Effusion Cytology of Granulocytic Sarcoma in an Unusual Clinical Scenario: A Diagnostic Challenge

Abstract

Background: Presentation of granulocytic sarcoma (GS) as an effusion is very rare and most cases are misdiagnosed as lymphoma infiltration. Detailed descriptions of cytological features of GS in an effusion have not been published to date. Case Report: We present the case of a 35-year-old male who presented clinically with a mediastinal mass, peripheral lymphadenopathy and pleural/pericardial effusion. His effusion cytology showed an atypical morphology. Immature cells with marked nuclear indentation/convolution, fine nuclear chromatin, conspicuous nucleoli and a moderate amount of cytoplasm were seen, without any granularity. GS was suspected based on the abnormal nuclear contours and fine nuclear chromatin, and was confirmed by lymph node fine needle aspiration and biopsy with immunocytochemistry. Conclusion: Abnormal nuclear contours are a significant marker in effusion cytology and provide an important morphological clue to the diagnosis of a myeloid malignancy in addition to fine nuclear chromatin especially in the absence of cytoplasmic granularity. In this case, these features helped to suspect the diagnosis despite a clinical scenario suggestive of non-Hodgkin’s lymphoma.

Myeloid Sarcoma: An Unusual Case of Mediastinal Mass and Malignant Pleural Effusion with Review of Literature

“…Five cases had non-promyelocytic [7,9,10,13,15,16], two had acute promyelocytic leukemia [8,20] and one had AML secondary to pre-existing MDS [11]. In the cases reviewed by us, we found that apart from our case there were four cases with biopsy proven myeloid sarcoma and malignant pleural effusion without concurrent acute myeloid leukemia.…”

“…In our literature review we found that the most common extra medullary site of myeloid sarcoma was the mediastinum [6][7][8][9][10] followed by pleura [11][12][13]. McCarty et al reported a case of a 33-year old man who developed myeloid sarcoma at two sites (mediastinum and paraspinal mass) within a span of 12 months along with right sided malignant pleural effusion [6].…”

Cytopathology of myeloid sarcoma: a study of 16 cases

“…The presentation of MS as an effusion is rare and may be misdiagnosed. 15,16 In 1 study involving 111 patients with AML and myelodysplastic syndrome, the etiology of pleural effusion was mostly due to infection (47%), followed by malignancy (36%), and infrequently other causes (volume overload, iatrogenic). 17 In contrast to previous studies, the majority of MS cases in our series were related to AML rather than CML.…”

An Unusual Site of Acute Lymphoblastic Leukaemia Relapse: Challenge for Gynaecologists

“…Rare sites like pancreas, mediastinum, pleura, spinal cord are also reported in medical literature [15][16][17]. In case of ALL, most common site of EMR is central nervous system.…”