Malignant tumors. Myeloid sarcoma in children. Clinical case. General symptoms and signs of the disease

Definition

Myeloid sarcoma (chlorleukemia, granulocytic sarcoma, extramedullary myeloid tumour) is a solid tumor composed of immature white blood cells called myeloblasts. Chloroma is an extramedullary manifestation of acute myeloid leukemia; in other words, it is a continuous mass of leukemic cells that originate outside the bone marrow.

Epidemiology

Chloromas are rare; accurate estimates of their prevalence are lacking, but they are rare, even by physicians who specialize in treating leukemia. Rarely, chloroma may develop as the only manifestation of recurrence after what appears to be successful treatment acute myeloid leukemia. In accordance with general behavior In chlorosomes, such an event should be considered as an early herald of a systemic relapse, and not as a localized process. In one review of 24 patients who developed isolated chloromas after treatment for acute myeloid leukemia, the median interval to bone marrow recurrence was 7 months (range, 1 to 19 months).

Chloromas may occur in patients diagnosed with myelodysplastic syndrome (MDS) or myeloproliferative syndromes (eg, chronic myelogenous leukemia (CML), polycythemia, significant thrombocytosis, or myelofibrosis). The discovery of chloroma is considered actual proof that these precancerous conditions have turned into acute leukemia, requiring appropriate treatment. For example, the presence of chloroma is sufficient to indicate that chronic myelogenous leukemia has entered the "explosion" phase.

Primary chloroma

Almost all reported cases of primary chloroma developed acute leukemia shortly thereafter (median time to onset of acute leukemia 7 months, range 1–25 months). Thus, primary chloroma can be considered the initial manifestation of acute leukemia rather than a localized process and can be considered as such. Where disease progression or markers indicate progression of acute promyleocytic leukemia (AML3), treatment should be tailored to that form of the disease.

Localization and symptoms

Chloromas can occur in almost any organ or tissue. The most common areas of involvement are the skin (also known as leukemia cutis) and the gums. Skin involvement usually manifests as whitish, raised plaques or nodules that show up on biopsy as myeloblast infiltration. Note that cutis leukemia is different from Sweet's syndrome, in which the skin is infiltrated by mature neutrophils into a paraneoplastic process.

Other tissues that may be involved include:

• The lymph nodes,
• small intestine,
• mediastinum,
• lungs,
• epidural areas,
• uterus,
• ovaries,
• orbits.

Symptoms of chloroma in these areas are related to their anatomical location; chloromas may also be asymptomatic and discovered incidentally when evaluating a person with acute myeloid leukemia.

Involvement of the central nervous system most often takes the form of meningeal leukemia or invasion of the subarachnoid space by leukemic cells. This condition is usually considered separate from chloroma, as it requires different treatments. True chloromas (i.e., solid leukemic tumors) of the central nervous system are extremely rare, but have been described.

Diagnostics

Definitive diagnosis of chloroma usually requires a biopsy of the lesion in question. Historically, even with tissue biopsy pathological diagnosis was an important issue, especially in patients without an explicit pre-existing diagnosis of acute myeloid leukemia. In one published series on chloroma, the authors stated that 47% of patients were initially misdiagnosed, most often with malignant lymphoma.

Chloroma diagnosis can be made more reliable using a panel of monoclonal antibodies against myeloperoxidase, CD68, CD43, and CD20, to accurately diagnose chloroma via immunohistochemistry and differentiate it from lymphoma. Currently, immunohistochemical staining using monoclonal antibodies against CD33 and CD117 is the basis of diagnosis.

Forecast

Evidence-based methods conflict with the predictive value of chlorine in patients with acute myeloid leukemia. In general, they predict a worse prognosis, with a poorer response to treatment and worse survival, however, there are reports of association of chloromes as a biological marker with other poor prognostic factors and, therefore, have no independent prognostic value.

Treatment

As described above, chloromas should always be seen as manifestations of a systemic disease rather than isolated local phenomena and treated as such. In a patient with newly diagnosed leukemia and associated chlorine, systemic anti-leukemia chemotherapy is usually used as first-line treatment unless there is an indication of local treatment chloromas (eg, spinal cord compression). Chloromas are usually quite sensitive to standard anti-leukemic chemotherapy. Allogeneic hematopoietic stem cell transplantation should be considered in eligible patients with a suitable available donor, as long-term remissions have been reported.

