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. 2007 Oct 31:2:42.
doi: 10.1186/1746-1596-2-42.

Myeloid sarcomas: a histologic, immunohistochemical, and cytogenetic study

Borislav A Alexiev  1 , Wenle Wang, Yi Ning, Saranya Chumsri, Ivana Gojo, William H Rodgers, Sanford A Stass, Xianfeng F Zhao
Affiliations

Myeloid sarcomas: a histologic, immunohistochemical, and cytogenetic study

Borislav A Alexiev et al. Diagn Pathol. .

Abstract

Context: Myeloid sarcoma (MS) is a neoplasm of immature granulocytes, monocytes, or both involving any extramedullary site. The correct diagnosis of MS is important for adequate therapy, which is often delayed because of a high misdiagnosis rate.

Objective: To evaluate the lineage differentiation of neoplastic cells in MS by immunohistochemistry, and to correlate the results with clinicopathologic findings and cytogenetic studies.

Design: Histologic and immunohistochemical examinations were performed on formalin-fixed paraffin-embedded tissue samples from 13 cases of MS. They were classified according to the World Health Organization criteria. Chromosomal analysis data were available in 11 cases. Clinical, pathological, and cytogenetic findings were analyzed.

Results: The study included six male and seven female patients with an age range of 25 to 72 years (mean, 49.3 years) and a male to female ratio of 1:1.2. MS de novo occurred in 4/13 (31%) of cases examined. The most sensitive immunohistochemical markers were CD43 and lysozyme present in all cases with MS (13/13, 100%). All de novo MS showed a normal karyotype, monoblastic differentiation, and lack of CD34. The most common chromosomal abnormalities in MS associated with a hematopoietic disorder were trisomy 8 and inv(16) (2/11, 18%).

Conclusion: An immunohistochemical panel including CD43, lysozyme, myeloperoxidase (MPO), CD68 (or CD163), CD117, CD3 and CD20 can successfully identify the vast majority of MS variants in formalin-fixed paraffin-embedded tissue sections. The present report expands the spectrum of our knowledge showing that de novo MS has frequent monoblastic differentiation and frequently carries a normal karyotype.

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Figures

Figure 1
Figure 1
Monoblastic sarcoma de novo, skin. (hematoxylin-eosin, × 100).
Figure 2
Figure 2
Monoblatic sarcoma de novo, skin. Multiple mitotic figures are seen. (hematoxylin-eosin, × 400).
Figure 3
Figure 3
Monoblastic sarcoma de novo. Neoplastic cells are positive for CD43. (B-SA, anti-CD43, × 400).
Figure 4
Figure 4
Monoblastic sarcoma de novo. Neoplastic cells are positive for CD163. (B-SA, anti-CD163, × 400).
Figure 5
Figure 5
Monoblastic sarcoma de novo. Neoplastic cells are negative for CD3. Residual T-lymphocytes are positive with CD3 antibody. (B-SA, anti-CD3, × 400).
Figure 6
Figure 6
Monoblastic sarcoma de novo. One single neoplastic cell is positive for MPO. (B-SA, anti-MPO, × 400).
Figure 7
Figure 7
Monoblastic sarcoma de novo. Neoplastic cell are negative for CD34. Stain for CD34 reveals endothelial cells. (B-SA, anti-CD34, × 400).
Figure 8
Figure 8
Monocytic sarcoma, gallbladder. (hematoxylin-eosin, × 100).
Figure 9
Figure 9
Monocytic sarcoma, gallbladder. Neoplastic cells have very dispersed chromatin and inconspicuous nucleoli. Note irregular and delicately convoluted nuclear configuration. (hematoxylin-eosin, × 400).
Figure 10
Figure 10
Monocytic sarcoma, gallbladder. Neoplastic cells are positive for CD43. (B-SA, anti-CD43, × 400).
Figure 11
Figure 11
Monocytic sarcoma, gallbladder. Neoplastic cells are positive for CD68. (B-SA, anti-CD68, × 400).
Figure 12
Figure 12
Monocytic sarcoma, gallbladder. Chromosomal analysis reveals trisomy 8 and trisomy 13. (standard G-banding)
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