Leukaemic Ascites and Peritoneal Myeloid Sarcoma: Rare but Not Impossible
  • Luís Landeiro
    Internal Medicine Department, Hospital da Luz Lisboa, Lisbon, Portugal
  • Tiago Neto Gonçalves
    Internal Medicine Department, Hospital da Luz Lisboa, Lisbon, Portugal
  • Margarida Proença
    Internal Medicine Department, Hospital da Luz Lisboa, Lisbon, Portugal
  • Albertina Nunes
    Hematology Department, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal
  • Alexandra Bayão Horta
    Internal Medicine Department, Hospital da Luz Lisboa, Lisbon, Portugal

Keywords

Peritoneal myeloid sarcoma, leukemic ascites

Abstract

A myeloid sarcoma is an extramedullary tumour arising from infiltration by leukemic cells at an anatomic site other than the bone marrow. Most commonly it precedes acute myeloid leukaemia but occasionally occurs simultaneously. It may also be associated with myeloproliferative neoplasms, myelodysplastic syndrome and the blast phase of chronic myeloid leukaemia.
The most common sites for extramedullary tumours are bone, periosteum, soft tissue, lymph node and skin. Although this disease can affect a wide range of body sites, there are very few reports of peritoneal myeloid sarcoma or cavity effusion.
The authors present the case of a 68-year-old man with myelodysplasia-related acute myeloid leukaemia and peritoneal myeloid sarcoma with myeloid ascites. The definitive diagnosis is challenging, requires a high level of suspicion, and relies on the exclusion of all alternative diagnoses and especially on complementary tests such as flow cytometry and immunohistochemistry analysis of ascitic fluid in order to detect the immature myeloid cells.

VIEW THE ENTIRE ARTICLE

References

  • Arber DA. The 2016 WHO classification of acute myeloid leukemia: what the practicing clinician needs to know. Semin Hematol 2019;56(2):90–95.
  • Narayanan D, Weinberg OK. How I investigate acute myeloid leukemia. Int J Lab Hematol 2020;42(1):3–15.
  • Almond LM, Charalampakis M, Ford SJ, Gourevitch D, Desai A. Myeloid sarcoma: presentation, diagnosis, and treatment. Clin Lymphoma Myeloma Leuk 2017;17(5):263–267.
  • Neiman RS, Barcos M, Berard C, Bonner H, Mann R, Rydell RE, et al. Granulocytic sarcoma: a clinicopathologic study of 61 biopsied cases. Cancer 1981;48(6):1426–1437.
  • Paydas S, Zorludemir S, Ergin M. Granulocytic sarcoma: 32 cases and review of the literature. Leuk Lymphoma 2006;47(12):2527–2541.
  • Frietsch JJ, Hunstig F, Wittke C, Junghanss C, Franiel T, Scholl S, et al. Extra-medullary recurrence of myeloid leukemia as myeloid sarcoma after allogeneic stem cell transplantation: impact of conditioning intensity. Bone Marrow Transplant 2021;56(1):101–109.
  • Prolla JC, Kirsner JB. The gastrointestinal lesions and complications of the leukemias. Ann Intern Med 1964;61:1084–1103.
  • Khan MY, Hussein KK, Walter MG, Hasan MK, Kern W, Kharfan-Dabaja MA. Granulocytic sarcoma presenting with malignant anasarca in a patient with secondary acute myeloid leukemia. Int J Hematol 2004;79(3):250–252.
  • Shinagare AB, Krajewski KM, Hornick JL, Zukotynski K, Kurra V, Jagannathan JP, et al. MRI for evaluation of myeloid sarcoma in adults: a single-institution 10-year experience. Am J Roentgenol 2012;199(6):1193–1198.
  • Meyer HJ, Pönisch W, Schmidt SA, Wienbeck S, Braulke F, Schramm D, et al. Clinical and imaging features of myeloid sarcoma: a German multicenter study. BMC Cancer 2019;19(1):1–8.
  • Campidelli C, Agostinelli C, Stitson R, Pileri SA. Myeloid sarcoma: extramedullary manifestation of myeloid disorders. Am J Clin Pathol 2009;132(3):426–437.
  • Yonal I, Kayar Y, Nazligul E, Yenerel MN, Kalayoglu-Besisik S. Leukemic ascites as an initial presentation of acute myelomonocytic leukemia with inversion of chromosome 16. Ann Saudi Med 2013;33(2):197–198.
  • Pantanowitz L, Steingart R, Miller KB, Kruskal JB, Pihan G. Leukemic ascites. Arch Pathol Lab Med 2005;129(2):262–263.
  • Ravulapati S, Siegel C, Dara A, Lionberger JM. Myeloid sarcoma without circulating leukemia mimicking gastrointestinal malignancy and lymphoma. Hematol Rep 2018;10(2):53–55.

    • Views: 474
    HTML downloads: 165
    PDF downloads: 279

    Published: 2022-02-16
    Issue: 2022: Vol 9 No 2 (view)

    How to cite:
    1.
    Landeiro L, Neto Gonçalves T, Proença M, Nunes A, Bayão Horta A. Leukaemic Ascites and Peritoneal Myeloid Sarcoma: Rare but Not Impossible. EJCRIM 2022;9 doi:10.12890/2022_003184.

    Most read articles by the same author(s)