If chloroma persists after completion of induction chemotherapy, topical treatments such as surgery or radiation therapy, although none of them affect survival.

Patients with primary chlorine usually receive systemic chemotherapy because the development of acute leukemia is almost universal in the short term after chloroma is detected.

Patients with "pre-leukemic" conditions, such as myelodysplastic syndromes or myeloproliferative syndromes, which predispose to the development of chloroma, are often treated as if they had already transformed into acute leukemia.

Epithelioid sarcoma

Epithelioid sarcoma is a tumor up to five centimeters in size, which looks like a dense knot. When cutting her body, it is determined light color structure with rare patches of brown or red. At histological examination, epithelioid sarcoma includes eosinophilic epithelioid and spindle cells.

In the photo: Histology of epitheloid sarcoma

Diagnosis is based on characteristic clinical picture, physical examination, instrumental and laboratory data. Epithelioid sarcoma undergoes differential diagnosis in order to distinguish it from such tumors as histiocytoma, fibromatosis, rhabdomyosarcoma. Epithelioid sarcoma should be subject to complex therapy, only in this case a favorable outcome of this pathology is possible.

Gliosarcoma

Gliosarcoma is a malignant neoplasm that develops in the structures of the central nervous system from glia. It contains neuroglial cells, as well as components of sarcomatous origin. Gliosarcoma originates as a result of mesodermal and ectodermal cellular degeneration.

Diagnosis is based on the application of such measures as:

• Echoencephaloscopy.
• Magnetic resonance imaging.
• The use of computed tomography.
• Collection of material by biopsy for histological examination.

Therapeutic tactics in case of detection of gliosarcoma is reduced to the intervention of neurosurgeons, the use of cytostatics and other components of chemotherapy, as well as radiation exposure to the tumor.

Neurosarcoma

Neurosarcoma is another type of tumor that develops in the central nervous system from neuroblasts and ganglionocytes. There are such types of it:

• Ganglioneuroblastoma.
• Astroblastoma.
• Neuroblastoma.
• Glioblastoma.
• Schwann tumor

Among the reasons for its formation, experts often mention gender, a certain age, genetic predisposition, exposure to radiation and other carcinogens, as well as occupational hazards. characteristic symptoms considered to be common epileptic seizures, up to the epistatus, the presence of focal cerebral symptoms, as well as hemorrhagic strokes.

As diagnostic methods use tomography, magnetic resonance imaging, radioisotope analysis, angiography, as well as examination of cerebrospinal fluid. Treatment tactics include radiosurgery and chemotherapy.

Neurofibrosarcoma

Neurofibrosarcoma is a tumor that includes in its structure the occurrence nerve cells. Tumors in this class include the following:

• Neurogenic sarcoma.
• Neurofibrosarcoma.
• Neurinoma.

Neurogenic sarcoma occurs in five percent of cases among all sarcomas. The development of this pathology is most often observed with malignant transformation of neurofibromatosis. The substrate is the sheath of nerve fibers. The risk group includes young people under thirty-five years of age. Macroscopically, the thickening of the nerve trunk is determined. Sometimes germination develops in blood vessels. Infrequent metastasis is a good predictor of survival, which is ninety percent.

Spindle cell sarcoma

Spindle cell sarcoma is one of the subspecies, which is characterized by a feature in the histological structure. On a section of a micropreparation, it consists of cells that look like a spindle, namely, they have an elongated shape and a hyperchromic nucleus.

Polymorphic cell sarcoma

Polymorphic cell sarcoma is a primary developing tumor, which is a dense dermal nodule, which is characterized by more peripheral growth and the presence of a border of reddened skin. The feature lies in total absence symptoms with the presence of cachexia and complete wasting syndrome. The treatment used today is only surgical.

Histiocytic sarcoma

Histiocytic sarcoma is a rare, aggressive tumor that most often involves digestive tract, skin and soft tissues. Metastatic lesions of the spleen, liver, bone marrow and structures of the central nervous system are the most frequent.

Clear cell sarcoma

Clear cell sarcoma is a slowly developing type of tumor lesion of soft tissues, which is most often observed in the area distal departments upper limbs.

