case_images: PMC8084685_01
case_images: Microscopic findings of the bone marrow smears. Bone marrow aspirate smears (May-Giemsa staining; magnification: x400) showed (a) myeloblasts (arrows) and a hyposegmented mature neutrophil (arrowhead), (b) a binucleated erythroblast, and (c) a micromegakaryocyte (indicated with a star). (d) Myeloperoxidase staining (magnification: x400) of the bone marrow cells showed a hypogranular neutrophil (indicated with an asterisk).
case_images: CRIHEM2021-6640597.001.jpg
case_images: PMC8084685_01_CRIHEM2021-6640597.001.jpg
case_images: fig1
case_images: At 87 years of age, the patient undertook BMA again because his pancytopenia had progressed, and he was diagnosed with MDS with excess blasts-2 (MDS-EB-2) based on the BMA findings, which revealed 11% myeloblasts and multilineage dysplastic changes of bone marrow cells (Figures 1(a)-1(d)), with a normal karyotype.
case_images: Cutaneous tumor lesions. (a) A painful cutaneous tumor, the top of which showed yellow-colored necrosis, which developed at the left groin 8 months after the second discontinuation of azacitidine. (b) Another cutaneous tumor, which appeared on the left cheek one month after the development of the first cutaneous lesion at the left groin.
case_images: CRIHEM2021-6640597.002.jpg
case_images: PMC8084685_01_CRIHEM2021-6640597.002.jpg
case_images: fig2
case_images: At eight months after the second discontinuation of AZA (at 89 years of age), a painful cutaneous tumor, the top of which showed yellow-colored necrosis (Figure 2(a)), developed at the left groin lesion. One month after the development of the first cutaneous lesion, another cutaneous tumor appeared on the left cheek (Figure 2(b)).
case_images: The histological findings of the tumor located in the left groin. A biopsy specimen showed the proliferation of tumor cells with a high nuclear/cytoplasmic ratio on hematoxylin and eosin staining (x20) (a). Immunohistochemical staining (x20) of tumor cells was positive for myeloperoxidase (b), partially positive for cluster of differentiation (CD) 68 (c), negative for CD4 (d), and negative for CD123 (e).
case_images: CRIHEM2021-6640597.003.jpg
case_images: PMC8084685_01_CRIHEM2021-6640597.003.jpg
case_images: fig3
case_images: Histological examination revealed the proliferation of tumor cells with a high nuclear/cytoplasmic ratio (Figure 3(a)). Immunohistochemically, the neoplastic cells were positive for myeloperoxidase (Figure 3(b)), partially positive for cluster of differentiation (CD) 68 (Figure 3(c)) and CD33, but negative for CD3, CD4 (Figure 3(d)), CD20, CD34, CD56, CD117, and CD123 (Figure 3(e)).
case_images: The response of cutaneous myeloid sarcoma (MS) to treatment with azacitidine. An MS located at the left groin before the first (6th in total) cycle of azacitidine retreatment (a). Before the second (7th in total) cycle (b). After the second cycle (c). An MS on the left cheek before the first cycle (d). Before the second cycle (e). After the second cycle (f).
case_images: CRIHEM2021-6640597.004.jpg
case_images: PMC8084685_01_CRIHEM2021-6640597.004.jpg
case_images: fig4