Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Acute Myeloid Leukemia: Significance of the Skin Test

Yavuz Yagar, Mehmet Ali Erkurt, Ilhami Berber, Ilknur Nizam*, Mustafa Koroglu, Haci Bayram Berktas, Engin Burak Selcuk, Emin Kaya, Irfan Kuku

Department of Hematology, Faculty of Medicine, Inonu University, Malatya, Turkey

Abstract: Granulocytic sarcoma is generally associated to acute myeloblastic leukemia, either as its first clinical manifestation, tissue expression of the disease, or initial symptom of its recurrence. Less than 1 percent of patients will present with prominent extramedullary disease (i.e., myeloid sarcoma, also called granulocytic sarcoma, myeloblastoma, or chloroma). We report the case of a young patient suffering from granulocytic sarcoma of her right ankle which is symptom of its recurrence.

Keywords: granulocytic sarcoma, dermatological symptoms, ankle, knee, acute myeloid leukemia

Received March 29, 2014; Revised April 09, 2014; Accepted April 11, 2014

Citation: Yavuz Yagar, Mehmet Ali Erkurt, Ilhami Berber, Ilknur Nizam, Mustafa Koroglu, Haci Bayram Berktas, Engin Burak Selcuk, Emin Kaya, Irfan Kuku, Acute Myeloid Leukemia: Significance of the Skin Test. American Journal of Medical Case Reports, 2 (3). 55-56. January 2014. doi:10.12691/ajmcr-2-3-4

1. Introduction

Leukemia is a malignant neoplasm affecting the hematopoietic system. Following a generalization phase in the bone marrow and subsequent appearance of leukemic cells in the peripheral blood, extramedullary manifestation can ocur in various organs of the body, including the skin. The classification of various types of leukemia is based on the biological behavior of disease as well as the morphological, immunophenotypical, and cytogenetic characteristics of neoplastic cells in acute and chronic, lymphocytic or myeloid forms of disease [1,2]. Acute leukemia has been divided into sub-types bythe French-American- British (FAB) Cooperative Group: acute myeloid leukemia (AML) into types M0–M7 [3,4]. The diagnosis of AML was defined using the World Health Organization (WHO)’s definition of >20% blasts in the bone marrow or peripheral blood [3].

Dermatological symptoms seen in leukemia are divided by clinical and histopathological criteria into unspecific and specific skin changes. Unspecific skin changes are mostly dermatological diseases which have been associated with leukemia and which develop on the basis of abnormal hematopoiesis or as an expression of a cutaneous paraneoplastic disorder. [4,5]. Less than 1 percent of patients will present with prominent extramedullary disease (i.e., myeloidsarcoma, also called granulocyticsarcoma, myeloblastoma, or chloroma) [6]. Granulocytic sarcoma is generally associated to acute myeloblastic leukaemia, either as its first clinical manifestation, tissue expression of this disease, orinitial symptom of its recurrence [7,8].

We report the case of a young patient suffering from granulocyticsarcoma (GS) of her right ankle which is symptom of its recurrence.

2. Case Report

A 46-year old female was diagnosed with AML-M5 in October 2010 due to periferal smear (%35 myeloblasts), flow cytometric immunophenotype and result of bone marrow biopsy. She suffered weight loss, general situation defect, expectoration, cough and fever. Her body temperature was 38.3°C, pulse rate was 102 bpm and respiratory rate was 15/min. Laboratory values were as follows (Table 1). There was no family history for any disease. No abnormally enlarged lymph nodes were palpable in any part of her body. Her abdomen was not distended, and her spleen and liver were not palpable. We reviewed the extremity and performed further immunohistochemical analysis to determine whether or not the tumoral cells were myeloid. The patient was started induction chemotherapy with cytosine arabinoside and idarubicin. Remission was determined by marrow aspiration with no blast cells at day 27th after first chemotherapy cycle. A third cycle high dose cytrabine 2x3 gr/m²/day was given. During the third chemotherapy cycle, we observed a purple skin lesion which was fluffy, rough, measuring about 2.5×1.5 cm, mobile, demarcated, ulcered and painless. It was on right ankle (Picture 1). New peripheral smear and bone marrow aspiration revealed recurrence. Excisional biopsy from right ankle was performed. The pathological diagnosis was granulocytic sarcoma (GS). Bone marrow biopsy revealed recurrence of acute myeloblastic leukaemia, which had identical characterictics compared to the initial sample.

