Transesophageal echocardiography-guided transvenous biopsy of an intracardiac tumor

Transesophageal echocardiography with simultaneous fluoroscopic guidance during a transvenous biopsy of an intracardiac tumor is a valuable technique. We present the case of a 67-year-old man with a metastasis in the right atrium from which histological examination of the tumor was indicated. The inaccessible location of the primary tumor in the liver and impaired hemostasis due to cirrhosis necessitated a transvenous biopsy of the metastasis. The procedure and the associated techniques are discussed in this case.     

Isolated granulocytic sarcoma of the small intestine successfully treated with chemotherapy and bone marrow transplantation

Isolated primary granulocytic sarcoma is a rare disease that presents as an extramedullary tumor of myeloid lineage cells. Most patients subsequently develop acute myelogenous leukemia (AML) within a short period, and their prognosis is poor. Herein, we report the case of a 33-year-old woman with a primary isolated granulocytic sarcoma which originated in the small intestine. After she recovered from surgery, she received intensive chemotherapy equivalent to that for AML, followed by allogeneic bone marrow transplantation from an HLA-matched, unrelated donor. Four years after the transplantation, she remains in complete remission without graft-versus-host disease or any other symptoms. This case illustrates the effectiveness of our therapeutic strategy for isolated granulocytic sarcoma, not only with surgical resection of the tumor and intensive chemotherapy equivalent to that for AML, but also with allogeneic bone marrow transplantation, performed while no sign of AML is observed.     

Karyotypic evolution in a granulocytic sarcoma developing in a myeloproliferative disorder with a novel (3;4) translocation

Summary. A 59-year-old man presented with a granulocytic sarcoma arising in the manubrium, and splenomegaly. The blood count showed 1-2 × 10⁹/1 eosinophils and a marrow aspirate was hypercellular with eosinophilia. Cytogenetic analysis of the marrow revealed a novel t(3;4) (pl3;ql2) and analysis of cells aspirated from the granulocytic sarcoma showed the same abnormality and an additional trisomy 8.
Intensive chemotherapy and local radiotherapy led to resolution of the chest mass but persistence of the chromosome translocation in the marrow.     

Transesophageal echocardiography-guided transvenous endomyocardial biopsy used to diagnose primary cardiac angiosarcoma

Primary cardiac tumors are rare clinical entities with the histologic diagnosis usually made from surgically obtained tissue or at postmortem examination. Transvenous endomyocardial biopsy has been used less frequently, under fluoroscopic or transthoracic echocardiographic guidance. In this case report, we utilized the transesophageal echocardiography to guide the endomyocardial biopsy from a right atrial tumor in a 35-year-old man. © 1996 Wiley-Liss, Inc.     

State of the art in myeloid sarcoma

Introduction: Myeloid sarcomas are extramedullary lesions composed of myeloid lineage blasts that typically form tumorous masses and may precede, follow, or occur in the absence of systemic acute myeloid leukemia. They most commonly involve the skin and soft tissues, lymph nodes, and gastrointestinal tract and are particularly challenging to diagnose in patients without an antecedent history of acute myeloid leukemia. Methods: We conducted a search of the English language medical literature for recent studies of interest to individuals involved in the diagnosis of myeloid sarcoma. Results: The differential diagnosis includes non‐Hodgkin lymphoma, blastic plasmacytoid dendritic cell neoplasm, histiocytic sarcoma, melanoma, carcinoma, and (in children) small round blue cell tumors. The sensitivity and specificity of immunohistochemical markers must be considered when evaluating a suspected case of myeloid sarcoma. A high percentage of tested cases have cytogenetic abnormalities. Conclusion: A minimal panel of immunohistochemical markers should include anti‐CD43 or anti‐lysozyme as a lack of immunoreactivity for either of these sensitive markers would be inconsistent with a diagnosis of myeloid sarcoma. Use of more specific markers of myeloid disease, such as CD33, myeloperoxidase, CD34 and CD117 is necessary to establish the diagnosis. Other antibodies may be added depending on the differential diagnosis. Identification of acute myeloid leukemia‐associated genetic lesions may be helpful in arriving at the correct diagnosis.     

右心声学造影对心内由右向左分流的半定量研究

目的探讨右心声学造影对心内由右向左分流半定量诊断的价值。方法对34例先天性心脏病患者，经静脉注射声振50％葡萄糖，根据左心显影情况进行半定量分级O级，造影剂局限于右心显影，左心无造影剂反射；Ⅰ级，左心有稀疏、范围局限的造影剂反射；Ⅱ级，左心有较浓密、范围较大的造影剂反射；Ⅲ级，左心腔及流出道充满浓密造影剂，其浓密程度与右心相似。穿刺取股动脉血液测定动脉血氧饱和度(SaO2)。结果0级，平均SaO     

Multilineage involvement in hypereosinophilic syndrome terminating in granulocytic sarcoma and leukaemic transformation with trisomy 8

We report a patient with hypereosinophilic syndrome (HES), which, 8 years later, transformed into granulocytic sarcoma in the brain and, subsequently, into acute myelocytic leukaemia. Repeated chromosome analyses showed a normal karyotype, until the time of leukaemic transformation when trisomy 8 was confirmed in cells from the bone marrow and cerebrospinal fluid. The combined techniques of May-Grunwald-Giemsa staining and fluorescence in situ hybridization identified trisomy 8 not only in blasts and eosinophils but also in neutrophils and erythroblasts. Our observation suggests that HES is a multilineage myeloproliferative disorder involving precursors of at least the eosinophil, neutrophil and erythroid lineages.     

