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Conjunctival myeloid sarcoma in acute myeloblastic leukemia-M1
Sarcoma granulocítico conjuntival en leucemia mieloblástica aguda M1
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"apellidos" => "Alvarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "C." "apellidos" => "Sevillano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmología, Complexo Hospitalario de Pontevedra, Pontevedra, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Complexo Hospitalario de Pontevedra, Pontevedra, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcoma granulocítico conjuntival en leucemia mieloblástica aguda M1" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 647 "Ancho" => 951 "Tamanyo" => 83323 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Upper tarsal conjunctival infiltration in the RE.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Acute myeloblastic leukemia (AML) is an aggressive hematological neoplasia with a mean survival rate of 19.5% after 5 years.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> There are 8 types of AML described according to the Franco-American British Classification (FAB), from M<span class="elsevierStyleInf">0</span> to M<span class="elsevierStyleInf">7</span>. Autopsy studies refer ophthalmic involvement of between 50% and 90% in leukemia patients.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The most frequent leukemia infiltration is in the retina and choroids.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">MS is characterized by the presence of one or more tumor masses comprised by immature myeloid masses at extra-medullar locations. It can predict or express together with acute or chronic myeloblastic leukemia or with myelodisplasic syndromes.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinic case</span><p id="par0015" class="elsevierStylePara elsevierViewall">A male, aged 69, presented with a personal history of AML M1 (myeloblastic without differentiation) in complete remission (CR) which started 11 months earlier after chemotherapy treatment according to the PETHEMA-LAM 99 protocol. In February 2008 the patient was admitted due to breathing condition with catarrh and significant nasal congestion without response to antibiotics. In addition, the patient exhibited erithematous papules in the back, supraclavicular and sub-maxillary adenopathies.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was referred by the hematologist due to red eye with 2 days evolution and without any other ocular symptoms. The exploration gave a corrected visual acuity of 20/20 in right eye (RE) and 18/20 in left eye (LE). Ocular reflexes, motility and tonometry were within normal ranges. Anterior pole biomicroscopy showed in the RE a fleshy, salmon-colored raised lesion in the upper (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and lower tarsus. In the LE we found a similar lesion in the lower tarsal conjunctiva (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The ocular fundus assessment did not reveal alterations.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The possibility of leukemic involvement of the conjunctiva was considered and a biopsy of the lesion was carried out, the histological study of which revealed a diffuse proliferation of myeloid habit cells arranged under the conjunctival epithelium which were positive at the immunohistochemical level for myeloperoxidase and CD43 (<a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3 and 4</a>), and negative for B and T cell markers (CD20, CD3, CD5) as well as for TdT, CD34 and CD117. Accordingly, the case was diagnosed as granulocytic sarcoma.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">New biopsies confirmed the involvement of the nasal mucosa and the skin. With these findings, the diagnosis was of MS involving the conjunctiva, the skin and the nasal mucosa. However, in a peripheral blood and a medulla ossea sample relapse was not observed and therefore it was concluded that at this level the CR persisted. Lumbar puncture as well as the rest of explorations gave normal results.</p><p id="par0035" class="elsevierStylePara elsevierViewall">After the diagnosis of extra-medullar relapse in the form of AML MS, second-line treatment was initiated according to the FLAG-IDA protocol with a good response by the infiltrating lesions. The patient died in May 2008, 3 months after the MS diagnosis due to a multiorgan failure.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Ocular involvement by leukemia is well known, with the most frequent being retinal hemorrhage<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> usually due to the systemic effects of the disease such as leukocytosis, hyperviscosity or anemia.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In turn, the retina is the most frequently involved ocular structure due to it being directly affected by leukemia cells, up to 30%.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In AML, the infiltration of the conjunctiva rarely occurs. It is more frequent in the myelomonocytic M4 and monocytic M5 forms. In the other types of AML, only 4 cases of conjunctival infiltration have been described, all of them located in the bulbar conjunctiva.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Two cases occurred in adults and a further 2 in children, with 50% of these cases being bilateral.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The appearance of the lesion was nodular although one was described as a “salmon-colored fleshy mass”.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> As far as we know, this is the first case in which MS is diagnosed as a salmon-colored mass in the tarsal conjunctiva with bilateral expression in an adult in CR of M1 AML, even though our patients exhibited MS simultaneously in other locations, with the most frequent being the periosteum and the skin including the subcutaneous cellular tissue according to other studies. Up to 25% of MS are found in the orbit, which is the most frequent location in children with AML. Occasionally, it appears in several areas at the same time as in the case presented here. It usually indicates that the disease is at an advanced stage.