Table 1. Laboratuar parameters of patient

Picture 1.

3. Discussion

Cutaneous paraneoplastic disease at AML includes pyoderma gangrenosum, Sweet syndrome, and insect-sting-like skin changes [4,5].

Less than 1 percent of patients will present with prominent extramedullary disease (i.e., myeloid sarcoma, also called granulocytic sarcoma, myeloblastoma, or chloroma) [6]. Extramedullary disease may present simultaneously with or precede bone marrow disease, and may be seen in relapse. Sites of isolated myeloid sarcoma include bone, periosteum, soft tissues, and lymph nodes, and less commonly the orbit, intestine, mediastinum, epidural region, uterus, and ovary [9,10,11].

GS is a rare entity that may precede the clinical manifestations of AML (it is often misdiagnosed like this case) or may occur as a relapse of a nonleukemic AML [8]. The patient’s diagnosis of AML with isolated(GS) was, however, more rapid than typically observed despite the initial lack of circulating myeloblasts on peripheral blood smear. So physical examination should be made carefully, GS may be first symptom of recurrence.

4. Conclusion

Any skin lesion at AML should be carefully evaluated and the physician should always be alert about GS.

Reference

[1]   | Büchner Th, Saußele S, Hehlmann R. Akute und chronischemyeloische Leukämie. In: Dietel M, Suttorp N, Zeitz M: Harrisons Innere Medizin Band 1. Berlin: ABW? Wissenschaftsverlag, 2009: 845-56.
[2]   | Pezzutto A, Dörken B. Neoplasiendes lymphatischen Systems. In: Dietel M, Suttorp N, Zeitz M: Harrisons Innere Medizin Band 1. Berlin: ABW? Wissenschaftsverlag, 2009: 857-73.
[3]   | Swerdlow SH, Campo E, Harris NL, et al. World Health Organization (WHO) Classification of Tumours of Haematopoietic.
[4]   | Jänner M. Hämoblastosen der Haut. In: Korting GW: Dermatologie in Praxisund Klinik. Stuttgart: Thieme, 1981: 39. 339. 26.
[5]   | Ratnam KV, Khor CJL, Su WPD. Leukemia cutis. Dermatol Clin 1994; 12: 419-31.
[6]   | Dores GM, Devesa SS, Curtis RE, et al. Acute leukemia incidence and patient survival among children and adults in the United States, 2001-2007. Blood 2012; 119: 34.
[7]   | B. Lee, G. M. Fatterpekar, W. Kim, and P. M. Som, “Granulocytic sarcoma of the temporal bone,”American Journal of Neuro radiology, vol. 23, no. 9, pp. 1497-1499, 2002. View at Scopus.
[8]   | R. S. Neiman, M. Barcos, and C. Berard, “Granulocytic sarcoma: a clinico pathologic study of 61 biopsied cases,” Cancer, vol. 48, no. 6, pp. 1426-1437, 1981. View at Scopus.
[9]   | Yamauchi K, Yasuda M. Comparison in treatments of nonleukemic granulocytic sarcoma: report of two cases and a review of 72 cases in the literature. Cancer 2002; 94: 1739.
[10]   | Byrd JC, Edenfield WJ, Shields DJ, Dawson NA. Extramedullary myeloid cell tumors in acute nonlymphocytic leukemia: a clinical review. J ClinOncol 1995; 13: 1800.
[11]   | Paydas S, Zorludemir S, Ergin M. Granulocyticsarcoma: 32 cases and review of the literature. LeukLymphoma 2006; 47: 2527.