Pleomorphic sarcoma

Pleomorphic sarcoma is a diagnosis that is established on the basis of an immunohistochemical study in the presence of an undifferentiated tumor.

myeloid sarcoma

Myeloid sarcoma, or as it is also called, granulocytic sarcoma, is a malignant neoplasm that develops in the hematopoietic system. It is classified as a myeloid leukemia. The exact causes of development are still not known. modern medicine, but proven genetic predisposition. Myeloid sarcoma manifests itself at the initial stages of its development as a seal skin, which is slightly elevated above the level of other tissues.

It then develops into hyperplasia. purple to which the pain syndrome joins. Myelosarcoma is a rather dangerous disease, since it does not manifest itself for a long time. Symptoms of iron deficiency anemia are possible, which later turns into aplastic anemia. With a long course, myeloid sarcoma can be characterized by hematogenous metastasis to distant tissues with their secondary lesion. Myeloid sarcoma is diagnosed based on the following methods:

• Histological examination of the material taken during trepanobiopsy.
• Study of the cerebrospinal fluid.
• Clinical blood test.
• Ultrasound examination of the spleen and liver.
• Computed, magnetic resonance imaging.

Myeloid sarcoma must necessarily be subject to complex treatment, which includes chemotherapy and exposure therapeutic doses radiation.

Sarcoma is a name that unites oncological tumors of a large group. Different types of connective tissue under certain conditions begin to undergo histological and morphological changes. Then the primary connective cells begin to grow rapidly, especially in children. A tumor develops from such a cell: benign or malignant with elements of muscles, tendons, and blood vessels.

Connective tissue cells divide uncontrollably, the tumor grows and without clear boundaries passes into the territory of healthy tissue. 15% of neoplasms become malignant, the cells of which are carried by blood throughout the body. As a result of metastasis, secondary growing oncoprocesses are formed, therefore it is believed that sarcoma is a disease that is characterized by frequent relapses. In terms of lethal outcomes, it occupies the second position among all oncological formations.

Is sarcoma cancer or not?

Some of the symptoms of sarcoma are the same as those of cancer. For example, it also grows infiltratively, destroys neighboring tissues, recurs after surgery, metastasizes early and spreads to organ tissues.

How is cancer different from sarcoma?

• cancer tumor has the appearance of a bumpy conglomerate, rapidly growing without symptoms in the early stages. Sarcoma is pinkish, reminiscent of fish meat;
• cancer is affected epithelial tissue, sarcoma - muscular connective;
• cancer progresses gradually certain body in people over 40 years of age. Sarcoma is a disease of young people and children, it instantly affects their organisms, but is not tied to any one organ;
• cancer is easier to diagnose, which increases the rate of its cure. Sarcoma is more often detected at stages 3-4, so its mortality is 50% higher.

Is sarcoma contagious?

No, she's not contagious. A contagious disease develops from a real substrate that carries the infection by airborne droplets or through the blood. Then a disease, such as influenza, can develop in the body of a new host. Sarcoma can develop as a result of a change genetic code chromosomal changes. Therefore, patients with sarcoma often have close relatives who have already been treated for any of its 100 types.

Sarcoma in HIV is a multiple hemorrhagic sarcomatosis called "angiosarcoma" or "". It is recognized by ulceration of the skin and mucous membranes. A person becomes ill as a result of herpes infection of the eighth type through the lymph, blood, secretions of the secretion of the skin and saliva of the patient, as well as through sexual contact. Even with antiviral therapy, Kaposi's tumor often recurs.

The development of sarcoma on the background of HIV is possible with a sharp decrease in immunity. At the same time, AIDS or a disease such as lymphosarcoma, leukemia, lymphogranulomatosis, or multiple myeloma can be detected in patients.

Causes of sarcomas

Despite the variety of types, sarcoma is rare, only in the amount of 1% of all oncological formations. The causes of sarcoma are varied. Among the established causes are: exposure to ultraviolet (ionizing) radiation, radiation. Viruses are also risk factors chemical substances, precursors of the disease, benign neoplasms, turning into oncological.

The causes of Ewing's sarcoma may be in the rate of bone growth and hormonal levels. Important risk factors such as smoking, work in chemical industries, contact with chemicals.

Most often, oncology of this type is diagnosed due to the following risk factors:

• genetic predisposition and genetic syndromes: Werner, Gardner, multiple basal cell pigmented skin cancer, neurofibromatosis or retinoblastoma;
• herpes virus;
• lymphedema in the legs chronic form, whose recurrence occurred after a radial mastectomy;
• injuries, wounds with suppuration, exposure to cutting and piercing objects (shards of glass, metal, wood chips, etc.);
• immunosuppressive and polychemotherapy (in 10%);
• organ transplant operations (in 75% of cases).

