Diagnostic Challenges in Identifying Concurrent Myeloid Sarcoma and High-Grade Prostatic Adenocarcinoma Within the...

Area of Science:

• Oncology
• Pathology
• Urology

Background:

• Myeloid sarcoma is a rare extramedullary tumor of myeloid blasts.
• Prostate involvement is exceptionally rare, with fewer than 30 cases reported.
• Concurrent prostatic myeloid sarcoma and adenocarcinoma has not been previously documented.

Purpose of the Study:

• To present the first documented cases of concurrent prostatic myeloid sarcoma and high-grade adenocarcinoma.
• To highlight the diagnostic challenges associated with these rare co-occurring conditions.
• To discuss the clinical presentation and outcomes in patients without a prior hematolymphoid neoplasm history.

Main Methods:

• Case identification through core needle biopsy and radical prostatectomy.
• Immunohistochemical analysis for myeloid markers, including NPM1.
• Review of patient history for prior hematolymphoid neoplasms or acute myeloid leukemia (AML).

Main Results:

• Two patients presented with concurrent prostatic myeloid sarcoma and high-grade adenocarcinoma.
• Both cases were positive for NPM1 by immunohistochemistry, suggesting NPM1 mutation.
• Neither patient received specific treatment for myeloid sarcoma/AML due to comorbidities.

Conclusions:

• Concurrent myeloid sarcoma and adenocarcinoma of the prostate is a newly described entity.
• NPM1 positivity may be a feature of prostatic myeloid sarcoma.
• These rare diagnoses pose significant clinical and diagnostic challenges, with poor prognoses often influenced by comorbidities.