Background: Presentation of granulocytic sarcoma (GS) as an effusion is very rare and most cases are misdiagnosed as lymphoma infiltration. Detailed descriptions of cytological features of GS in an effusion have not been published to date. Case Report: We present the case of a 35-year-old male who presented clinically with a mediastinal mass, peripheral lymphadenopathy and pleural/pericardial effusion. His effusion cytology showed an atypical morphology. Immature cells with marked nuclear indentation/convolution, fine nuclear chromatin, conspicuous nucleoli and a moderate amount of cytoplasm were seen, without any granularity. GS was suspected based on the abnormal nuclear contours and fine nuclear chromatin, and was confirmed by lymph node fine needle aspiration and biopsy with immunocytochemistry. Conclusion: Abnormal nuclear contours are a significant marker in effusion cytology and provide an important morphological clue to the diagnosis of a myeloid malignancy in addition to fine nuclear chromatin especially in the absence of cytoplasmic granularity. In this case, these features helped to suspect the diagnosis despite a clinical scenario suggestive of non-Hodgkin’s lymphoma.

Keywords:
Effusion cytology, Granulocytic sarcoma, Immunohistochemical staining, Lymphoma infiltration, Myeloid sarcoma
1.
Byrd JC, Edenfield WJ, Shields DJ, Dawson NA: Extramedullary myeloid cell tumors in acute nonlymphocytic leukema: a clinical review. J Clin Oncol 1995;13:1800–1816.
2.
Pileri SA, Orazi A, Falini B: Myeloid sarcoma; in Swerdlow SH (ed): WHO Classification of Tumors of Hematopoetic and Lymphoid Tissue. Lyon, International Agency for Research on Cancer, 2008, pp 140–141.
3.
Mital OP, Sachan AS, Singh RP, Katiyar SK, Nath N: Acute myelogenous leukaemia presenting as massive pleural effusion. Indian J Chest Dis1975;17:179–181.
4.
Saha PK, Agrawal BV, Mishra SK, Vaish SK, Agrawal SK: Pleuro-pericardial effusion: a presenting manifestation of acute myeloblastic leukaemia. Indian Heart J 1977;29:165–169.
5.
Rege K, Powles R, Norton J, Mahendra P, Mitchell P, Agrawal S, Mehta J, Treleaven J: An unusual presentation of acute myeloid leukaemia with pericardial and pleural effusions due to granulocytic sarcoma. Leuk Lymphoma 1993;11:305–307.
6.
Dettrick AJ, Robertson T, Morris KL: Diagnosis of granulocytic sarcoma on pleural effusion cytology: report of a case. Diagn Cytopathol 2004;31:126–128.
7.
Yam IT: Granulocytic sarcoma with pleural involvement: identification of neoplastic cells with cytochemistry. Acta Cytol 1985:29,63–66.
8.
Ioachim HL: Granulocytic sarcoma; in Ioachim HL (ed): Lymph Node Biopsy. Philadelphia, Lippincott, 1982, pp 352–357.
9.
Liu PI, Ishimaru T, McGregor DH, Okada H, Steer A: Autopsy study of granulocytic sarcoma (chloroma) in patients with myelogenous leukemia, Hiroshima-Nagasaki 1949–1969. Cancer 1973;31:948–949.
10.
Sica S, Salutari P, d’Onofria G, Zini G, Laurenti L, Sora F, Leone G: Bulky lymphadenopathy in acute myeloid leukemia. Ann Hematol 1998;77:65–67.
11.
Varma S, Varma N, Dhar S, Jain A, Rajwanshi A, Dash S, Sharma BK: Cytodiagnosis of granulocytic sarcoma presenting as superior vena cava syndrome in acute myeloblastic leukemia. A case report. Acta Cytol 1992;36:371–372.
12.
Ramasamy K, Lim Z, Pagliuca A, Devereux S, Ho AY, Mufti GJ: Acute myeloid leukaemia presenting with mediastinal myeloid sarcoma: report of three cases and review of literature. Leuk Lymphoma 2007;48:290–294.
13.
Tsai MH, Yang CP, Chung HT, Shih LY: Acute myeloid leukemia in a young girl presenting with mediastinal granulocytic sarcoma invading pericardium and causing superior vena cava syndrome. J Pediatr Hematol Oncol 2009;31:980–982.
14.
Suh YK, Shin HJ: Fine-needle aspiration biopsy of granulocytic sarcoma: a clinicopathologic study of 27 cases. Cancer 2000;90:364–372.
15.
Awasthi A, Gupta N, Srinivasan R, Nijhawan R, Rajwanshi A: Cytopathological spectrum of unusual malignant pleural effusions at a tertiary care centre in north India. Cytopathology 2007;18:28–32.
16.
Tao J, Wu M, Fuchs A, Wasserman P: Fine-needle aspiration of granulocytic sarcomas: a morphologic and immunophenotypic study of seven cases. Ann Diagn Pathol 2000;4:17–22.
17.
Menasce LP, Banerjee SS, Beckett E, Harris M: Extra-medullary myeloid tumour (granulocytic sarcoma) is often misdiagnosed: a study of 26 cases. Histopathology 1999;34:391–398.
18.
Audouin J, Comperat E, Le Tourneau A, Camilleri-Broët S, Adida C, Molina T, Diebold J: Myeloid sarcoma: clinical and morphologic criteria useful for diagnosis. Int J Surg Pathol 2003;11:271–282.
19.
Hicklin GA, Drevyanko TF: Primary granulocytic sarcoma presenting with pleural and pulmonary involvement. Chest 1988;94:655–656.
20.
Rowlands CG: Cytology of ascitic fluid in a patient with granulocytic sarcoma (extramedullary myeloid tumor). A case report. Acta Cytol 1999;43:227–231.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.