Mustafa Karagülle

Isolated Granulocytic Sarcoma of the Breast after Allogeneic Stem Cell Transplantation: A Rare Involvement Also Detected by 18FDG-PET/CT.

Granulocytic sarcoma is a tumor consisting of myeloid blasts with or without maturation that occurs at an anatomical site other than bone marrow. Most frequently affected sites are skin, lymph nodes, gastrointestinal tract, bone, soft tissue and testes. AML may manifest as granulocytic sarcoma at diagnosis or relapse. Although it has been considered to be rare relapse as granulocytic sarcoma after stem cell transplantation is being increasingly reported. However it is rare without bone marrow involvement and in AML M6 subtype. Breast is also a rare involvement. We report a 30-year-old woman with AML M6 relapsed 16 months after allogeneic stem cell transplantation as a granulocytic sarcoma in right breast without bone marrow involvement. She was treated with systemic chemotherapy but died of sepsis. 18FDG-PET/CT images were also obtained and detected lesions other than detected by breast ultrasound. The incidence of granulocytic sarcoma may increase if suspected or new diagnostic modalities are performed.

Gaucher Cells or Pseudo-Gaucher Cells: That's the Question.

To the Editor, Bone marrow cells with morphological characteristics similar to Gaucher cells and without cytoplasmic crystalline inclusions are rare. These Gaucher-like or pseudo-Gaucher cells can be seen in a variety of conditions such as acute lymphoblastic leukemia, multiple myeloma, myelodysplasia, Hodgkin’s disease, thalassemia, and disseminated mycobacterial infection [1,2,3,4,5,6,7,8]. Since the presence of these cells may obscure neoplastic cells in multiple myeloma and may lead to misdiagnosis, it is important for hematologists and hematopathologists to be aware of such a condition in order to make a prompt and accurate diagnosis. Herein we report a case of multiple myeloma in which the presence of plasma cells was missed on initial histological diagnosis. A 44-year-old female without history of any previous systemic disease presented with oliguria, easy fatigability, and breathlessness for 7 days. On examination she had crepitating rales, jugular venous congestion, abdominal distension, and pretibial edema. The complete blood count showed Hb of 67 g/L, WBC count of 3.4x109/L, and platelet count of 69x109/L. Erythrocyte sedimentation rate was 112 mm/h. Bone marrow aspirate and biopsy were performed. The bone marrow aspirate revealed numerous large cells with plentiful cytoplasm and a small eccentric nucleus. Scattered among these were plasma cells, which were obscured by sheets of Gaucher-like cells (Figure 1A). Immunohistochemical staining of bone marrow biopsy showed that plasma cells were positive for CD38 and kappa light chain (Figures 1B and 1C), and the large cells were positive for CD68 (Figure 1D). There were crystalline inclusion bodies within these cells, which were negative for smooth muscle actin, HHF-35, and keratin. The erythroid and myeloid series were normal. Serum electrophoresis revealed an M band. Skull X-ray showed lytic bone lesions. Taken together, a diagnosis of multiple myeloma associated with a prominent pseudo-Gaucher histiocytic response was made.

Thrombelastographic evaluation of the influence of 2-RBC apheresis on donor’s coagulation system

Rotation thrombelastogram (ROTEM®/TEG®) assays allow rapid global assessment of hemostatic function using whole blood. Since published data about the effects of automated red cell collection on coagulation system are scarce, we aimed to investigate the effects of 2-RBC apheresis on donors coagulation system using ROTEM® assays. In INTEM assay, CFT was significantly shortened 24h after apheresis compared with baseline value (p<0.05) and MCF was significantly prolonged immediately after apheresis and 24h after apheresis compared with baseline value (p<0.05 and p<0.01, respectively). In EXTEM assay, CFT was significantly prolonged immediately after apheresis and 24h after apheresis compared with baseline value (p=0.001 and p<0.001, respectively) and MCF was significantly prolonged 24h after apheresis compared with baseline value (p<0,001). Our results demonstrate thromboelastographic signs of hypercoagulability in donors undergoing 2-RBC apheresis.

Pleural Effusion: A Rare Side Effect of Nilotinib—A Case Report

Pleural effusion, as a side effect of tyrosine kinases, may be seen as most commonly associated with dasatinib and very rarely seen with nilotinib. In this report we present a chronic phase of CML case that was treated with nilotinib due to imatinib (Gleevec) allergy and had pleural effusion with nilotinib at 5th year of treatment. If pleural effusion develops in patients taking nilotinib and if this effusion is exudative and lymphocyte predominant, after ruling out pulmonary and cardiac etiologies, it must be associated with nilotinib; according to stage of effusion drug should be discontinued and/or steroid should be started and/or surgery should be performed.

Ill-fitting dentures as primary presentation of mantle cell lymphoma: A case report and literature review of the primary mantle cell lymphomas of the hard palate

Mantle cell lymphoma (MCL) is a subtype of B-cell non-Hodgkins lymphoma seen predominantly in males. Common extra-nodal sites of involvement of MCL are Waldeyers ring, gastrointestinal tract, bone marrow and peripheral blood. The extra-nodal palatal localization of MCL is quite uncommon. MCL is seen in predominantly older patients, therefore undiagnosed MCL patients are likely to have total prosthesis. In this study, a case of MCL, initially presenting as palatal swelling was reported with relevant literature review and the possible role of dental professionals in the diagnosis of this rare entity was discussed.