Infiltration of thyroid papillary cancer tissue with myeloid leukemic cells: a case report

Abstract

Background Extramedullary leukemia, also known as myeloid sarcoma, is a rare form of acute myeloid leukemia and often accompanies bone marrow involvement. Myeloid infiltration of the thyroid gland is extremely rare. Here, a unique case in which thyroid cancer tissue was infiltrated with myeloid cells is presented. Case presentation We present a case of thyroid papillary cancer infiltrated by blastic cells and bilateral breast and axillary myeloid sarcoma in a 30-year-old Caucasian female patient with a history of osteosarcoma and MDS-RAEB2. The patient firstly received 6 cycles of chemotherapy for osteosarcoma, and allogeneic hematopoietic stem cell transplantation was performed after anthracycline-based chemotherapy due to MDS-RAEB2. The patient remained in remission on follow-up in terms of both osteosarcoma and MDS-RAEB2. Malignant features (Bethesda VI) were observed in the fine needle aspiration biopsy performed from a newly developed firm, fixed thyroid nodule approximately 4–5 cm in length in the left thyroid lobe. Because of the Bethesda VI thyroid nodule, the patient underwent total thyroidectomy. In the pathological evaluation, CD34-, CD117-, MPO-, and HLA-DR-positive blastic cells which infiltrated into follicular variant papillary thyroid carcinoma were detected. In the evaluation performed due to blastic cell infiltration, multiple lesions showing increased 18-fluorodeoxyglucose activity in bilateral breast and axillae were detected. Myeloid sarcoma was found as a result of tru-cut biopsy from these lesions. A fungal cystic lesion was detected in the frontal region of the patient who developed altered consciousness after the second cycle of treatment of myeloid sarcoma. During her follow-up in the intensive care unit, she died of cranial septic embolism and acute infarction. Conclusions Here, we present a very interesting case that is the first. A staged approach to diagnosis with methods including immunohistochemical staining, radiological imaging methods, and cytogenetic and molecular analyses can help make the definitive diagnosis.

Isolated Myeloid Sarcoma: A Diagnostic Dilemma

“…Due to the rarity of the case and lack of randomized clinical trials, there is no standardized treatment strategy. The modalities of treatment available include systemic chemotherapy, local radiotherapy, allogeneic bone marrow transplantation, targeted therapy, and immunotherapy [ 2 , 9 ]. Local therapy with surgery or radiotheraphy alone is considered ineffective due to the high risk of recurrence and progression to AML.…”

“…However, local therapy combined with systemic chemotherapy is a preferred option. Various AML chemotherapy-like regimens have been used in MS, including idarubicin and cytarabine; cyclophosphamide, cytarabine, topotecan, and granulocyte colony-stimulating factor (G-CSF) (CATG); fludarabine, cytarabine, idarubicin, and G-CSF (FLAG); and daunorubicin and cytarabine [ 9 ]. Tsimberidou et al reported a 69% complete remission rate of isolated MS with cytarabine, idarubicin, and fludarabine [ 4 ].…”

“…Favorable outcomes with allogeneic or autologous hematopoietic cell transplantation have been reported in several retrospective studies. Five-year survival rates of 48% have been reported with allogeneic stem cell transplantation (alloSCT) [ 2 , 9 ]. Another study reported an overall survival rate of 76% with auto/alloSCT at 48 months compared to 0% in non-transplant patients [ 7 ].…”

“…Another study reported an overall survival rate of 76% with auto/alloSCT at 48 months compared to 0% in non-transplant patients [ 7 ]. Further studies are needed to determine the role of SCT as first-line treatment in MS after induction of remission [ 9 ]. A humanized anti-CD33 monoclonal antibody, tyrosine kinase inhibitors, immune checkpoint inhibitors like anti-cytotoxic T-lymphocyte-associated protein 4 (ipilimumab) have been used in MS.…”

“…A humanized anti-CD33 monoclonal antibody, tyrosine kinase inhibitors, immune checkpoint inhibitors like anti-cytotoxic T-lymphocyte-associated protein 4 (ipilimumab) have been used in MS. However, complete understanding of the genetic profile is necessary to investigate the role of novel targeted therapies and develop prospective multicenter controlled trials [ 9 - 12 ].…”