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[Isolated granulocytic sarcoma in the breast].
Ken Oyama1, Takao Suzuki, Satoshi Yoshimura
1Division of Hematology Oncology, St. Marianna University School of Medicine.
[Rinsho Ketsueki] the Japanese Journal of Clinical Hematology
|October 28, 2003
Summary
Granulocytic sarcoma (GS) in a teen was initially misdiagnosed but confirmed via specific staining and high WT-1 mRNA levels. Monitoring WT-1 mRNA may aid in early relapse detection for this bone marrow-related condition.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- A 16-year-old female presented with a breast tumor initially diagnosed as non-Hodgkin lymphoma.
- Pathological re-evaluation raised suspicion for sarcoma, prompting further investigation.
Observation:
- A second tumor appeared in the contralateral breast, leading to a biopsy.
- Tumor touch preparations showed positivity for myeloperoxidase and chloroacetate esterase.
- High WT-1 mRNA levels were detected in bone marrow and tumor cells, despite normal peripheral blood and bone marrow cytogenetics.
Findings:
- The diagnosis was revised to granulocytic sarcoma (GS), a rare extramedullary manifestation.
- Treatment with an acute myelogenous leukemia protocol led to breast tumor resolution.
- WT-1 mRNA levels in bone marrow decreased but remained elevated post-treatment.
Implications:
- These findings suggest granulocytic sarcoma may originate from the bone marrow.
- Monitoring WT-1 mRNA levels could be a valuable tool for early detection of relapse in GS.
- This case highlights the importance of thorough pathological examination and molecular markers in diagnosing rare hematologic malignancies.