All Title Author
Keywords Abstract


Paraneoplastic Autoimmunity Associated with Testicular Myeloid Sarcoma and Chronic Myelomonocytic Leukemia

DOI: 10.1155/2013/656543

Full-Text   Cite this paper   Add to My Lib

Abstract:

Myeloid sarcomas are rare extramedullary solid tumors composed of immature myeloid cells. The clinical presentations of these malignant neoplasms are highly variable, ranging from asymptomatic to localized mass effect. Here, we report an unusual case of myeloid sarcoma of the testis found in association with chronic myelomonocytic leukemia where the presenting symptoms were autoimmune pericarditis and migratory arthralgias and myalgias that preceded testicular enlargement by nearly three months. Treatment with both radical orchiectomy and leukemia-directed chemotherapy led to immediate reductions in symptom severity, suggesting that these early symptoms were paraneoplastic in origin. Review of the literature identified the association between hematological malignancies, including chronic myelomonocytic leukemia, and paraneoplastic autoimmune phenomena with features similar to polymyalgia rheumatica and rheumatoid arthritis. Importantly, rheumatologic symptoms related to these disease entities may be easily dismissed as vague or unrelated complaints or treated as purely rheumatologic conditions, thus delaying the formal diagnoses. Clinicians must recognize the common association between possible paraneoplastic rheumatologic symptoms and hematologic malignancies such as chronic myelomonocytic leukemia. 1. Introduction Myeloid sarcomas are tumor masses that consist of myeloid blasts or immature myeloid cells that occur at extramedullary sites throughout the body [1]. While the most commonly affected sites are the skin, lymph nodes, bone, soft tissues, and gastrointestinal tract, these neoplasms may be found at any location and are often accompanied by bone marrow involvement of an underlying hematologic malignancy [2]. Myeloid sarcomas are not associated with a classical presentation but are rather associated with an assortment of clinical findings dependent on tumor size, tumor location, and the direct consequences of underlying hematologic disorders (e.g., infection, bleeding, and organomegaly) [3]. Myeloid sarcomas occur less frequently than many other solid tumors, and the histomorphologic diagnosis is often difficult or delayed in the absence of a previously diagnosed blood-born malignancy [4]. Due to histomorphological similarity to non-Hodgkin’s lymphomas, myeloid sarcomas are often initially confused with aggressive large B-cell lymphomas [5]. Obtaining the correct diagnosis is critical, however, as the chemotherapeutic regimens used for treating malignant lymphoproliferative disorders differ substantially from those used for treating acute

References

[1]  S. A. Pilieri, A. Orazi, and B. Falini, “Myeloid sarcoma,” in WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, S. H. Swerdlow, E. Campo, N. L. Harris, et al., Eds., p. 140, International Agency for Research on Cancer (IARC) Press, Lyon, France, 4th edition, 2008.
[2]  J. C. Byrd, W. J. Edenfield, D. J. Shields, and N. A. Dawson, “Extramedullary myeloid cell tumors in acute nonlymphocytic leukemia: a clinical review,” Journal of Clinical Oncology, vol. 13, no. 7, pp. 1800–1816, 1995.
[3]  J. Audouin, E. Comperat, A. le Tourneau et al., “Myeloid sarcoma: clinical and morphologic criteria useful for diagnosis,” International Journal of Surgical Pathology, vol. 11, no. 4, pp. 271–282, 2003.
[4]  J. M. Klco, J. S. Welch, T. T. Nguyen et al., “State of the art in myeloid sarcoma,” International Journal of Laboratory Hematology, vol. 33, no. 6, pp. 555–565, 2011.
[5]  L. P. Menasce, S. S. Banerjee, E. Beckett, and M. Harris, “Extra-medullary myeloid tumour (Granulocytic sarcoma) is often misdiagnosed: a study of 26 cases,” Histopathology, vol. 34, no. 5, pp. 391–398, 1999.
[6]  S. A. Pileri, S. Ascani, M. C. Cox et al., “Myeloid sarcoma: clinico-pathologic, phenotypic and cytogenetic analysis of 92 adult patients,” Leukemia, vol. 21, no. 2, pp. 340–350, 2007.
[7]  J. R. Valbuena, J. H. Admirand, P. Lin, and L. J. Medeiros, “Myeloid sarcoma involving the testis,” American Journal of Clinical Pathology, vol. 124, no. 3, pp. 445–452, 2005.
[8]  M. W. Saif, J. L. Hopkins, and S. D. Gore, “Autoimmune phenomena in patients with myelodysplastic syndromes and chronic myelomonocytic leukemia,” Leukemia and Lymphoma, vol. 43, no. 11, pp. 2083–2092, 2002.
[9]  C. Campidelli, C. Agostinelli, R. Stitson, and S. A. Pileri, “Myeloid sarcoma: extramedullary manifestation of myeloid disorders,” American Journal of Clinical Pathology, vol. 132, no. 3, pp. 426–437, 2009.
[10]  A.-M. Tsimberidou, H. M. Kantarjian, E. Estey et al., “Outcome in patients with nonleukemic granulocytic sarcoma treated with chemotherapy with or without radiotherapy,” Leukemia, vol. 17, no. 6, pp. 1100–1103, 2003.
[11]  N. M. Corcoran, A. Tsui, A. J. Costello, and D. Bouchier-Hayes, “Unilateral testicular mass in man with chronic myelomonocytic leukemia: unusual presentation of chronic myelomonocytic leukemia sequela,” Urology, vol. 65, no. 5, p. 1001, 2005.
[12]  A.-M. Tsimberidou, H. M. Kantarjian, S. Wen et al., “Myeloid sarcoma is associated with superior event-free survival and overall survival compared with acute myeloid leukemia,” Cancer, vol. 113, no. 6, pp. 1370–1378, 2008.
[13]  S. Giannouli, T. Kanellopoulou, and M. Voulgarelis, “Myelodysplasia and autoimmunity,” Current Opinion in Rheumatology, vol. 24, no. 1, pp. 97–102, 2012.
[14]  V. Racanelli, M. Prete, C. Minoia, E. Favoino, and F. Perosa, “Rheumatic disorders as paraneoplastic syndromes,” Autoimmunity Reviews, vol. 7, no. 5, pp. 352–358, 2008.
[15]  C. András, Z. Csiki, A. Ponyi, A. Illés, and K. Dankó, “Paraneoplastic rheumatic syndromes,” Rheumatology International, vol. 26, no. 5, pp. 376–382, 2006.
[16]  K. Elenitoba-Johnson, G. F. Hodges, T. C. King, C. D. Wu, and L. J. Medeiros, “Extramedullary myeloid cell tumors arising in the setting of chronic myelomonocytic leukemia: a report of two cases,” Archives of Pathology and Laboratory Medicine, vol. 120, no. 1, pp. 62–67, 1996.
[17]  J. A. Ferry, J. R. Srigley, and R. H. Young, “Granulocytic sarcoma of the testis: a report of two cases of a neoplasm prone to misinterpretation,” Modern Pathology, vol. 10, no. 4, pp. 320–325, 1997.
[18]  A. Saxena, B. Saidman, D. Greenwald, and M. A. Wasik, “Testicular extramedullary myeloid cell tumor in a patient with myelodysplastic syndrome,” Archives of Pathology and Laboratory Medicine, vol. 120, no. 4, pp. 389–392, 1996.

Full-Text

comments powered by Disqus

Contact Us

service@oalib.com

QQ:3279437679

微信:OALib Journal