A Case of Acute Promyelocytic Leukemia Presenting as Sternal Infiltrate
DOI:
https://doi.org/10.21276/apalm.3206Keywords:
Acute myeloid leukemia, Acute promyelocytic leukemia (APL), Myeloid sarcomaAbstract
Granulocytic sarcoma (GS) or myeloid sarcoma (MS) is a localized extramedullary tumor composed of immature myeloid cells which can develop de novo or concurrently with acute myeloid leukemia (AML), myeloproliferative disorders (MPN) or myelodysplastic syndrome (MDS). It can present before, along with or after the diagnosis of acute myeloid leukemia, MPN, MDS or may present as a manifestation of relapse in a previously treated AML patient. The occurrence of MS in an acute promyelocytic leukemia (APL) patient is a very uncommon clinical event especially as initial or primary presentation. APL is often associated with a life threatening coagulopathy making prompt diagnosis and initiation of therapy critical. Unusual clinical localization may lead to misdiagnosis, or delayed diagnosis and treatment. Hence being aware of such atypical presentations of APL is crucial. Here we report a patient with acute promyelocytic leukemia who presented with sternal infiltrate but without any systemic symptoms. The diagnostic challenges are of particular interest given the unusual clinical presentation along with atypical morphology of the abnormal promyelocytes.
References
Doucet M and SchmieJ: "A rare case of acute promyelocytic leukemia with focal bone marrow involvement presenting as a paraspinal myeloid sarcoma." J Hematopathol (2016) 9:161–166.
Worch J, Ritter J, Frühwald MC. "Presentation of acute promyelocytic leukemia as granulocytic sarcoma." Pediatr Blood Cancer 2008;50:657-60.
Kyaw TZ, Maniam JA, Bee PC, et al. "Myeloid sarcoma: an unusual presentation of acute promyelocytic leukemia causing spinal cord compression." Turk. J. Haematol. 29(3), 2012, 278–282.
Thomas X, Chelghoum Y. "Promyelocytic sarcoma of the sternum: a case report and review of the literature." Korean J Hematol. 2011;46:52–6.
Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pilleri SA, et al. "WHO Classification of Tumours of Hematopoietic and Lymphoid Tissues." Lyon: IARC; 2017 Revised edition.
Winters C, Chen A I, Moore S, Traer E, Dunla J. "Acute promyelocytic leukemia presenting with features of metastatic osseous disease." Leukemia Research Reports 2018, 36–37.
Evans, G. D., and D. J. Grimwade. "Extramedullary disease in acute promyelocytic leukemia." Leuk. Lymphoma 33, 1999, 219–229.
Neiman S.R., Barcosm., Berard C., Bonnerh., Mannr., Rydell R. E. & Bennett J. M. (1981) "Granulocytic sarcoma: A clinicopathologic study of 61 biopsied cases." Cancer 48, 1426-1437.
Sawhney S, Holtzman NG, Davis DL, Kaizer H, Giffi V, Emadi A, & Koka1 R. "Promyelocytic sarcoma of the right humerus: an unusual clinical presentation with unique diagnostic and treatment considerations." Clinical Case Reports 2017;5(11):1874–1877.
Oravcova I, Mikuskova E, Leitnerova M, et al. "A unique clinical presentation of de novo acute promyelocytic leukemia as a myeloid sarcoma of the breast." International Journal of Hematology, 108, 550-553, 2018.
Yamashita, Y., N. Isomura, Y. Hamasaki, M. Goto, et al. "Case of pediatric acute promyelocytic leukemia presenting as extramedullary tumor of the mandible." Head Neck 35.
M. Nair, P. Kusumakumary, P.S. Nair. "Rare presentation of pediatric acute promyelocytic leukemia as multiple lytic bone lesions: case report and review of literature." J. Cancer Res. Therapeut. 10(2), 2014, 381–383.
J. Stankova, D. Mitchell, C. Bernard, J.P. Farmer, R. Faingold, N. Jabado. "Atypical presentation of acute promyelocytic leukaemia." Br. J. Haematol. 132(3), 2006, 379–380.
Mohamedbhai, S., M. Pule, B. Conn, C. Hopper, A. Ramsay, and A. Khwaja. "Acute promyelocytic leukaemia presenting with a myeloid sarcoma of the tongue." Br. J. Haematol. 141, 2008, 565.
Fukushima S, Terasaki M, Tajima Y, Shigemori M. "Granulocytic sarcoma: an unusual complication of acute promyelocytic leukemia causing cerebellar hemorrhage. Case report." J Neurosurg 2006;105:912-5.
Ajarim DS, Santhosh-Kumar CR, Higgy KE, el Saghir NS, Almomen AK, Shipkey FD. "Granulocytic sarcoma of the thymus in acute promyelocytic leukaemia." Clin Lab Haematol 1990;12:97-9.
Savranlar A, Ustündag Y, Ozer T, et al. "A thoracic-epidural granulocytic sarcoma case that was diagnosed preceding the onset of and that recurred co-incidental to acute promyelocytic leukemia, which developed after surgical treatment." Acta Med Okayama 2004;58:251-4.
Kubonishi I, Ohtsuki Y, Machida K, et al. "Granulocytic sarcoma presenting as a mediastinal tumor. Report of a case and cytological and cytochemical studies of tumor cells in vivo and in vitro." Am J Clin Pathol 1984;82:730-4.
Tosi A, De Paoli A, Fava S, et al. "Undifferentiated granulocytic sarcoma: a case with epidural onset preceding acute promyelocytic leukemia." Haematologica 1995;80:44-6.
Suárez-Cuenca JA, Arellano-Sánchez JL, Scherling-Ocampo AA, Sánchez-Hernández, Pérez-Guevara D, and Chalapud-Revel JR. "Rapidly progressing, fatal and acute promyelocytic leukaemia that initially manifested as a painful third molar: a case report." Journal of Medical Case Reports 2009, 3:102.
Sainty D, Liso V, Cantu`-Rajnoldi A, Head D, Mozziconacci MJ, Arnoule C, et al. "A new morphologic classification system for acute promyelocytic leukemia distinguishes cases with underlying PLZF/RARA gene rearrangements." Blood 96, 2000, 1287-1296.
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Copyright (c) 2023 Kalyani Bapat, Dia Mansukhani, Shanaz Khodaiji, Balkrishna Padate, Abha Dubey
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