Accesso libero

An Autopsy Case of Acute Transformation of Myelodysplastic Syndrome Leading to Carcinomatous Cardiac Tamponade

Junji Hatakeyama
Junji Hatakeyama
, 
Ryo Ageishi
Ryo Ageishi
 e 
Fumito Kato
Fumito Kato
   | 27 giu 2024
Journal of Cardiovascular Emergencies's Cover Image
INFORMAZIONI SU QUESTO ARTICOLO
Articolo precedente
Articolo Successivo
Cita
Article Category: Case Report
Pubblicato online: 27 giu 2024
Pagine: 83 - 88
Ricevuto: 30 mag 2024
Accettato: 17 giu 2024
DOI: https://doi.org/10.2478/jce-2024-0013
Parole chiave
© 2024 Junji Hatakeyama et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

FIGURE 1.

A,B, Echocardiography on arrival to the hospital. A, Parasternal left border left ventricular short-axis image showing pericardial effusion (red arrow). B, The apical tetralogy of the pericardium also shows pericardial effusion (red arrow).
A,B, Echocardiography on arrival to the hospital. A, Parasternal left border left ventricular short-axis image showing pericardial effusion (red arrow). B, The apical tetralogy of the pericardium also shows pericardial effusion (red arrow).

FIGURE 2.

A–D, Cytology of pericardial effusion and cell block at the time of presentation. A,B, Atypical cells are scattered, and the possibility of myelomonocytic blasts (red arrows) is suspected, suggesting the possibility of acute MDS transformation. C,D, In the cell block, numerous blast-like cells with irregular nuclei are seen. Many are CD34 positive (stained brown, red arrow) and MPO positive (stained brown, blue arrow), consistent with acute myeloid leukemia.
A–D, Cytology of pericardial effusion and cell block at the time of presentation. A,B, Atypical cells are scattered, and the possibility of myelomonocytic blasts (red arrows) is suspected, suggesting the possibility of acute MDS transformation. C,D, In the cell block, numerous blast-like cells with irregular nuclei are seen. Many are CD34 positive (stained brown, red arrow) and MPO positive (stained brown, blue arrow), consistent with acute myeloid leukemia.

FIGURE 3.

Cross-section of the heart at autopsy. Diffuse greenish-white neoplastic lesions extending circumferentially and diffusely around the pericardial epicardium (red arrow).
Cross-section of the heart at autopsy. Diffuse greenish-white neoplastic lesions extending circumferentially and diffusely around the pericardial epicardium (red arrow).

Laboratory findings at admission

WBC 2,100/μl T-Bil 3.0 U/L pH 7.21
Seg 28% AST 1,440 U/L PaCO2 19 mmHg
Band 8.0% ALT 1,391 U/L PaO2 169 mmHg
Lymph 58% LDH 2,076 U/L HCO3− 7.9 mmol/L
Mono 2.5% ALP 276 U/L Lactate 140 mg/dL
Blast 1.0% GGT 41 U/L
Hb 8.0 g/dl BUN 57.5 mg/dl
Plt 8.2 × 104/μl Cr 2.9 mg/dl
APTT 34.2 s Na 142 mEq/L
PT-INR 1.98 K 5.2 mEq/L
D-dimer 8.9 μg/dl CRP 5.09 mg/dlL
CK 166 U/L
CK-MB 106 U/L
TropT 0.08 ng/ml
BNP 153 pg/ml

Reported cases of myeloid sarcoma with MDS

Author, year Base disease Age/Sex Symptom Clinical findings Treatment Pericardiocentesis Outcome
Mateen et al., 20066 MDS, RAEB 64/F Dyspnea Ejection fraction decrease Pericardial effusion Blood transfusion NA Died
Matkowskyj et al., 20105 t-MDS, RAEB 59/M Dyspnea Acute heart failure Pericardial tamponade Diuretic Intravenous dobutamine Pericardial drainage No appearance of blasts Died
Present case, 2020 MDS 80/M Loss of consciousness Pericardial tamponade Pericardial drainage Higher blasts ratio compared to peripheral blood Died
eISSN:
2457-5518
Lingua:
Inglese
Frequenza di pubblicazione:
4 volte all'anno
Argomenti della rivista:
Medicine, Clinical Medicine, Emergency Medicine and Intensive-Care Medicine, Radiology, Internal Medicine, Cardiology
Feed RSS della rivista