Informative video

General symptoms and signs of the disease

Signs of sarcoma appear depending on its location in the vital organs. The biological characteristics of the root cause of the cell and the tumor itself affect the nature of the symptoms. An early sign of a sarcoma is the noticeable size of the lesion as it grows rapidly. Pain in the joints and bones appears early (especially at night), which is not relieved by analgesics.

For example, due to the growth of rhabdominosarcoma, the oncoprocess spreads to tissues healthy organs and is manifested by various pain symptoms and hematogenous metastasis. If sarcoma develops slowly, signs of the disease may not appear for several years.

Symptoms of lymphoid sarcoma are reduced to the formation of oval or round nodes and small swelling in the lymph node. But even with sizes of 2-30 cm, a person may not feel pain at all.

In other types of tumors with rapid growth and progression, fever, veins under the skin, and cyanotic ulcerations on them, may appear. On palpation of the formation, it is revealed that it is limited in mobility. The first signs of sarcoma are sometimes characterized by deformation of the joints of the extremities.

Liposarcomas, along with other types, can be of a primary multiple nature with sequential or simultaneous manifestation in different areas of the body. This significantly complicates the search for a primary tumor that metastasizes.

Symptoms of sarcoma, located in soft tissues, are expressed in painful sensations on palpation. Such a tumor has no outline, and it quickly penetrates into the tissues nearby.

With a pulmonary oncological process, the patient suffers from shortness of breath, which causes oxygen starvation of the brain, pneumonia, pleurisy, dysphagia may begin, and the right sections of the heart may increase.

Cells of the nerve membranes are reborn into neurofibrosarcoma, connective tissue cells and fibers - into. Spindle cell sarcoma, consisting of large cells, affects the mucous membranes. Mesothelioma grows from the mesothelium of the pleura, peritoneum and pericardium.

Types of sarcomas by location

Types of sarcoma are distinguished depending on the location.

And Out of 100 species, sarcomas most often develop in the area:

• peritoneum and retroperitoneal space;
• neck, head and bones;
• mammary glands and uterus;
• stomach and intestines (stromal tumors);
• fatty and soft tissues of the limbs and trunk, including desmoid fibromatosis.

Especially often new ones are diagnosed in fatty and soft tissues:

• developing from adipose tissue;
• , which refers to fibroblastic / myofibroblastic formations;
• fibrohistiocytic soft tissue tumors: plexiform and giant cell;
• - from smooth muscle tissue;
• glomus oncotumor (pericytic or perivascular);
• from the muscles of the skeleton;
• and epithelioid hemangioepithelioma, which refers to vascular formations of soft tissues;
• mesenchymal chondrosarcoma, extraskeletal osteosarcoma - bone and cartilage tumors;
• malignant SM of the gastrointestinal tract (stromal tumor of the gastrointestinal tract);
• tumor formation of the nerve trunk: peripheral nerve trunk, newt tumor, granular cell tumor, ectomesenchymoma;
• sarcomas of unclear differentiation: synovial, epithelioid, alveolar, clear cell, Ewing, desmoplastic round cell, intimal, PEComu;
• undifferentiated / unclassified sarcoma: spindle cell, pleomorphic, round cell, epithelioid.

From bone oncological formations according to the WHO classification (ICD-10), the following tumors are often found:

• cartilage tissue - chondrosarcoma: central, primary or secondary, peripheral (periosteal), clear cell, dedifferentiated and mesenchymal;
• bone tissue - osteosarcoma, an ordinary tumor: chondroblastic, fibroblastic, osteoblastic, as well as telangiectatic, small cell, central low degree of malignancy, secondary and paraosteal, periosteal and superficial high degree of malignancy;
• fibrous tumors - fibrosarcoma;
• fibrohistiocytic formations - malignant fibrous histiocytoma;
• / PNET;
• hematopoietic tissue - plasmacytoma (myeloma), malignant lymphoma;
• giant cell: malignant giant cell;
• oncology of the chord - "Dedifferentiated" (sarcomatoid);
• vascular tumors - angiosarcoma;
• smooth muscle tumors - leiomyosarcoma;
• adipose tissue tumors - liposarcoma.

