|LETTER TO THE EDITOR
|Year : 2020 | Volume
| Issue : 1 | Page : 35-36
Extramedullary deposits in leukemia: Out of blood but not out of mind
Kamal Kant Sahu1, Kundan Mishra2, Pankaj Malhotra2
1 Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street, Worcester, 01608, MA, USA
2 Clinical Hematology Division, Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
|Date of Web Publication||5-Feb-2020|
Dr. Pankaj Malhotra
Clinical Hematology Division, Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sahu KK, Mishra K, Malhotra P. Extramedullary deposits in leukemia: Out of blood but not out of mind. J Microsc Ultrastruct 2020;8:35-6
|How to cite this URL:|
Sahu KK, Mishra K, Malhotra P. Extramedullary deposits in leukemia: Out of blood but not out of mind. J Microsc Ultrastruct [serial online] 2020 [cited 2020 Nov 27];8:35-6. Available from: https://www.jmau.org/text.asp?2020/8/1/35/267749
Gomaa et al. reported a challenging case of breast myeloid sarcoma in a young woman. Extramedullary granulocytic sarcomas (EMS) have varied presentations depending on the site of involvement. It is very important to be aware of extramedullary deposits while treating any patient to monitor the size, to assess the need of local radiotherapy, and to evaluate for any mass effect compromising organ function. We hereby share our institutional experience on extramedullary deposits with special emphasis on female reproductive system.
Author's case was worked up for breast lump and was found to have EMS of the left breast. Other than in acute myeloid leukemia (AML), EMS are also seen in chronic myeloid leukemia (CML), myelodysplastic syndrome etc [Table 1]: Case no. 3, 5, and 9]. Case no. 3 had CML in chronic phase (CML-CP) and was on imatinib therapy (400 mg/day) for 10 years before she had disease progression to accelerated phase (AP) requiring dose escalation. One year later, she developed a left shoulder EMS requiring local radiotherapy and higher dose of chemotherapy. Contrarily, Case no. 9 developed dual-site EMS at the scalp and spinal cord but unfortunately died secondary to sepsis.
|Table 1: Recent institutional experience of Postgraduate Institute of Medical Education and Research, Chandigarh, on extramedullary deposits (secondary to leukemias)|
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Chatterjee et al. (Case no. 6) reported bilateral breast lumps as an initial presentation of AML. Case no. 4 was diagnosed with B-cell acute lymphoblastic leukemia and received modified BFM-90 chemotherapy successfully. On follow-up, she presented with postcoital bleeding and was diagnosed to have extramedullary relapse involving ovary.
As evident in [Table 1], we recently reported other cases of EMS involving other rare sites such as orbit, spinal cord, uterus, paravertebral mass presenting as Horner's syndrome, pleura, and mediastinum.,,,,, In most cases, any meningeal or parenchymal lesion in a known case of leukemia should prompt us to think of central nervous system relapse. However, Salunke et al. from our institute recently reported biopsy-confirmed meningeal-based tuberculoma in a known CML case which teaches us not to limit the differentials only to relapse based on history of malignancy.
In our recent review of literature on EMS of vulva and heart, we found that these rare sites of involvement are more challenging and can be easily missed unless a strong suspicion is kept.,,, It is important to know that besides leukemia, renal cell carcinoma, carcinoma of lung, plasmacytoma, and Burkitt's lymphoma are also reported to present as breast lumps.,,, However, we want to reemphasize to readers to consider common causes of breast lump such as fibroadenoma and benign fibrocystic disease as the first possibilities and not to forget the above-mentioned conditions in the differentials.
We conclude with the hope to enhance knowledge about the rare entities presenting as breast lumps. EMS of breast can mimic as common benign entities such as fibroadenoma and hamartoma, especially in reproductive age group. Hence, combined effort of oncologists, gynecologists, and pathologists is of utmost importance to hasten the diagnosis and treatment in any proven case.
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Conflicts of interest
There are no conflicts of interest.
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