Korean J Hematol.  2009 Sep;44(3):148-152. 10.5045/kjh.2009.44.3.148.

A Case of Acute Myeloid Leukemia with Mediastinal Sarcoma

• Nam YH
• Lee JH
• Kwon KA
• Lee S
• Oh SY
• Kim SH
• Kwon HC
• Han JY
• Hong SH
• Kim HJ

• KMID: 2252133
• DOI: http://doi.org/10.5045/kjh.2009.44.3.148

Abstract

Myeloid sarcoma (MS) is a solid extramedullary tumor that is composed of immature myeloid cells. The incidence of MS in patients with acute myeloid leukemia (AML) has been reported to be 3~8%. Lymph nodes are the most frequent site of presentation for MS, and other clinical presentations such as an abdominal mass with bowel involvement, a pancreatic mass, isolated central nervous system infiltration, a testicular mass and breast lumps have also been reported. AML with mediastinal MS is a relatively rare disease. The patients with AML with mediastinal MS has been reported to have complex cytogenetic abnormalities and a poor long-term prognosis. The optimal treatment of AML with MS remains to be determined. We report here on an unusual case of a 37-year-old man who presented multiple lymph node enlargements on the neck and a huge mediastinal mass that was considered to be lymphoma. He was finally diagnosed as AML with MS according to the surgical excisional biopsy of a left supraclavicular lymph node and bone marrow examination. He achieved complete remission and the multiple enlarged lymph nodes on the neck and the mediastinal mass disappeared after remission induction chemotherapy. Thereafter, he received HLA-matched unrelated allogenic hematopoietic stem cell transplantation.

Keyword

Acute myeloid leukemia; Myeloid sarcoma; Mediastinum

MeSH Terms

Adult
Biopsy
Bone Marrow Examination
Breast
Central Nervous System
Chromosome Aberrations
Hematopoietic Stem Cells
Humans
Incidence
Leukemia, Myeloid, Acute
Lymph Nodes
Lymphoma
Mediastinum
Myeloid Cells
Neck
Prognosis
Rare Diseases
Remission Induction
Sarcoma
Sarcoma, Myeloid

Figure

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  Fig. 1. (A) Initial chest PA radiography shows prominent left suprahilar mass lesion. (B) Chest computed tomography (CT) shows multiple lymphadenopathies at intra-thoracic area and a huge mass at anterior mediastinal area.

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  Fig. 2. Histopathologic examination of surgical excisional lymph node biopsy reveals myeloid sarcoma. (A) The lymph node is almost replaced by diffusely infiltrating atypical cells (Hematoxylin-Eosin, x200). (B) The cells surrounding the lymphoid follicle are positive for myeloperoxidase (Immunohistochemical stain, x400). (C) The cells surrounding the lymphoid follicle are positive for CD34 (Immunohistochemical stain, x400).

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  Fig. 3. (A) Bone marrow biopsy. The marrow is nearly replaced by a diffuse infiltration of leukemic blasts and dense fibrosis (×1,000). (B) Bone marrow aspiration, ×1,000. Marked proliferation of leukemic blasts is seen, characterized by large size, a high nuclear/chromatin ratio, and prominent multiple nucleoli.

Reference

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