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Breast malignant, males, children

Other malignancies

Myeloid sarcoma


Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 17 November 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Definition
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● See also leukemia-acute chapter
● Neoplasm of myeloid cells associated with acute myeloid leukemia (usually as relapse), myeloproliferative or myelodysplastic disorder

Terminology
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● Also called granulocytic sarcoma or chloroma
● Not part of WHO breast classification

Epidemiology
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● Uncommon (< 100 cases reported)
● Almost always women
● Median age 52 years, range 31-73 years

Clinical features
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● Rarely occurs as an isolated mass (Arch Pathol Lab Med 2005;129:32)
● Need immunostains to diagnose and to prevent misdiagnosis as lymphoma or sarcoma (Breast J 2004;10:48)
● In patients with leukemia, diagnosis is typically followed by bone marrow relapse after mean 7 months (range, 1-19 months) and poor outcome (Chin Med J (Engl) 2008;121:1854)

Case reports
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● 25 year old woman with AML without maturation (Coll Antropol 2010;34:641)
● 40 year old woman with synchronous granulocytic sarcoma of the breast and spine (Chin Med J (Engl) 2008;121:1854)
● Elderly woman with isolated breast myeloid metaplasia 16 years after initial diagnosis (Am J Surg Pathol 1980;4:281)
● Bilateral myeloid sarcoma of breast (J Clin Oncol 2012;30:e199)
● Other cases: Eur J Gynaecol Oncol 2011;32:435, Breast J 2004;10:48

Treatment
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● Systemic chemotherapy (similar to acute leukemia), possibly radiation therapy (Ann Hematol 2003;82:431)

Micro description
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● Well to poorly differentiated to blastic tumor of immature and mature granulocytes or monocytes
● Also immature eosinophilic precursors
● Usually preserves ductal and lobular structures
● No / minimal necrosis
● Dissection of collagen by tumor cells is common (Chin Med J (Engl) 2008;121:1854)

Micro images
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Various images


Myeloperoxidase+ and CD43+

Positive stains
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Varies by type of myeloid leukemia:
● Naphthol AS-D chloroacetate esterase, myeloperoxidase, lysozyme, CD43, CD68
● Variable CD117, CD45, TdT, CD79a and PAX5

Negative stains
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● CD3, CD20

Molecular description
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● May demonstrate mutations of primary hematopoietic neoplasm / leukemia (J Clin Pathol 2010;63:558)

Differential diagnosis
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● Small round cell tumors (in children)
Lymphoma
Lobular carcinoma

End of Breast malignant, males, children > Other malignancies > Myeloid sarcoma


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