4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta
4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta
4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta
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Clinical Cytology - Posters<br />
MYELOID SARCOMA INVOLVING THE BREAST<br />
Jelić Puškarić B1 , Ostojić-Kolonić S2 , Planinc-Peraica A2 , Obad-Kovačević D3 ,<br />
Kardum-Skelin I1 , Jakšić B2 1Merkur University Hospital, Department of Medicine, Laboratory for Cytology and Hematology,<br />
Zagreb, Croatia<br />
2 Merkur University Hospital, Department of Medicine, Zagreb, Croatia<br />
3Merkur University Hospital, Department of Diagnostic and Interventional Radiology,<br />
Zagreb, Croatia<br />
Myeloid sarcoma is a tumor mass with extramedulary growth pattern, composed of myeloblasts<br />
or immature myeloid cells. The development of myeloid sarcoma may precede<br />
or concur with acute or chronic myeloid leukemia or other myeloproliferative diseases<br />
or myelodysplastic syndromes. Isolated myeloid sarcoma of the breast is very rare. A<br />
case is presented of a 25-year-old, previously healthy woman that presented to our department<br />
for a palpable node, 5x2 cm in size, in the upper medial quadrant of her left<br />
breast. Fine needle aspiration cytology (FNAC) FNAC produced a sample consisting of<br />
medium sized blasts of dispersed, gentle chromatin and basophile cytoplasm structure<br />
showing negative reaction to PAS, nonspecific esterase and myeloperoxidase; however,<br />
immunocytochemistry yielded positive reaction to myeloperoxidase and negative reaction<br />
to lymphocytic markers CD20, CD3 and CD10. Additional work-up revealed anemia<br />
(E <strong>4.</strong>1x10/L), thrombocytopenia (53x109/L) and leukocytosis (10x109/L), along with atypical<br />
blasts detected in peripheral blood smear (76%). Bone marrow FNAC yielded a hypercellular<br />
sample of bone marrow with 97% of atypical blasts of the same cytochemical and<br />
immunocytochemical characteristics as the breast FNAC sample. On flow cytometry,<br />
the phenotype of the breast and bone marrow samples showed a very high percentage<br />
expression of the immature myeloid cell markers CD34, CD33 and HLA DR. Cytogenetic<br />
analysis of the breast and bone marrow samples indicated numerous alterations (81,XX,-<br />
X,-X,-7,-8,-8,-9,add(17p)x2,-18,-18[15]/46,xx[3]). Based on the morphology, cytochemical<br />
characteristics and immature cell immunophenotype, it was considered a case of acute<br />
myeloid leukemia without maturation, AML-M1. In spite of intensive chemotherapy, the<br />
patient died within a year of diagnosis. In cases of isolated breast myeloid sarcoma, the<br />
diagnosis can be missed if the possibility of myeloid sarcoma is not remembered on differential<br />
diagnosis of a breast neoplasm. Immunohistochemical studies are extremely<br />
helpful to recognize isolated myeloid sarcoma.<br />
biljana.jelic.puskaric@zg.t-com.hr<br />
123<br />
4 th <strong>Croatian</strong> <strong>Congress</strong> of Clinical Cytology / 1 st <strong>Croatian</strong> Symposium of Analytical Cytology / 2 nd <strong>Croatian</strong> Symposium of Cytotechnology