Myeloid Sarcoma: Features in Cytological Preparations and the Utility of Rapid On-Site Evaluation (ROSE) in Triage

Log in to MyKarger to check if you already have access to this content.

Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Access via DeepDyve Unlimited fulltext viewing Of this article Organize, annotate And mark up articles Printing And downloading restrictions apply

Select

Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more

Subcription rates

Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview

Abstract of Nongynecologic Cytopathology

Received: June 29, 2022
Accepted: August 16, 2022
Published online: November 01, 2022

Number of Print Pages: 15
Number of Figures: 6
Number of Tables: 3

ISSN: 0001-5547 (Print)
eISSN: 1938-2650 (Online)

For additional information: https://www.karger.com/ACY

Abstract

Introduction: Myeloid sarcoma (MS) is a rare extramedullary tumor consisting of blasts of granulocytic, monocytic, erythroid, or megakaryocytic lineage that disrupts the architecture of the involved tissue. MS shows vast clinical, morphologic, immunophenotypic, and genetic heterogeneity posing a diagnostic dilemma, especially in small biopsy specimens such as fine-needle aspiration (FNA) and core biopsy. The objective of this study is to highlight the morphologic features of MS in cytological preparations and investigate the efficacy of pathologist-performed rapid on-site evaluation (ROSE) in assuring accurate triage. Methods: A retrospective review was performed for cases of MS with concurrent cytology and ROSE results from 2006 to 2017. FNA smears and touch preparations were reviewed, and the results of ROSE, immunohistochemistry (IHC), flow cytometric immunophenotyping (FCI), cytogenetics/FISH, and histology were analyzed. Results: A total of 15 cases were found including 6 (40%) with monocytic morphology comprising promonocytes and monoblasts and 9 (60%) with conventional myeloblastic morphology. The most common genetic subgroup was KMT2A-rearranged MS (33.3%) followed by extramedullary blast crisis of chronic myeloid leukemia (26.6%). ROSE provided sufficient preliminary information and ensured the procurement of adequate tissue for histology, IHCs, FCI, and cytogenetics/FISH, leading to an accurate and complete diagnosis of MS in all cases. Discussion/Conclusion: MS is a rare malignancy that shows pronounced clinical, morphologic, immunophenotypic, and genetic heterogeneity that often overlaps with other neoplastic and non-neoplastic entities. Features including the presence of classic myeloblasts, promonocytes, monoblasts, nucleated red blood cells, left-shifted granulocytes, cytoplasmic granules, and pseudopods are helpful hints in cytological preparations. In the modern era where pathologists are increasingly expected to do extensive diagnostic, molecular, and therapeutic biomarker testing on tissue that is historically diminishing in size, ROSE is a highly effective tool to ensure effective triage of MS aiding in an accurate, timely, and complete diagnosis.