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">By way of conclusion, we emphasize that leukemic infiltration of the conjunctiva in the context of acute leukemia is an ominous prognostic sign. In our case, matching the mean descriptions of the literature, survival did not exceed 3 months.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Said infiltration can be a sign of presentation of leukemia or relapse thereof and usually does not involve the eyesight.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interests</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have not declared any conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres152713" "titulo" => array:3 [ 0 => "Abstract" 1 => "Clinical case" 2 => "Discussion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec140712" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres152714" "titulo" => array:3 [ 0 => "Resumen" 1 => "Caso clínico" 2 => "Discusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec140711" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-03-16" "fechaAceptado" => "2011-07-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec140712" "palabras" => array:5 [ 0 => "Acute myeloblastic leukemia" 1 => "Myeloid sarcoma" 2 => "Conjunctiva" 3 => "Immunohistochemistry" 4 => "Prognosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec140711" "palabras" => array:5 [ 0 => "Leucemia mieloblástica aguda" 1 => "Sarcoma granulocítico" 2 => "Conjuntiva" 3 => "Inmunohistoquímica" 4 => "Pronóstico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Clinical case</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 69-year-old man with a history of acute myeloblastic leukemia-M1 presented with bilateral conjunctival injection. Ophthalmological examination revealed lesions located at the upper tarsal conjunctiva of the right eye and lower tarsal conjunctiva of both eyes. Histological and immunohistochemical studies confirmed conjunctival myeloid sarcoma (MS). The patient died due to multiorgan failure three months later.</p> <span class="elsevierStyleSectionTitle">Discussion</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Extramedullary recurrence of leukemia can appear as an ocular manifestation that brings about a recurrence of the leukemia, leading to a poor prognosis.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Caso clínico</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Varón de 69 años diagnosticado de leucemia mieloblástica aguda M1 en remisión completa, remitido a Oftalmología por cuadro de ojo rojo no doloroso. Biomicroscópicamente se observan lesiones sobreelevadas asalmonadas en conjuntiva tarsal superior de ojo derecho e inferior de ambos ojos. Mediante estudios histológicos e inmunohistoquímicos se confirma recidiva extramedular en forma de sarcoma mieloide en conjuntiva. El paciente fallece a los 3 meses de un fallo multiorgánico.</p> <span class="elsevierStyleSectionTitle">Discusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La recidiva extramedular de una leucemia puede presentarse como una manifestación ocular que conlleva una recurrencia de la leucemia, siendo esta de mal pronóstico.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Méndez-Cepeda P, et al. Sarcoma granulocítico conjuntival en leucemia mieloblástica aguda M1. Arch Soc Esp Oftalmol. 2012;87:79–81.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 647 "Ancho" => 951 "Tamanyo" => 83323 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Upper tarsal conjunctival infiltration in the RE.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 715 "Ancho" => 950 "Tamanyo" => 83785 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Lower tarsal conjunctival infiltration in the LE.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 716 "Ancho" => 952 "Tamanyo" => 152865 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Proliferation of myeloid habit cells under the conjunctival epithelium (hematoxylin–eosin, 200×).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 716 "Ancho" => 952 "Tamanyo" => 179374 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Positive result with myeloperoxidase for the tumor population (myeloperoxidase, 200×).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improvements in survival of adults diagnosed with acute myeloblastic leukemia in the early 21st century" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 4 | 3 | 7 |
| 2018 February | 9 | 0 | 9 |
| 2018 January | 23 | 2 | 25 |
| 2017 December | 15 | 1 | 16 |
| 2017 November | 21 | 1 | 22 |
| 2017 October | 24 | 3 | 27 |
| 2017 September | 32 | 2 | 34 |
| 2017 August | 26 | 3 | 29 |
| 2017 July | 26 | 8 | 34 |
| 2017 June | 32 | 3 | 35 |
| 2017 May | 39 | 1 | 40 |
| 2017 April | 31 | 5 | 36 |
| 2017 March | 38 | 10 | 48 |
| 2017 February | 29 | 3 | 32 |
| 2017 January | 33 | 2 | 35 |
| 2016 December | 39 | 7 | 46 |
| 2016 November | 72 | 7 | 79 |
| 2016 October | 57 | 6 | 63 |
| 2016 September | 44 | 4 | 48 |
| 2016 August | 40 | 5 | 45 |
| 2016 July | 42 | 1 | 43 |
| 2016 June | 49 | 7 | 56 |
| 2016 May | 44 | 13 | 57 |
| 2016 April | 36 | 8 | 44 |
| 2016 March | 31 | 10 | 41 |
| 2016 February | 43 | 13 | 56 |
| 2016 January | 32 | 14 | 46 |
| 2015 December | 39 | 8 | 47 |
| 2015 November | 28 | 7 | 35 |
| 2015 October | 24 | 4 | 28 |
| 2015 September | 24 | 5 | 29 |
| 2015 August | 46 | 4 | 50 |
| 2015 July | 41 | 4 | 45 |
| 2015 June | 28 | 3 | 31 |
| 2015 May | 39 | 4 | 43 |
| 2015 April | 30 | 3 | 33 |
| 2015 March | 43 | 6 | 49 |
| 2015 February | 23 | 2 | 25 |
| 2015 January | 28 | 4 | 32 |
| 2014 December | 49 | 10 | 59 |
| 2014 November | 20 | 2 | 22 |
| 2014 October | 39 | 5 | 44 |
| 2014 September | 43 | 6 | 49 |
| 2014 August | 26 | 4 | 30 |
| 2014 July | 31 | 4 | 35 |
| 2014 June | 17 | 3 | 20 |
| 2014 May | 36 | 4 | 40 |
| 2014 April | 26 | 6 | 32 |
| 2014 March | 27 | 3 | 30 |
| 2014 February | 30 | 5 | 35 |
| 2014 January | 27 | 6 | 33 |
| 2013 December | 24 | 3 | 27 |
| 2013 November | 30 | 4 | 34 |
| 2013 October | 36 | 1 | 37 |
| 2013 September | 23 | 1 | 24 |
| 2013 August | 14 | 5 | 19 |
| 2013 July | 5 | 0 | 5 |
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