Aims Myeloid sarcoma (MS) is a rare extramedullary neoplasm composed of immature myeloid precursor cells thought to be a unique clinical presentation of acute myeloid leukaemia (AML). Like AML, MS has a poor prognosis, but due to the rare nature of MS there are limited studies examining potential prognostic factors. We report our institutional experience, with the aim of investigating and establishing salient clinicopathological and molecular features of MS. Methods and results We retrospectively examined all clinicopathological and molecular data on MS patients between 2001 and 2017 from the University of Alabama at Birmingham (UAB) electronic medical records. The UAB electronic medical records were also reviewed and compared with the literature for other potential prognostic factors. Sixty‐three patients were included in the study. The median overall survival was 24 months in the group with normal karyotype and 12 months in patients with an abnormal karyotype. Conclusions We found that an abnormal karyotype was associated with a statistically significant worse prognosis.

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Prostate cancer can be difficult to appreciate grossly and therefore partial sampling of the gland can lead to incorrect grading, staging, or margin status. However, submitting the entire prostate is more time consuming and costly. We investigated the use of magnetic resonance imaging/ultrasound-targeted biopsy for the selective submission of prostatectomy specimens. We performed a retrospective review for patients with cancer on targeted prostate biopsy who underwent subsequent radical prostatectomy. Prostatectomy specimens were submitted in their entirety and assessed for Grade Group, extraprostatic extension (EPE), margins, and number of blocks. For Targeted-Grossing (TG) assessment, apex margin, bladder neck margin, seminal vesicles, and vas deferens sections were included. For the remainder of the prostate, only sections from areas shown to be positive for cancer on targeted biopsy were included in the analysis. With total tissue submission, EPE was found in 39/81 (48.1%) cases and positive margins in 19/81 (23.5%) cases. The TG method required significantly fewer blocks: 15.8 ± 5.9 versus 44.9 ± 11.9 ( P < .0001). The TG method would have diagnosed the correct stage in 73/81 (90.1%) cases, Grade Group in 74/81 (91.4%) cases, and margin status in 79/81 (97.5%) cases. EPE was missed completely by the TG method in 7 cases ( P = .008), of which 5/7 (71.4%) had focal EPE. There was no significant difference in stage ( P = .24), Grade Group ( P = .95), or margin status ( P = .16) between the 2 methods. Grossing utilizing selective tissue submission from areas found to be positive for prostate cancer on magnetic resonance imaging/ultrasound-targeted prostate biopsy remains inferior to complete submission of tissue for radical prostatectomy specimens.

Leprosy is a chronic infectious disease caused by the obligate intracellular microorganism, Mycobacterium leprae and presents as skin lesions and peripheral neuropathies with upper respiratory mucosa involvement. We present a case of a 36-year-old immunocompromised female whom was recently diagnosed polyarteritis nodosa vasculitis (PAN) in Trinidad and returned back to the US with a two week history of pleuritic chest pain, fever, chills, fatigue, nausea, vomiting, epistaxis and cough.  Physical examination revealed a diffuse rash. Pancytopenia prompted a bone marrow biopsy, which revealed acid-fast bacteria, suspicious for disseminated tuberculosis. Histologic examination of the skin lesions revealed disseminated acid-fast, Fite-positive microorganisms within the dermis and nerves. She developed anuric renal failure and purpura fulminans with disseminated intravascular coagulation (DIC). PCR results from the skin sample shortly thereafter revealed the presence of M. leprae DNA. Mycobacterium tuberculosis complex DNA was not identified.This case demonstrates an unusual presentation of leprosy with bone marrow involvement and highlights the importance of utilizing histologic examination together with molecular diagnostic techniques to aid in establishing the correct diagnosis and treatment. This case also cautions that leprosy can be misdiagnosed as a vasculitis, specifically PAN, as there is overlap in the clinical presentation of each disease and that clinicopathologic correlation is essential.

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