| Background and Objective Myeloid sarcomas are neoplasms of myeloblasts or immature myeloid cells occurring in extramedullary sites. The tumors are often presented with various kinds of meyloproliferative disorders or may appear as solitary myeloid sarcoma in some of the cases. In the present study, 82 cases of myeloid sarcoma were analyzed in clinical manifestations and histopathology retrospectively, and immunophenotype analysis of multiple antigen markers. The purpose is to investigate the clinical and pathologic features of the tumor, to evaluate the significances and effects of immunophenotype analysis in diagnosis and differential diagnosis of the tumor. Statistic analysis was used for evaluation of prognosis related factors of myeloid sarcoma. Materials and Methods 82 cases of myeloid sarcomas were selected from the files of Pathology Department, West China Hospital of Sichuan University from Jan 1990 to Feb 2005. Related clinical data were collected and follow up was performed for all of the cases. Multi factor statistic study was used for survival analysis of the tumors. Histologic classification was according to the WHO classification for tumors of hematopoietic and lymphoid tissue(2001).Immunophenotype analysis was performed by SP method. The selected antibodies included MPO, lysozyme, CD68(KP1), CD68(pg-m1), LCA, CD15, CD34, CD43, CD99, CD117and Ki-67, etc. Results (1) Clinical manifestation: the mean age of myeloid sarcomas was 34.6Y, the ratio of male and female was 1.4:1. Sites more commonly involved were lymph node, skin, nose, bone and soft tissue, and then breast and gastrointestinal tracts etc. 51 cases(62.2%) were meyloproliferative disorder associated myeloid sarcomas, which included 38 cases(46.3%) with AML, 13 cases(15.9%) with CMPD, respectively. 25 cases (30.5%) were solitary myeloid sarcomas , and the remaining 6 cases were undetermined because of insufficiency of clinical data. (2) Pathology and histological classification: the histological feature of the cases in this study was relatively monomorphic and medium-sized tumor cells infiltration with more or less demolishment of the involved organs and tissues. 79 cases (96.3%) were granulocytic sarcomas, which composed of 41 cases(51.9%) of blast type, 25 cases(31.6%) of immature type, 13 cases(16.5%) of differentiated type respectively. 3 cases (3.7%) were monoblastic sarcomas. Immature eosinophils could be found in 51 cases(64.6%) of granulocytic sarcoma. (3) Immunophenotype: Immunohistochemical analysis of 73 cases showed that 69/73 cases (95.9%) were positive for MPO, 63/66 cases(95.5%) for lysozyme, 60/63 cases(95.2%) for CD68(Kpd, 59/65 cases (90.8%) for LCA, 54/63 cases (85.7%) for CD43, 49/63 cases (77.8%) for CD117, 37/63 cases(58.7%) for CD99, 34/63 cases(54.0%) for CD15, 14 cases(22.2%) for CD34, 3/64 cases(4.7%) for CD68(PG-mi)-Proliferation index(PI) of Ki-67 was 0.49+0.22. (4) Statistic analysis: Follow up data was obtained in 59 of 82 cases (72%). 2 and 5 yearsurvival rate were 36.1% and 17.3% respectively. No other significant prognosis related factors were found in the survival analysis. Conclusions (1) Myeloid sarcomas are often associated with various kinds of meyloproliferative disorders, they may develop in the process of the diseases or after remission of them. Myeloid sarcomas may involve any organs and tissues of human bodies as well. About 1/3 cases appeared as solitary myeloid sarcomas. (2) Blast type of granulocytic sarcoma is the most common type of myeloid sarcoma. Immature eosinophile, which is a very important feature for diagnosis of the tumor histologically, could be found in 64.6% of the cases of granulocytic sarcomas. Monoblastic sarcoma is less commonly seen, and it is difficult to distinguish it from granulocytic sarcoma in morphology alone. (3) Tumor cells of myeloid sarcoma express at least more than one of myeloid lineage associated antigens, so that Immunophenotypic analysis combined use multiple antigen markers is a useful method to make the diagnosis. MPO is specific for granulocyte and its tumors, and CD68 (pg-md is a special antigen for monocyte and its tumors. (4) No significant prognosis related factors was found in the statistic analysis in present study.
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