The maturity of all types of sarcomas can be low, medium and highly differentiated. The lower the differentiation, the more aggressive the sarcoma. The treatment and prognosis of survival depends on the maturity and stage of education.

Stages and degrees of the malignant process

There are three degrees of malignancy of sarcoma:

1. Poorly differentiated degree, in which the tumor consists of more mature cells and the process of their division is slow. It is dominated by stroma - normal connective tissue with a small percentage of oncoelements. The mass rarely metastasizes and recurs little, but can grow to large sizes.
2. A highly differentiated degree in which tumor cells divide rapidly and uncontrollably. With rapid growth, a dense vascular network with a large number of high-grade cancer cells forms in the sarcoma, and metastases spread early. Surgical treatment of a high-grade mass may be ineffective.
3. A moderately differentiated degree, in which the tumor has an intermediate development, and with adequate treatment, a positive prognosis is possible.

The stages of sarcoma do not depend on its histological type, but on the location. More determines the stage according to the state of the organ where the tumor began to develop.

The initial stage of sarcoma is characterized by small size. It does not extend beyond those organs or segments where it originally appeared. There are no violations of the working functions of organs, compression, metastasis. Virtually no pain. If a highly differentiated stage 1 sarcoma is detected, with complex treatment achieve positive results.

signs initial stage sarcomas, depending on the location in a particular organ, for example, the following:

• in the oral cavity and on the tongue - a small node up to 1 cm in size and with clear boundaries appears in the submucosal layer or mucous membrane;
• on the lips - the node is felt in the submucosal layer or inside the tissue of the lip;
• in the cellular spaces and soft tissues of the neck - the size of the node reaches 2 cm, it is located in the fascia, limiting its location, and does not go beyond them;
• in the larynx area - the mucous membrane or other layers of the larynx limit the node, up to 1 cm in size. It is located in the fascial case, does not go beyond it and does not disturb phonation and breathing;
• in the thyroid gland - a node up to 1 cm in size is located inside its tissues, the capsule does not germinate;
• in the mammary gland - a node up to 2-3 cm grows in a lobule and does not go beyond its limits;
• in the area of ​​the esophagus - the onconode up to 1-2 cm is located in its wall, without disturbing the passage of food;
• in the lung - manifested by the defeat of one of the segments of the bronchi, without going beyond it and without violating the working function of the lung;
• in the testicle - a small node develops without involvement of the albuginea in the process;
• in the soft tissues of the extremities - the tumor reaches 5 cm, but is located within the sheaths of the fascia.

Stage 2 sarcoma is located inside the organ, germinates all layers, violates functional work organ with an increase in size, but there is no metastasis.

The oncoprocess manifests itself as follows:

• in the oral cavity and on the tongue - a noticeable growth in the thickness of the tissues, the germination of all membranes, mucous membranes and fascia;
• on the lips - germination of the skin and mucous membranes;
• in cellular spaces and soft tissues of the neck - up to 3-5 cm in height, beyond the fascia;
• in the region of the larynx - the growth of the node is more than 1 cm, the germination of all layers, which disrupts phonation and respiration;
• in the thyroid gland - the growth of the node is more than 2 cm and the involvement of the capsule in the oncological process;
• in the mammary gland - the growth of the node up to 5 cm and the germination of several segments;
• in the esophagus - the germination of the entire thickness of the wall, including the mucous and serous layers, the involvement of the fascia, severe dysphagia (difficulty swallowing);
• in the lungs - compression of the bronchi or spread to the nearest pulmonary segments;
• in the testicle - germination of the albumin;
• in the soft tissues of the extremities - the germination of fascia, limiting the anatomical segment: muscle, cell space.

At the second stage, when the tumor is removed, the excision area is expanded, so relapses are not frequent.

Sarcoma stage 3 is characterized by the germination of fascia and nearby organs. Sarcoma metastasizes to regional lymph nodes.