© 2022 S. Karger AG, Basel

References Murati A, Brecqueville M, Devillier R, Mozziconacci MJ, Gelsi-Boyer V, Birnbaum D. Myeloid malignancies: mutations, models and management. BMC Cancer. 2012;12:304. Pileri SA, Orazi A, Falini B. Myeloid sarcoma. In: Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al., editors. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon: IARC; 2017. Klco JM, Welch JS, Nguyen TT, Hurley MY, Kreisel FH, Hassan A, et al. State of the art in myeloid sarcoma. Int J Lab Hematol. 2011;33(6):555–65. Pileri SA, Ascani S, Cox MC, Campidelli C, Bacci F, Piccioli M, et al. Myeloid sarcoma: clinico-pathologic, phenotypic and cytogenetic analysis of 92 adult patients. Leukemia. 2007;21(2):340–50. Falini B, Lenze D, Hasserjian R, Coupland S, Jaehne D, Soupir C, et al. Cytoplasmic mutated nucleophosmin (NPM) defines the molecular status of a significant fraction of myeloid sarcomas. Leukemia. 2007;21(7):1566–70. Numan Y, Tariq H, Fan J, Xie P, Burkart M, Abaza Y, et al. Myeloid sarcoma reveals a unique tumor micro-environment and differential prognosis based on transplant status and type of treatment received. Blood. 2021;138(Suppl 1):3432. Hurley MY, Ghahramani GK, Frisch S, Armbrecht ES, Lind AC, Nguyen TT, et al. Cutaneous myeloid sarcoma: natural history and biology of an uncommon manifestation of acute myeloid leukemia. Acta Derm Venereol. 2013;93(3):319–24. Alexiev BA, Wang W, Ning Y, Chumsri S, Gojo I, Rodgers WH, et al. Myeloid sarcomas: a histologic, immunohistochemical, and cytogenetic study. Diagn Pathol. 2007;2:42. Liu H, Guinipero TL, Schieffer KM, Carter C, Colace S, Leonard JR, et al. De novo primary central nervous system pure erythroid leukemia/sarcoma with t(1;16)(p31;q24) NFIA/CBFA2T3 translocation. Haematologica. 2020;105(4):e194–7. Manresa P, Tarín F, Niveiro M, Tasso M, Alda O, López F, et al. A rare case of pure erythroid sarcoma in a pediatric patient: case report and literature review. Children. 2017;4(12):113. Majhi U, Murhekar K, Sundersingh S. Primary myeloid sarcoma with megakaryocytic differentiation in lymph nodes and skin. Indian J Pathol Microbiol. 2011;54(3):660–1. Chaudhary H, Aboushi H, Minkowitz J, Edwards JA, Beltre D, Parmar P, et al. Liver granulocytic sarcoma with megakaryocytic differentiation: a rare extra medullary involvement that warrants liver biopsy for prompt diagnosis. Cureus. 2021;13(7):e16366. Hancock JC, Prchal JT, Bennett JM, Listinsky CM. Trilineage extramedullary myeloid cell tumor in myelodysplastic syndrome. Arch Pathol Lab Med. 1997;121(5):520–3. Shan M, Lu Y, Yang M, Wang P, Lu S, Zhang L, et al. Characteristics and transplant outcome of myeloid sarcoma: a single-institute study. Int J Hematol. 2021;113(5):682–92. Nunes G, Pinto-Marques P, Mendonça E, Gargaté L. First case report of pancreatic myeloid sarcoma diagnosed through EUS-FNA. Gastroenterol Hepatol. 2019;42(10):627–8. Tao J, Wu M, Fuchs A, Wasserman P. Fine-needle aspiration of granulocytic sarcomas: a morphologic and immunophenotypic study of seven cases. Ann Diagn Pathol. 2000;4(1):17–22. Barker TH. Granulocytic sarcoma of the breast diagnosed by fine needle aspiration (FNA) cytology. Cytopathology. 1998;9(2):135–7. Cross A, Chajewski OS, Rutland C, Smith K, Woodham P, Skipper D, et al. Myeloid sarcoma diagnosed on pleural effusion cytology: a case report and literature review. Diagn Cytopathol. 2021;49(8):E316–9. Snider JS, Eichel Y, Caudell AM, Chajewski OS, Yang J, Lindsey KG. Myeloid sarcoma identified on liquid-based cervical cytology samples: a report of two cases. Diagn Cytopathol. 2017;45(10):953–7. Sahu KK, Tyagi R, Law AD, Khadwal A, Prakash G, Rajwanshi A, et al. Myeloid Sarcoma: an unusual case of mediastinal mass and malignant pleural effusion with review of literature. Indian J Hematol Blood Transfus. 2015;31(4):466–71. Stephen N, Manivannan P, Gochhait D, Sreerekha J, Ramasubramanian N, Srinivas BH, et al. The utility of fine needle aspiration cytology in orbital haematolymphoid neoplasms. Cytopathology. 2021;32(2):217–26. Osman M, Akkus Z, Jevremovic D, Nguyen PL, Roh D, Al-Kali A, et al. Classification of monocytes, promonocytes and monoblasts using deep neural network models: an area of unmet need in diagnostic hematopathology. J Clin Med. 2021;10(11):2264. Bain BJ. What is a promonocyte? Am J Hematol. 2013 Oct;88(10):919. Krause JR, Bredeweg A. Importance of distinguishing the promonocyte in leukemia. Proc. 2020;33(4):649–50. Goasguen JE, Bennett JM, Bain BJ, Vallespi T, Brunning R, Mufti GJ, et al. Morphological evaluation of monocytes and their precursors. Haematologica. 2009;94(7):994–7. Singhal RL, Monaco SE, Pantanowitz L. Cytopathology of myeloid sarcoma: a study of 16 cases. J Am Soc Cytopathol. 2015;4(2):98–103. Walter K, Cockerill PN, Barlow R, Clarke D, Hoogenkamp M, Follows GA, et al. Aberrant expression of CD19 in AML with t(8;21) involves a poised chromatin structure and PAX5. Oncogene. 