How I treat extramedullary acute myeloid leukemia

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How I treat extramedullary acute myeloid leukemia by Richard L. Bakst, Martin S. Tallman, Dan Douer, and Joachim Yahalom Blood Volume 118(14):3785-3793 October 6, 2011 ©2011 by American Society of Hematology

Histologic appearance of EM leukemia. Histologic appearance of EM leukemia. (A) Hematoxylin and eosin staining of a MS along the right psoas muscle (original magnification ×40), demonstrating blasts in the skeletal muscle. Dense dermal infiltrate of monocytic leukemic cells (B; original magnification ×10; C: original magnification ×40), consistent with LC. Images were captured by the Olympus BX 41 microscope using an Olympus DP20 camera (Olympus) and imported directly as a series of .tif files. Richard L. Bakst et al. Blood 2011;118:3785-3793 ©2011 by American Society of Hematology

Immunophenotypic profile of EM myeloid leukemia. Immunophenotypic profile of EM myeloid leukemia. A panel of immunohistochemical markers may be useful in establishing the diagnosis of MS or LC. Myeloid (A) and monocytic (B) blast cells can express variable immunophenotypes, which may aid in their distinction. Richard L. Bakst et al. Blood 2011;118:3785-3793 ©2011 by American Society of Hematology

Radiographic appearance of MS Radiographic appearance of MS. MS along with the path of the right femoral nerve on (A) coronal computed tomography imaging, (B) coronal axial T1 postmagnetic resonance imaging, and (C) positron emission tomography. Radiographic appearance of MS. MS along with the path of the right femoral nerve on (A) coronal computed tomography imaging, (B) coronal axial T1 postmagnetic resonance imaging, and (C) positron emission tomography. Richard L. Bakst et al. Blood 2011;118:3785-3793 ©2011 by American Society of Hematology

Radiation therapy treatment field design and response. Radiation therapy treatment field design and response. (A) MS in the right pelvis on positron emission tomography. (B) Radiation field treated to 24 Gy. Positron emission tomography scan 2 months after radiation, demonstrating resolution of lesion. Richard L. Bakst et al. Blood 2011;118:3785-3793 ©2011 by American Society of Hematology

Leukemic cell surface markers implicated in EM homing. Leukemic cell surface markers implicated in EM homing. Blast cell CD56 (neural cell adhesion molecule) expression has been associated with both MS and LC. Homing of blast cells into the skin may be mediated through interactions between lymphocyte function-associated antigen-1 (LFA-1) and intercellular adhesion molecule-1 (ICAM-1) and/or cutaneous leukocyte antigen (CLA) and E-selectin. Richard L. Bakst et al. Blood 2011;118:3785-3793 ©2011 by American Society of Hematology