The third stage appears:

• large size, severe pain syndrome, disruption of normal anatomical relationships and chewing in the mouth and tongue, metastases in the lymph nodes under the jaw and on the neck;
• large sizes, deforming the lip, spreading through the mucous membranes and metastases in the lymph nodes under the jaw and on the neck;
• violation of the functions of the organs located along the neck: the innervation and blood supply, swallowing and respiratory function with soft tissue sarcoma of the neck and cell spaces. With growth, the tumor reaches the vessels, nerves and nearby organs, metastases reach the lymph nodes of the neck and sternum;
• a sharp violation of breathing and distortion of the voice, germination in the organs, nerves, fascia and vessels in the neighborhood, metastasis from oncology of the larynx to the superficial and deep lymphatic cervical collectors;
• in the mammary gland - large sizes that deform the mammary gland and metastasize to the lymph nodes under the armpits or above the collarbone;
• in the esophagus - huge in size, reaching the tissue of the mediastinum and disrupting the food passage, metastases in the mediastinal LU;
• in the lungs - by squeezing the bronchi with large sizes, metastases in the LU of the mediastinum and peribronchial;
• in the testicle - deformation of the scrotum and germination of its layers, metastasis to the LU of the groin;
• in the soft tissues of the arms and legs - tumor foci 10 cm in size. As well as dysfunction of the limbs and deformation of tissues, metastases to regional lymph nodes.

At the third stage, extended surgical interventions are carried out, despite this, the frequency of recurrence of sarcoma increases, the results of treatment are ineffective.

Stage 4 sarcoma is very difficult, the prognosis after its treatment is the most unfavorable due to its gigantic size, sharp compression of the surrounding tissues and germination in them, the formation of a continuous tumor conglomerate, which is prone to bleed. Often there is a recurrence of sarcoma of soft tissues and other organs after surgery or even complex treatment.

Metastasis reaches regional lymph nodes, liver, lungs, and bone marrow. It stimulates a secondary oncoprocess - the growth of a new sarcoma.

Metastases in sarcoma

Ways of metastasis of sarcoma can be lymphogenous, hematogenous and mixed. From the organs of the small pelvis, intestines, stomach and esophagus, larynx, metastases of sarcoma reach the lungs, liver, bones of the skeleton and other organs along the lymphogenous pathway.

Tumor cells or metastases also spread through the hematogenous pathway (through venous and arterial vessels) to healthy tissues. But sarcomas, for example, of the mammary and thyroid glands, pulmonary, bronchial, from the ovaries spread by lymphogenous and hematogenous routes.

It is impossible to predict the organ where the elements of the microvasculature will accumulate and the growth of a new tumor will begin. Dust metastases of the sarcoma of the stomach and pelvic organs spread through the peritoneum and chest area with hemorrhagic effusion - ascites.

Oncoprocess on the lower lip, the tip of the tongue and in the oral cavity metastasizes more to the lymph nodes of the chin and under the jaw. Formations in the root of the tongue, at the bottom of the oral cavity, in the pharynx, larynx, thyroid gland metastasize to the lymph nodes of the vessels and nerves of the neck.

From the mammary gland, oncocells spread to the region of the clavicle, to the LN from the outside of the sternocleidomastoid muscle. From the peritoneum they go to inside sternocleidomastoid muscle and can be located behind or between its legs.

Most of all, metastasis occurs in adults, lymphosarcoma, liposarcoma, fibrous histiocytoma, even with a size of up to 1 cm due to the accumulation of calcium in the oncological focus, intense blood flow and active growth cancer cells. These formations lack a capsule that could limit their growth and reproduction.

The course of the oncological process does not become more complicated, and its treatment due to metastases to regional lymph nodes will not be so global. With distant metastases in internal organs on the contrary, the tumor grows to large sizes, there may be several of them. Treatment becomes more complicated, complex therapy is used: surgery, chemistry and radiation. Remove, as a rule, single metastases. Excision of multiple metastases is not carried out, it will not be effective. Primary foci differ from metastases in a large number of vessels, cell mitoses. In metastases, there are more necrosing areas. Sometimes they are found earlier than the primary focus.

The consequences of sarcoma are as follows:

• surrounding organs are compressed;
• obstruction or perforation may occur in the intestine, peritonitis - inflammation of the abdominal sheets;
• elephantiasis occurs against the background of a disturbed outflow of lymph during compression of the lymph nodes;
• limbs are deformed, and movement is limited in the presence of large tumors in the area of ​​\u200b\u200bbones and muscles;
• internal hemorrhages occur during the disintegration of oncological formation.

Diagnosis of sarcomas

Diagnosis of sarcoma begins in the doctor's office, where it is determined by external diagnostic signs: emaciation, jaundice, pale color skin and change in its color over the tumor, cyanotic tint of the lips, swelling of the face, overflow of veins on the surface of the head, plaques and nodules in skin sarcoma.

