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Clinicopathological, Cytogenetic, and Prognostic Analysis of 131 Myeloid Sarcoma Patients

Kawamoto, Keisuke MD; Miyoshi, Hiroaki MD, PhD; Yoshida, Noriaki MD, PhD; Takizawa, Jun MD, PhD; Sone, Hirohito MD, PhD; Ohshima, Koichi MD, PhD

The American Journal of Surgical Pathology: November 2016 - Volume 40 - Issue 11 - p 1473–1483
doi: 10.1097/PAS.0000000000000727
Original Articles

Myeloid sarcoma (MS) is an extramedullary tumor of immature myeloid cells. We analyzed 131 patients with MS, including: (1) de novo MS; (2) MS with concomitant acute myeloid leukemia (AML); (3) MS following myelodysplastic syndrome, myeloproliferative neoplasm, or chronic myelogenous leukemia; and (4) MS as a recurrence of AML. The most common development site was the lymph node. Testicular lesions were statistically more frequent in MS as a recurrence of AML than in other types of MS (P=0.0183). MS tended to lack myeloid markers (myeloperoxidase was present in 63.2%, CD68 in 51.3%, CD13 in 48.7%, and CD33 in 48.7% of patients) and express T-cell markers such as CD3 (20.7%) and CD5 (34.2%). All T-cell marker–positive MS cases were negative for the αβ and γδ T-cell receptors on immunohistochemistry. Underlying myelodysplastic syndrome or myeloproliferative neoplasm was a poor prognostic factor (vs. de novo MS: P=0.0383; vs. MS with concomitant AML: P=0.0143). However, there was no statistical difference in prognosis between de novo MS and MS with concomitant AML (P=0.288). There were no significant differences in prognosis between the prognoses of T-cell marker–positive and T-cell marker–negative MS cases. In addition, CXCR4 expression was a poor prognostic factor in MS (P=0.0229). This study involves the largest MS cohort to date and expands the clinical and pathologic knowledge of the disease.

*Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata

Department of Pathology, School of Medicine, Kurume University, Kurume, Japan

Dana-Farber Cancer Institute, Medical Oncology, Boston, MA

Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Hiroaki Miyoshi, MD, PhD, Department of Pathology, School of Medicine, Kurume University, 67, Asahi-Machi, Kurume, Fukuoka, Japan (e-mail:

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