Fine‐needle aspiration cytology of granulocytic sarcoma and myeloid metaplasia

Abstract

The fine-needle aspiration (FNA) cytology of two cases of granulocytic sarcoma involving the breast is reported along with the FNA cytology of one case of myeloid metaplasia (extramedullary hematopoiesis) involving an axillary lymph node. Two patients had known myeloproliferative disorders, while granulocytic sarcoma of the breast was the initial presentation of an unsuspected acute granulocytic leukemia in the other patient. Diff-Quik-stained preparations aided in the diagnosis of all three cases. Immunoperoxidase stains for factor VIII-related antigen helped confirm the megakaryocytic differentiation of the cells in the FNA cytology of myeloid metaplasia. Electron microscopic (EM) examination performed on the aspirated material also showed megakaryocytic differentiation of the bizarre cells. FNA cytology can make a specific diagnosis of granulocytic sarcoma and myeloid metaplasia. The workup of these unusual extramedullary myeloproliferative masses was aided when immunocytochemistry and EM were performed on the aspirated material.

Granulocytic Sarcoma Presenting as a Retroperitoneal Lymph Node Mass

“…8 Cytologic features of granulocytic sarcoma include discohesive cells with a moderate amount of cytoplasm, large round to oval nuclei, distinct nuclear membranes, fine chromatin and prominent nucleoli. This entity may be easily confused cytologically with large cell and lymphoblastic lymphoma, 1,7,11,12,14 especially, as in this case, when the lesion arises in lymphoid tissue. Flow cytometry and/or immunohistochemistry is quite useful in elucidating a granulocytic rather than lymphocytic origin and arriving at a correct diagnosis.…”

“…Flow cytometry and/or immunohistochemistry is quite useful in elucidating a granulocytic rather than lymphocytic origin and arriving at a correct diagnosis. 1,6,7,11,12,14 In conclusion, flow cytometric studies were espe- cially crucial in arriving at the correct diagnosis in this case. The case demonstrates the utility of obtaining material for flow cytometry when performing fine needle aspiration biopsy of lymph nodes and demonstrates that granulocytic sarcoma should be considered in the differential diagnosis of such masses.…”

“…8 Only rarely has this entity been diagnosed by fine needle aspiration cytology. 1,3,[5][6][7]12,[14][15][16][17] Described below is a case of granulocytic sarcoma unassociated with leukemia and diagnosed by fine needle aspiration cytology and flow cytometry.…”

Diagnosis of Granulocytic Sarcoma by Fine-Needle Aspiration Cytology

“…To date, only a few cases of GS diagnosed by FNAC have been reported in the literature [17, 18, 25, 29, 30, 31, 32, 33]. Clinically, GS has to be differentiated from an infectious …”

“…With the advent of fine-needle aspiration cytology (FNAC), the etiology of tumorous masses is relatively simple to determine without resorting to excisional biopsies. Surprisingly, there are only few cases reported in the literature on FNAC and GS [17, 18, 25, 29, 30, 31, 32, 33]. In this article, we report our experience with FNAC in determining the etiology of GS in 26 patients during a period of 10 years.…”