Diagnosis of high-grade sarcoma is carried out according to the pronounced symptoms of intoxication of the body: loss of appetite, weakness, elevated temperature body and perspiration at night. Cases of oncology in the family are taken into account.

When conducting laboratory tests, they examine:

• biopsy by histological method under a microscope. In the presence of tortuous thin-walled capillaries, multidirectional bundles of atypical oncocells, altered large-nuclear cells with thin shell, a large amount of substance between cells containing cartilaginous or hyaline connective tissue substances, histology diagnoses sarcoma. At the same time, in the nodes there are no normal cells characteristic of the tissue of the organ.
• anomalies in the chromosomes of cancer cells by the cytogenetic method.
• there are no specific blood tests for oncomarkers, so there is no way to unambiguously determine its variety.
• complete blood count: with sarcoma, it will show the following deviations:

1. hemoglobin and erythrocyte levels will decrease significantly (less than 100 g / l), which indicates anemia;
2. the level of leukocytes will slightly increase (above 9.0x109 / l);
3. the number of platelets will decrease (less than 150․109/l);
4. ESR will increase (above 15 mm/h).

• biochemical blood test, it determines elevated level lactate dehydrogenase. If the enzyme concentration is above 250 U/l, then we can talk about the aggressiveness of the disease.

Diagnosis of sarcoma is supplemented by X-ray chest. The method can detect a tumor and its metastases in the sternum and bones.

Radiological signs of sarcoma are as follows:

• the tumor has a rounded or irregular shape;
• the sizes of education in a mediastinum happen from 2-3 mm to 10 and more cm;
• the structure of the sarcoma will be heterogeneous.

X-ray is necessary to detect pathology in the lymph nodes: one or more. In this case, the LU on the radiograph will be darkened.

If a sarcoma is diagnosed on ultrasound, then it will be characteristic, for example:

• heterogeneous structure, uneven scalloped edges and lesions of the LU - with lymphosarcoma in the peritoneal region;
• the absence of a capsule, compression and expansion of surrounding tissues, foci of necrosis inside the tumor - with sarcoma in the organs and soft tissues of the abdominal cavity. Knots will be visible in the uterus and kidneys (inside) or in the muscles;
• formations of different sizes without borders and with foci of decay inside them - with skin sarcoma;
• multiple formations, heterogeneous structure and metastases of the primary tumor - with fatty sarcoma;
• heterogeneous structure and cysts inside, filled with mucus or blood, fuzzy edges, effusion in the cavity of the joint bag - with joint sarcoma.

Tumor markers in sarcoma are determined in each specific organ, as in cancer. For example, with ovarian cancer -, with breast sarcoma -, gastrointestinal tract - CA 19-9 or, lungs - ProGRP (precursor of gastrin, releasing, peptide), etc.

Computed tomography is performed with the introduction of an X-ray contrast agent to determine the location, boundaries of the tumor and its forms, damage to surrounding tissues, blood vessels, lymph nodes and their mergers into conglomerates.

Magnetic resonance imaging is performed to detect exact dimensions, metastases, destruction of the skin, bones, tissues, periosteal fibrillation, thickening of the joints and others.

The diagnosis is confirmed by a biopsy and determines the malignancy by histological examination:

• bundles of tangled spindle-shaped cells;
• hemorrhagic exudate - fluid coming out of the walls of blood vessels;
• hemosiderin - a pigment formed during the breakdown of hemoglobin;
• giant atypical cells;
• mucus and blood in the sample and otherwise.

Lumbar (spinal) puncture tests will indicate sarcoma, where there may be traces of blood and many atypical cells of different sizes and shapes.

Do not remove:

• after 75 years;
• at serious illnesses heart, kidney and liver;
• with a large tumor in vital organs that cannot be removed.

