内容紹介
Subcutaneous Myeloid Sarcoma in a Patient with Essential Thrombocythemia That Transformed into Acute Myeloid Leukemia
Summary
Since November 2008, an 80-year-old man had been administered hydroxyurea and aspirin for the treatment of essential thrombocythemia(ET). In January 2012, his white blood cell count was markedly elevated, and he was treated with busulfan and cytarabine. In October 2012, he was hospitalized because of fever and general malaise, and a central venous port was placed in the right anterior chest owing to difficulty obtaining peripheral vascular access. Approximately 2 weeks after port placement, a subcutaneous mass was observed near the port. The patient died in November 2012 owing to exacerbation of the original disease. Autopsy revealed transformation to acute myeloid leukemia(AML; M2 subtype)and myeloid sarcoma(MS)in lymph nodes and the right anterior chest. The incidence of transformation of ET to AML is low, and MS as a comorbidity is rare. However, the risk of MS complications should be considered in patients with hematological malignancies due to recent increases in the use of central venous ports in such cases.
要旨
症例は80歳,男性。2008年11月より本態性血小板血症(essential thrombocythemia: ET)の診断でhydroxyureaとaspirinの内服を行っていた。2012年1月に白血球数が著増し,busulfanとcytarabineの併用投与を行った。同年10月に発熱と全身倦怠感のため入院となり,末梢血管の確保が困難であり右前胸部に中心静脈ポートを造設した。ポート造設の約2週間後ポート近傍に皮下腫瘤を認め,11月に原病悪化のため死亡した。剖検でAML(M2)への転化,およびリンパ節と右前胸部の骨髄性肉腫(myeloid sarcoma: MS)を確認した。ETはAMLへの移行頻度は低く,MSの併発はまれである。最近,造血器腫瘍患者への中心静脈ポート造設の機会が増加しており,MSの合併に注意が必要である。
目次
Summary
Since November 2008, an 80-year-old man had been administered hydroxyurea and aspirin for the treatment of essential thrombocythemia(ET). In January 2012, his white blood cell count was markedly elevated, and he was treated with busulfan and cytarabine. In October 2012, he was hospitalized because of fever and general malaise, and a central venous port was placed in the right anterior chest owing to difficulty obtaining peripheral vascular access. Approximately 2 weeks after port placement, a subcutaneous mass was observed near the port. The patient died in November 2012 owing to exacerbation of the original disease. Autopsy revealed transformation to acute myeloid leukemia(AML; M2 subtype)and myeloid sarcoma(MS)in lymph nodes and the right anterior chest. The incidence of transformation of ET to AML is low, and MS as a comorbidity is rare. However, the risk of MS complications should be considered in patients with hematological malignancies due to recent increases in the use of central venous ports in such cases.
要旨
症例は80歳,男性。2008年11月より本態性血小板血症(essential thrombocythemia: ET)の診断でhydroxyureaとaspirinの内服を行っていた。2012年1月に白血球数が著増し,busulfanとcytarabineの併用投与を行った。同年10月に発熱と全身倦怠感のため入院となり,末梢血管の確保が困難であり右前胸部に中心静脈ポートを造設した。ポート造設の約2週間後ポート近傍に皮下腫瘤を認め,11月に原病悪化のため死亡した。剖検でAML(M2)への転化,およびリンパ節と右前胸部の骨髄性肉腫(myeloid sarcoma: MS)を確認した。ETはAMLへの移行頻度は低く,MSの併発はまれである。最近,造血器腫瘍患者への中心静脈ポート造設の機会が増加しており,MSの合併に注意が必要である。