2010;29(20):2927–37. Hurwitz CA, Raimondi SC, Head D, Krance R, Mirro JJ, Kalwinsky DK, et al. Distinctive immunophenotypic features of t(8;21)(q22;q22) acute myeloblastic leukemia in children [see comments]. Blood. 1992;80(12):3182–8. Menter T, Lundberg P, Wenzel F, Dirks J, Fernandez P, Friess D, et al. RUNX1 mutations can lead to aberrant expression of CD79a and PAX5 in acute myelogenous leukemias: a potential diagnostic pitfall. Pathobiology. 2019;86(2–3):162–6. Kita K, Nakase K, Miwa H, Masuya M, Nishii K, Morita N, et al. Phenotypical characteristics of acute myelocytic leukemia associated with the t(8;21)(q22;q22) chromosomal abnormality: frequent expression of immature B-cell antigen CD19 together with stem cell antigen CD34. Blood. 1992;80(2):470–7. Wilson CS, Medeiros LJ. Extramedullary manifestations of myeloid neoplasms. Am J Clin Pathol. 2015;144(2):219–39. Hagen PA, Singh C, Hart M, Blaes AH. Differential diagnosis of isolated myeloid sarcoma: a case report and review of the literature. Hematol Rep. 2015;7(2):5709. Sharma A, Das AK, Pal S, Bhattacharyya S. Fine-needle aspiration cytology of granulocytic sarcoma presenting as a breast lump: report of a rare case with a comprehensive literature search. J Lab Physicians. 2018;10(1):113–5. Emile JF, Abla O, Fraitag S, Horne A, Haroche J, Donadieu J, et al. Revised classification of histiocytoses and neoplasms of the macrophage-dendritic cell lineages. Blood. 2016;127(22):2672–81. Skala SL, Lucas DR, Dewar R. Histiocytic Sarcoma: review, discussion of transformation from B-cell lymphoma, and differential diagnosis. Arch Pathol Lab Med. 2018;142(11):1322–9. Gökçe M, Aytaç S, Ünal Ş, Altan İ, Gümrük F, Çetin M. Acute megakaryoblastic leukemia with t(1;22) mimicking neuroblastoma in an infant. Turk J Haematol. 2015;32(1):64–7. Liang C, Chan KH, Yoon PJ, Lovell MA. Clinicopathological characteristics of extramedullary acute megakaryoblastic leukemia (AMKL): report of a case with initial mastoid presentation and review of literature to compare extramedullary AMKL and non-AMKL cases. Pediatr Dev Pathol. 2012;15(5):385–92. Støve HK, Sandahl JD, Abrahamsson J, Asdahl PH, Forestier E, Ha SY, et al. Extramedullary leukemia in children with acute myeloid leukemia: a population-based cohort study from the Nordic Society of Pediatric Hematology and Oncology (NOPHO). Pediatr Blood Cancer. 2017;64(12):e26520. El Jamal SM, Salama A, Marcellino BK, Abulsayen HA, Zhou X, Hassan M, et al. Myeloid Sarcoma of the testis in children: clinicopathologic and immunohistochemical characteristics with KMT2A (MLL) gene rearrangement correlation. Appl Immunohistochem Mol Morphol. 2020;28(7):501–7. Alwan AF. Acute transformation in chronic myelogenous leukaemia. Tikrit Med J. 2007;13:12–7. Ware AD, Wake L, Brown P, Webster JA, Smith BD, Duffield AS. B-lymphoid blast phase of chronic myeloid leukemia: a case report and review of the literature. AJSP Rev Rep. 2019;24(5):191–5. Hehlmann R, Voskanyan A, Lauseker M, Pfirrmann M, Kalmanti L, Rinaldetti S, et al. High-risk additional chromosomal abnormalities at low blast counts herald death by CML. Leukemia. 2020;34(8):2074–86. Churpek JE, Larson RA. The evolving challenge of therapy-related myeloid neoplasms. Best Pract Res Clin Haematol. 2013;26(4):309–17. Tariq H, Barnea Slonim L, Coty Fattal Z, Alikhan MB, Segal J, Gurbuxani S, et al. Therapy-related myeloid neoplasms with normal karyotype show distinct genomic and clinical characteristics compared to their counterparts with abnormal karyotype. Br J Haematol. 2022;197(6):736–44. Bharati P, Deepak D, Kaushal M, Gupta P. Diagnostic utility of rapid on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration samples: a study in a region of high tuberculosis burden. Cytopathology. 2021;32(4):428–35. Collins BT, Garcia TC, Hudson JB. Rapid on-site evaluation improves fine-needle aspiration biopsy cell block quality. J Am Soc Cytopathol. 2016;5(1):37–42. Tariq H, Forker C, Mais DD. Impact of rapid on-site evaluation (ROSE) on the diagnostic rate of pancreatic endoscopic ultrasound guided fine need aspirations. Lab Invest. 2018;98:795–6. Khoury T, Sbeit W. Cost-effectiveness of rapid on-site evaluation of endoscopic ultrasound fine needle aspiration in gastrointestinal lesions. Cytopathology. 2021;32(3):326–30. Witt BL. Rapid on site evaluation (ROSE): a pathologists’ perspective. Tech Vasc Interv Radiol. 2021;24(3):100767. Article / Publication Details

First-Page Preview

Abstract of Nongynecologic Cytopathology

Received: June 29, 2022
Accepted: August 16, 2022
Published online: November 01, 2022

Number of Print Pages: 15
Number of Figures: 6
Number of Tables: 3

ISSN: 0001-5547 (Print)
eISSN: 1938-2650 (Online)

For additional information: https://www.karger.com/ACY

留言 (0)

沒有登入
gif