Granulocytic sarcoma presenting as bilateral adrenal masses

Granulocytic sarcoma (GS) is a collection of immature myeloid cells contained outside the bone marrow often seen in association with acute myeloid leukemia or as a sign of leukemic transformation in myeloproliferative disorders. Rarely, GS is an isolated finding unaccompanied by another hematological disorder. GS can occur at a variety of sites, most commonly involving the bone, soft tissue, lymph nodes, or skin. We report GS presenting as bilateral adrenal masses in a patient without an antecedent hematologic illness.     

Eosinophilia and granulocytic dysplasia terminating in acute myeloid leukaemia after 24 years

Eosinophilia of variable duration, and subsequent progression to granulocytic sarcoma and acute myeloid leukaemia, has been infrequently reported in the literature. We report a patient with eosinophilia and normal cytogenetics who, after 24 years, showed transformation to a granulocytic sarcoma of the brain. Haematological counts were normal but the marrow revealed the cytogenetic abnormality trisomy 8 in 25% of mitoses. Subsequently an AML-M2 developed, showing a complex karyotype including the trisomy 8 in all metaphases. FISH analysis combined with cytological examination identified the trisomy 8 in blasts, eosinophils and dysplastic granulocytes only. Thus progressive leukaemic transformation selectively involved the myeloid compartment.     

房颤消融中心腔内超声引导下的房间隔穿刺

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An autopsy case of granulocytic sarcoma of the porta hepatis causing obstructive jaundice

We describe an extremely rare case of granulocytic sarcoma of the porta hepatis causing obstructive jaundice. The patient was an 84-year-old man admitted because of obstructive jaundice. Ultrasonography (US) and computed tomography (CT) scanning of the abdomen disclosed a mass about 2.5 cm in diameter near the neck of the gallbladder, and thickening of the gallbladder wall. Based on these findings, gallbladder carcinoma was suspected. After endoscopic retrograde biliary drainage (ERBD) was performed, the jaundice resolved. However, blast cells were detected in the peripheral blood 51 days after admission, and laboratory studies disclosed acute myelocytic leukemia (AML: French-American-British [FAB] type M0). We treated him conservatively, with antibiotics and ERBD but he died of disseminated intravascular coagulation. Autopsy showed that the suspected gallbladder carcinoma was actually a granulocytic sarcoma arising in association with AML and causing obstructive jaundice. The largest tumor involved the porta hepatis. It should be kept in mind that granuloctyic sarcoma is a possible cause of obstructive jaundice, even in patients with no evidence of AML. (Received July 7, 1997; accepted Oct. 30, 1997)     

Rare malignant spindle cell sarcoma of the left atrium diagnosed with TEE: A case report

Introduction:One of the purposes of echocardiography is to determine the nature of a space-occupying lesion. The conventional transthoracic echocardiogram (TTE) is the preferred method for the diagnosis of cardiac space-occupying lesions as it can reveal the baseline information. For patients with poor conditions, however, TTE cannot clearly display the boundary, it has a limited role in determining the nature of the lesions.Patient concerns:A 47-year-old woman presented with intermittent fever for 7 days and chest distress/shortness of breath for 5 days.Diagnosis:In our current case, we inferred the nature of space-occupying lesions in the left atrium more accurately using transesophageal echocardiography (TEE) than TTE, which may offer diagnostic evidence for surgical treatment.Interventions:The patient underwent surgical resection of the left atrial tumor and reconstruction of the left atrial wall. However, the patient''s posterior lobe of the mitral valve was infiltrated by tumor, which was difficult to completely remove.Outcomes:Echocardiography was performed 3 months after surgery and the tumor recurred in the posterior lobe of the mitral valve. Although almost all tumors have been removed by surgery, the average survival time is often less than 1 year, as it is difficult to completely remove and easy to relapse with poor prognosis.Conclusion:Transesophageal echocardiography (TEE) plays a relatively more important role in the determination and differential diagnosis of cardiac space-occupying lesions     

Granulocytic sarcoma of the pancreas: a report of two cases and literature review

Granulocytic sarcomas (GS) are extramedullary tumour masses of immature myeloid cells, also known as chloroma and extramedullary myeloid cell tumour. These neoplasms usually occur simultaneously with, or follow the onset of, acute myeloid leukaemia (AML). Rarely, they are the first manifestation of AML. GS may also be the first sign of transformation to AML in patients with chronic myeloproliferative disorders and myelodysplastic syndromes. GS have been reported to occur in a variety of tissues, but presentation as an abdominal mass and, in particular, infiltration of the pancreas is rare. We report two cases of pancreatic GS, review the literature, and discuss recent insights into the basic biological properties of these rare tumours.