Han X, Xu J, Liu C F, Song Y, Zhao J J, Gao N, Zhao J
Department of Respiratory, Dalian Municipal Central Hospital, Dalian 116033, China.
Department of Hematology, Dalian Municipal Central Hospital, Dalian 116033, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2020 Oct 12;43(10):839-843. doi: 10.3760/cma.j.cn112147-20200526-00639.
To analyze the clinic features of isolated myeloid sarcoma (IMS) involving the pleural cavity. A case of pleural isolated myeloid sarcoma (PIMS) with pleural effusion as the first manifestation was described. The related cases in literatures were reviewed with"myeloid sarcoma"and"pleural effusions"as the keywords to search China HowNet, Wanfang database and PubMed database. A 59-year-old man complained of right chest pain for 2 months and worsening pain with distress and shortness of breath for 2 weeks. The chest CT scan showed pleural effusion on the right side. Flow cytometric analysis of pleural fluid showed that a population of blasts with CD expressing was 37.6% of the total nucleated cells. The pleural biopsy through medical thoracoscopy indicated lymphoproliferative lesions by pathological examination. Immunohistochemistry was performed on pleural histological sections and cell blocks of pleural effusions, which showed CD and CD positive expression. The diagnosis of PIMS was finally made. Two literature papers with 2 complete cases were found and reviewed. The 3 cases were analyzed. There were 2 males and 1 female. The age was 59, 51, 56 years respectively. One case was a patient with 3 weeks of right upper quadrant and epigastric pain, nausea, and weight loss. Cytological examination of the pleural fluid showed numerous poorly differentiated malignant cells. Histology from an open laparotomy in duodenal biopsies, gallbladder, and mesenteric lymph nodes supported the diagnosis of IMS. The other case was a patient with 6 weeks of dyspnea and a large swelling in the upper vestibular region. Thoracentesis showed 82% myeloid blasts in the pleural fluid. A gingival biopsy showed a diffuse infiltration by cells with a blastic appearance and supported IMS. PIMS was a very rare cause of pleural effusions. The cytological and histopathological evidences were useful to diagnose IMS involving the pleural cavity.
分析累及胸腔的孤立性髓系肉瘤（IMS）的临床特征。描述1例以胸腔积液为首发表现的胸膜孤立性髓系肉瘤（PIMS）病例。以“髓系肉瘤”和“胸腔积液”为关键词检索中国知网、万方数据库及PubMed数据库，复习相关文献。1例59岁男性，主诉右胸痛2个月，近2周疼痛加重伴窘迫和气短。胸部CT扫描显示右侧胸腔积液。胸腔积液流式细胞术分析显示，表达CD的原始细胞群占总核细胞的37.6%。经内科胸腔镜胸膜活检，病理检查提示淋巴增殖性病变。对胸膜组织切片及胸腔积液细胞块进行免疫组化检测，显示CD及CD阳性表达。最终确诊为PIMS。检索到并复习2篇文献报道的2例完整病例，对这3例病例进行分析。3例患者中男性2例，女性1例，年龄分别为59岁、51岁、56岁。1例患者有右上腹及上腹部疼痛、恶心、体重减轻3周。胸腔积液细胞学检查显示大量低分化恶性细胞。十二指肠活检、胆囊及肠系膜淋巴结开放剖腹组织学检查支持IMS诊断。另1例患者有气短6周，上前庭区有巨大肿物。胸腔穿刺显示胸腔积液中髓系原始细胞占82%。牙龈活检显示有母细胞样外观的细胞弥漫浸润，支持IMS诊断。PIMS是胸腔积液非常罕见的病因。细胞学和组织病理学证据有助于诊断累及胸腔的IMS。
