Multiple Jejunal Myeloid Sarcomas Presenting with Intestinal Obstruction in a Non-leukemic Patient: A Case Report with Ultrastructural Observations
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Myeloid sarcoma is a rare extramedullary myeloid tumor, which is frequently misdiagnosed when no evidence of leukemia is initially observed. Here, we report on a peculiar case of a 49-year-old man afflicted with multiple masses in the jejunum, the superior mesentery, and the serosa of the transverse colon, without leukemic manifestation. The tumor was composed of undifferentiated small round cells containing eosinophilic cytoplasm, which were negative for myeloperoxidase, nonspecific esterase, lysozyme, terminal deoxynucleotidyl transferase, leukocyte common antigen, CD3, CD4, CD15, CD20, CD30, CD43, CD56, CD68/PG-M1, CD79a, human melanoma black-45, c-kit, and CD34 with positivity only for CD68/KP1, CD99, and vimentin. Under electron microscopy, those cells had abundant membrane-bound cytoplasmic granules that measured 200 to 300 nm in diameter, which were consistent with granulocytic azurophilic granules. The tumor was finally diagnosed as a myeloid sarcoma. The presence of non-leukemic myeloid sarcomas showing immunonegativity for conventional myeloid-leukemic markers necessitated a diagnosis by ultrastructural observation.
Abstract
Myeloid sarcoma is a rare extramedullary myeloid tumor, which is frequently misdiagnosed when no evidence of leukemia is initially observed. Here, we report on a peculiar case of a 49-year-old man afflicted with multiple masses in the jejunum, the superior mesentery, and the serosa of the transverse colon, without leukemic manifestation. The tumor was composed of undifferentiated small round cells containing eosinophilic cytoplasm, which were negative for myeloperoxidase, nonspecific esterase, lysozyme, terminal deoxynucleotidyl transferase, leukocyte common antigen, CD3, CD4, CD15, CD20, CD30, CD43, CD56, CD68/PG-M1, CD79a, human melanoma black-45, c-kit, and CD34 with positivity only for CD68/KP1, CD99, and vimentin. Under electron microscopy, those cells had abundant membrane-bound cytoplasmic granules that measured 200 to 300 nm in diameter, which were consistent with granulocytic azurophilic granules. The tumor was finally diagnosed as a myeloid sarcoma. The presence of non-leukemic myeloid sarcomas showing immunonegativity for conventional myeloid-leukemic markers necessitated a diagnosis by ultrastructural observation.
참고문헌 (20)
- Pressler H, "Isolated granulocytic sarcoma of the ovary: histologic, electron microscopic, and immunohistochemical findings", Int J Gynecol Pathol, 11, pp.68~74 (1992)
- Ghafoor T, "Granulocytic sarcoma of the small intestine: an unusual presentation of acute myelogenous leukaemia", J Pak Med Assoc, 60, pp.133~135 (2010)
- Kohl SK, "Granulocytic sarcoma of the small intestine", Arch Pathol Lab Med, 130, pp.1570~1574 (2006)
- Corpechot C, "Granulocytic sarcoma of the jejunum: a rare cause of small bowel obstruction", Am J Gastroenterol, 93, pp.2586~2588 (1998)
- Markoc F, "Granulocytic sarcomas: difficulties in diagnosis", Tumori, 96, pp.149~153 (2010)
- Menasce LP, "Extra-medullary myeloid tumour (granulocytic sarcoma) is often misdiagnosed: a study of 26 cases", Histopathology, 34, pp.391~398 (1999)
- Ioannidis O, "Primary myeloid sarcoma of the jejunum and greater omentum causing small intestine obstruction", Acta Gastroenterol Belg, 72, pp.369~372 (2009)
- Arnal-Monreal FM, "Meningeal granulocytic sarcoma without evidence of leukemia: light and ultrastructural study of one case", Virchows Arch A Pathol Anat Histol, 392, pp.111~118 (1981)
- Bahrami A, "Undifferentiated tumor: true identity by immunohistochemistry", Arch Pathol Lab Med, 132, pp.326~348 (2008)
- Brunning RD, "Acute myeloid leukaemia not otherwise categorised, In World Health Organization classification of tumours: pathology and genetics of tumours of haematopoietic and lymphoid tissues", pp.104~105 (2001), IARC Press
- Pileri SA, "Myeloid sarcoma: clinico-pathologic, phenotypic and cytogenetic analysis of 92 adult patients", Leukemia, 21, pp.340~350 (2007)
- Chang CC, "Immunophenotypic profile of myeloid cells in granulocytic sarcoma by immunohistochemistry. Correlation with blast differentiation in bone marrow", Am J Clin Pathol, 114, pp.807~811 (2000)
- Kurata H, "Myeloid markers should be undertaken in cases of CD56 positivity to exclude granulocytic sarcoma", Br J Dermatol, 147, pp.609~611 (2002)
- Kang LC, "Immunoreactivity of MIC2 (CD99) and terminal deoxynucleotidyl transferase in bone marrow clot and core specimens of acute myeloid leukemias and myelodysplastic syndromes", Arch Pathol Lab Med, 130, pp.153~157 (2006)
- Levy R, "A human thymus-leukemia antigen defined by hybridoma monoclonal antibodies", Proc Natl Acad Sci U S A, 76, pp.6552~6556 (1979)
- Goldstein NS, "Granulocytic sarcoma: potential diagnostic clues from immunostaining patterns seen with anti-lymphoid antibodies", Int J Surg Pathol, 2, pp.177~186 (1995)
- Toner PG, "Cellular organization and cellular interrelationships, In Theb Oxford textbook of pathology: Vol. 1. Principles of pathology", pp.3~33 (1992), Oxford University Press
- Andre J, "Tuberculosis and myelosclerosis with myeloid metaplasia: report of three cases", JAMA, 178, pp.1169~1174 (1961)
- Banik S, "Granulocytic sarcoma of the cervix: an immunohistochemical, histochemical, and ultrastructural study", J Clin Pathol, 42, pp.483~488 (1989)
- Golomb HM, "“Microgranular” acute promyelocytic leukemia: a distinct clinical, ultrastructural, and cytogenetic entity", Blood, 55, pp.253~259 (1980)