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      Extramedullary Myeloid Tumor Involving the Pancreas: A Case Report and Review of the Literature Translated title: Pankreasın Ekstra-Medüller Miyeloid Tümörü: Olgu Sunumu ve Literatürün Gözden Geçirilmesi

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          Abstract

          Extramedullary myeloid tumors (EMMTs) are the tumors of myeloid cells. These tumors may occur in all of the organs of the body, but some localizations are rare. Pancreatic involvement of EMMTs is a rare entity. Here we report a case of EMMT of the pancreas 4 years after allogeneic stem cell transplantation and we review the existing data about EMMTs involving the pancreas.

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          Granulocytic sarcoma: 32 cases and review of the literature.

          Melek Ergin, Suzan Zorludemir, Semra Paydaş (2006)
          Thirty-two cases of granulocytic sarcoma (GS) are reported in this paper. Age range was from 16 - 70 years. GS was accompanied by AML in 13 cases, ALL (My+) in one case, CML in 11 cases and MDS in two cases. GS was diagnosed simultaneously with leukemia in five cases and preceded the leukemia in eight. Lymph node and soft tissue were the most commonly detected localizations. Seven cases had first been diagnosed as NHL. Histopathologically blastic, immature and mature variants were found in 11, nine and 11 cases respectively and overall survival was shortest in the blastic type. Myeloperoxidase and lysozyme were found to be positive in 30 and 24 cases respectively. Therapy was radiation in five cases and surgery in three. Systemic chemotherapy was given to the cases. The clinical outcome of the patients after the diagnosis of GS was poor. GS is a unique entity; prognosis is poor but it is important to detect the signaling pathways associated with migration of myeloid cells to the extra-medullary tissues. The critical factors for detecting this interesting tumor are to be aware of this disease, cooperation between clinician and pathologist and the application of special stains to detect the myeloid origin.
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            Extramedullary relapse after allogeneic bone marrow transplantation for haematological malignancy.

            G Chong, J Szer, A Grigg … (2000)
            We describe the risk factors for and the natural history and response to treatment of extramedullary (EM) relapse in 183 patients who underwent allogeneic bone marrow transplantation (alloBMT) for a variety of haematological malignancies at our institution over a 7 1/2 year period. Fifty-one patients relapsed; 15 had EM relapse either alone or in association with marrow involvement. A retrospective analysis found that the presence of chronic GVHD and a longer interval between transplant and relapse were independently associated with an increased risk of EM compared to marrow-only relapse. EM relapse was also associated with a longer post-relapse survival. Patients with EM relapse appeared to respond to cytotoxic therapy but not to DLI. EM relapse after alloBMT may be more common than previously thought and have a better prognosis than marrow-only relapse. While patients developing chronic GVHD after alloBMT have a lower overall relapse risk than those who do not, they may be more prone to delayed relapse at EM sites.
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              Granulocytic sarcoma of Core-binding Factor (CBF) acute myeloid leukemia mimicking pancreatic cancer.

              Henning Schäfer, Heiko Becker, Annette Schmitt-Gräff … (2008)
              Granulocytic sarcoma mimicking a synchronous second primary neoplasm (SPN) constitutes a diagnostic and therapeutic challenge particularly in elderly patients. We report on a 75-year-old female presenting with a Core-binding Factor (CBF) AML of M4eo subtype. The patient also had jaundice, highly elevated bilirubin, lipase, alkaline phosphatase (AP), CA 19-9, and a pancreatic mass highly suspicious of infiltrating pancreatic carcinoma. However, a biopsy demonstrated granulocytic sarcoma. Since the patient had no comorbidities and had been in excellent performance status until the diagnosis of AML, induction chemotherapy was initiated, with subsequent normalization of bilirubin, CA 19-9, lipase and AP. Complete hematologic remission of AML was attained and the pancreatic mass could not be detected anymore. Retrospective analysis of the c-kit protooncogene did not disclose activating mutations of exons 8 or 17. Following one consolidation treatment, the patient remained in excellent health until relapse occurred 7 months later and she succumbed to AML. In conclusion, AML can rarely mimic the clinical picture of pancreatic cancer. The initially good response of this CBF leukemia highlights the principal usefulness of aggressive induction chemotherapy also in older AML patients, if they are carefully selected not only according to biological risk factors such as cytogenetics, but also to "host factors" (good performance status, lack of comorbidities, etc.).
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                Author and article information

                Journal
                Journal ID (nlm-ta): Turk J Haematol
                Journal ID (iso-abbrev): Turk J Haematol
                Journal ID (publisher-id): TJH
                Title: Turkish Journal of Hematology
                Publisher: Galenos Publishing
                ISSN (Print): 1300-7777
                ISSN (Electronic): 1308-5263
                Publication date (Print): September 2014
                Publication date (Electronic): 5 September 2014
                Volume: 31
                Issue: 3
                Pages: 295-300
                Affiliations
                [1 ] Çukurova University Faculty of Medicine, Department of Medical Oncology, Adana, Turkey
                [2 ] Çukurova University Faculty of Medicine, Department of Medical Hematology, Adana, Turkey
                [3 ] Çukurova University Faculty of Medicine, Department of Internal Medicine, Adana, Turkey
                [4 ] Çukurova University Faculty of Medicine, Department of Medical Pathology, Adana, Turkey
                Author notes
                * Address for Correspondence: Çukurova University Faculty of Medicine, Department of Medical Oncology, Adana, Turkey E-mail: sepay@ 123456cu.edu.tr
                Article
                Publisher ID: 1277
                DOI: 10.4274/tjh.2012.0166
                PMC ID: 4287032
                PubMed ID: 25330524
                SO-VID: 4b9d7238-22ed-4c35-8ddb-8f5a9b6a88b0
                Copyright © © Turkish Journal of Hematology, Published by Galenos Publishing.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 4 November 2012
                Date accepted : 13 March 2013
                Categories
                Subject: Case Reports

                Keywords: extramedullary myeloid tumor,pancreas,allogeneic stem cell transplantation
                Data availability:
                Keywords: extramedullary myeloid tumor, pancreas, allogeneic stem cell transplantation

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