伴有腹水形成的腹腔髓系肉瘤临床病理特征

目的 腹腔髓系肉瘤(myeloid sarcoma,MS)伴腹水形成较为罕见,本文总结其临床病理特征、治疗及预后.方法 报道江苏省中医院1例确诊的以腹水为首发症状的腹腔髓系肉瘤患者的临床资料、影像学检查、腹水细胞学、免疫组化、骨髓穿刺、治疗预后和随访结果.分别在万方数据库和PubMed检索到6篇中文和8篇英文腹腔髓系肉...

Clinicopathological characteristics of abdominal myeloid sarcoma with ascites formation

Objective The primary myeloid sarcoma(myeloid sarcoma,MS)of the abdominal cavity with ascites formation is rare.This article summarized its clinicopathological characteristics,treatment and prognosis.Methods The clinical data,imaging examination,ascites cytology,immunohistochemistry,bone marrow puncture,treatment prognosis and follow?up results of a patient with a confirmed abdominal myeloid sarcoma with ascites as the first symptom in Jiangsu Provincial Hospital of Traditional Chinese Medicine were reported.A total of 14 cases of abdominal myeloid sarcoma with ascites formation were retrieved from Wanfang Medical Database and PubMed respectively in 6 Chinese and 8 English articles,all of which were case reports.Results A 49?year?old female patient presented with abdominal distension and abdominal pain without obvious cause.CT showed small intestinal space with large amounts of ascites.Chest MRI showed that there were multiple solid nodules in both lungs and anterior mediastinum,and metastic lessions could not be excluded.Light microscopy of ascites cell smear showed a large number of diffusely distributed round and oval tumor cells,relatively uniform in size,less basophilic cytoplasm;nuclear grooves and small nucleoli were seen in some cells,and mitotic figures were rare;a small number of precursor eosinophils were seen in the background.Cell block immunohistochemistry showed that the tumor expressed diffuse MPO,CD34,and CD68.The patient’s subsequent bone marrow aspiration showed that primordial granulocyte accounted for 21.6%,and combined chemotherapy was performed.Ascites subsided and symptoms improved significantly.Reviewing the Chinese and English literature and combining our case found that the formation of abdominal myeloid sarcoma with ascites could easily lead to clinical misdiagnosis.Ascites cytology combined with cell wax immunohistochemistry could be further diagnosed pathologically.Most myeloid sarcomas with ascites formation were accompanied by acute myeloid leukemia(AML).Chemotherapy for granulocytic sarcoma was usually effective,but the overall prognosis was poor.Conclusion The abdominal myeloid sarcoma is usually accompanied by ascites formation and is relatively rare.For patients with no history of acute myeloid leukemia,clinical presentation and imaging are easily misdiagnosed.Ascites cytology combined with cell wax block immunohistochemistry can make accurate pathological diagnosis.