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[Granulocytic sarcoma developing in lymph nodes]
Ichiro Watanabe1, Yoshihiro Yakushijin, Ikuya Sakai
1First Department of Internal Medicine, Ehime University School of Medicine.
Insights
A rare case of granulocytic sarcoma initially misdiagnosed as non-Hodgkin lymphoma highlights the importance of comprehensive diagnostic markers. This myeloid malignancy requires specific treatment for optimal patient outcomes.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- A 77-year-old male presented with a cervical tumor initially diagnosed as non-Hodgkin lymphoma.
- The patient received chemotherapy (THP-COP) for stage IV disease.
Observation:
- Flow cytometry revealed co-expression of lymphoid (CD5, 7, 21) and myeloid (CD11b, 33, 34) markers.
- Immunohistochemistry showed positivity for MT1 (CD43) but negativity for myeloperoxidase and chloroacetate esterase.
- Genetic analysis detected no IgH, TCR C beta 1, or TCR J gamma gene rearrangement.
Findings:
- The diagnostic re-evaluation shifted the diagnosis from malignant lymphoma to granulocytic sarcoma.
- THP-COP therapy achieved complete remission of the granulocytic sarcoma.
- The patient later developed acute myelocytic leukemia (AML M1) and succumbed to pneumonia despite further treatment.
Implications:
- Accurate diagnosis of granulocytic sarcoma is crucial, requiring integrated analysis of flow cytometry, immunohistochemistry, and genetic studies.
- Co-expression of lymphoid and myeloid markers can complicate lymphoma diagnoses.
- Granulocytic sarcoma may precede or transform into acute myeloid leukemia, necessitating vigilant monitoring.
Abstract:
A 77-year-old man was admitted to a hospital because of a left cervical tumor. He was initially diagnosed as having non-Hodgkin lymphoma, diffuse large cell type, Ann Arbor stage IV, and transferred to our hospital for chemotherapy. Flow cytometric analysis of the left axillary lymph node cells derived from a biopsy specimen showed that in addition to lymphoid surface markers (CD5, 7, 21), myeloid surface markers (CD11b, 33, 34) were also positive. The diagnosis of malignant lymphoma was therefore confirmed. The patient, was treated with THP-COP therapy, which proved very effective. Thereafter, a biopsy specimen was found to be positive for MT1 (CD43) staining but negative for myeloperoxidase and chloroacetate esterase staining on immunohistochemistry. Furthermore, no rearrangement of the IgH JH, TCR C beta 1 or TCR J gamma gene was detected by Southern blot analysis. On basis of these findings and the previous results of flow cytometry, we changed the diagnosis from malignant lymphoma to granulocytic sarcoma. THP-COP therapy was continued, and complete remission was achieved. Two months later, however, the patient developed acute myelocytic leukemia (AML M1) and received DCP therapy, but he died of pneumonia.