117 +ve, CD43 +ve, CD34 +ve/-ve
Site soft tissue lesion
Prevalence rare
Clin. DDx other soft tissue lesions
Treatment see acute myeloid leukemia

Granulocytic sarcoma is an uncommon malignant soft tissue lesion that really represents a hematologic malignancy; it is a soft tissue manifestation of acute myeloid leukemia. It is not a sarcoma. In a small number of cases, granulocytic sarcoma may precede systemic disease and may show a aleukaemic picture, i.e. there may not be significant numbers of blasts circulating in the blood.

Numerous other terms refer to this including extramedullary leukemia,[1] myeloid sarcoma and chloroma.

Less common terms include:[2] myeloblastoma, chloromyeloma, chloromyelosarcoma, granulocytic leukosarcoma, and myelosarcoma.

General

Microscopic

Features:

  • Cluster of atypical small blue cells in soft tissue with scant cytoplasm.

DDx:

Images

  • Chloroma - intermed. mag. (WC)

  • Chloroma - high mag. (WC)

  • Chloroma - very high mag. (WC)

  • Myeloid sarcoma within a lymph node (WC)

www:

IHC

Features:[4] Markers of immaturity:

  • CD34 +ve/-ve (5 of 9 cases).
  • CD117 +ve (9 of 9 cases).
  • TdT

Myeloid markers:

  • CD43 +ve (7 of 7 cases) - sensitive, but not specific
  • Myeloperoxidase +ve (8 of 10 cases).
  • CD11c (myelomonocytic marker)
  • CD13 (granulopoietic marker)
  • CD33 (granulopoietic marker, specific but less sensitive)

CD34, CD117 and myeloperoxidase are more commonly positive in cases showing granulopoietic differentiation, but can be negative in cases with a myelomonocytic or monocytic differentiation, where CD68, CD163 and lysozyme may be helpful.[5]

Sign out

  • It is prudent to mention acute myeloid leukemia somewhere in the report to ensure the appropriate referral is made.

See also

References

  1. ↑ Bakst, RL.; Tallman, MS.; Douer, D.; Yahalom, J. (Oct 2011). "How I treat extramedullary acute myeloid leukemia.". Blood 118 (14): 3785-93. doi:10.1182/blood-2011-04-347229. PMID 21795742.
  2. ↑ 2.0 2.1 Eom, KS.; Kim, TY. (Mar 2011). "Intraparenchymal myeloid sarcoma and subsequent spinal myeloid sarcoma for acute myeloblastic leukemia.". J Korean Neurosurg Soc 49 (3): 171-4. doi:10.3340/jkns.2011.49.3.171. PMC 3085814. PMID 21556238. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085814/.
  3. ↑ Arthur, C.; Cermak, J.; Delaunay, J.; Mayer, J.; Mazur, G.; Thomas, X.; Wierzbowska, A.; Jones, MM. et al. (2015). "Post hoc analysis of the relationship between baseline white blood cell count and survival outcome in a randomized Phase III trial of decitabine in older patients with newly diagnosed acute myeloid leukemia.". J Blood Med 6: 25-9. doi:10.2147/JBM.S64067. PMID 25678833.
  4. ↑ Seifert, RP.; Bulkeley, W.; Zhang, L.; Menes, M.; Bui, MM. (Aug 2014). "A practical approach to diagnose soft tissue myeloid sarcoma preceding or coinciding with acute myeloid leukemia.". Ann Diagn Pathol 18 (4): 253-60. doi:10.1016/j.anndiagpath.2014.06.001. PMID 24969631.
  5. ↑ "Myeloid sarcoma of the head and neck region". Arch Pathol Lab Med 137 (11): 1560–8. November 2013. doi:10.5858/arpa.2012-0537-OA. PMID 23530613.
Retrieved from "https://librepathology.org/w/index.php?title=Granulocytic_sarcoma&oldid=52252"