The following therapeutic tactics are also used:

1. With low- and moderately differentiated sarcomas at stages 1-2, operations and regional lymph node dissection are performed. After - polychemotherapy (1-2 courses) or external beam radiation therapy for sarcoma.
2. With highly differentiated sarcomas at stages 1-2, surgical treatment and extended lymph node dissection. performed before and after surgery, and with complex treatment is added.
3. At the third stage of the oncological process, combined treatment is carried out: before surgery, radiation and chemotherapy are used to reduce the size of the tumor. During the operation, all germinating tissues, collectors of regional lymphatic drainage are removed. Restore important damaged structures: nerves and blood vessels.
4. Amputation is often required for sarcomas, especially osteosarcomas. Bone resection is performed for low-grade superficial osteosarcomas in older people. Next is prosthetics.
5. At the 4th stage, apply symptomatic treatment: correction of anemia, detoxification and analgesic therapy. For a comprehensive full treatment at the last stage, access to oncological formation is necessary in order to remove it, small size, location in the surface layers of tissues, single metastases.

Of the modern methods, remote radiation therapy with linear accelerators is used according to special programs that plan the irradiation fields and calculate the power and doses of exposure to the oncoprocess zone. Radiotherapy is carried out under full computerized control and automatic verification of the correctness of the settings set on the accelerator control panel in order to eliminate human error. used for sarcomas different localization. It accurately irradiates the tumor with a high dose of radiation without damaging healthy tissue. The source is introduced into it by remote control. Brachytherapy may replace in some cases surgical intervention and external exposure.

Traditional medicine for sarcoma

Treatment of sarcoma with folk remedies is included in complex therapy. For each type of sarcoma there is its own medicinal herb, mushrooms, resins, food. Diet in oncology is of great importance, since fortified foods and with the presence of micro- and macroelements increase immunity, give strength to fight cancer cells, and prevent metastasis.

At malignant sarcomas treatment is carried out:

• infusions;
• alcohol tinctures;
• decoctions;
• poultices.

Herbs used:

• henbane black;
• hemlock spotted;
• bullock;
• cocklebur;
• water lily white;
• grape clematis;
• poppy samosey;
• sun milk,
• red fly agaric;
• norichnik knotty;
• mistletoe white;
• incense pikulnik;
• peony evasive;
• European wormwood;
• common hop;
• common blackhead;
• large celandine;
• saffron seed;
• ash is tall.

With chronic sarcoma ulcers on the skin and mucous membranes, they treat avran officinalis, skin sarcoma - wolfberry, medicinal sweet clover, cocklebur, kirkazon and grape-leaved clematis, euphorbia-sun-gazer and bittersweet nightshade, common tansy and European dodder, common hops and medicinal garlic.

During the oncological process in the organs, drugs will be needed:

• in the stomach - from wolfberry, crow, common dope and cocklebur, evading peony, large celandine and bitter wormwood;
• in duodenum- from aconites, marsh belozor;
• in the esophagus - from spotted hemlock;
• in the spleen - from wormwood;
• in the prostate gland - from spotted hemlock;
• in the mammary gland - from spotted hemlock, icterus levkoin and common hops;
• in the uterus - from evading peony, bitter wormwood, hellebore Lobel and sowing saffron;
• in the lungs - from the magnificent colchicum and cocklebur.

Osteogenic sarcoma is treated with tincture: crushed St. John's wort (50 g) is poured with grape vodka (0.5 l) and infused for two weeks with daily shaking of the container. Before meals, take 30 drops 3-4 times.

With sarcoma, folk remedies are used according to the method of M.A. Ilves (from the book "The Red Book of the White Land"):

1. To increase immunity: mixed in equal weight fractions: tartar (flowers or leaves), calendula flowers, tricolor and field violets, cocklebur, chamomile flowers and veronica, celandine and sandy immortelle flowers, mistletoe and young burdock root. Brew 2 tbsp. l. collection of 0.5-1 l of boiling water and insist 1 hour. Drink during the day.
2. Divide the herbs from the list into 2 groups (5 and 6 items each) and drink for 8 days each collection.

Important! In the collection, plants such as celandine, violet, cocklebur and mistletoe are poisonous. Therefore, the dose cannot be exceeded.

To eliminate cancer cells, the treatment of sarcoma with folk remedies includes the following Ilves recipes:

• grind celandine in a meat grinder and squeeze out the juice, mix with vodka in equal parts(preserve) and store at room temperature. Drink 3 times a day for 1 tsp. with water (1 glass);
• crush 100 g of root marin (evading peony) and pour vodka (1 l) or alcohol (75%), leave for 3 weeks. Take 0.5-1 tsp. 3 times with water;
• grind white mistletoe, place in a jar (1 l) by 1/3, pour vodka to the top and let it brew for 30 days. Separate the thick and squeeze, drink 1 tsp. 3 times with water;
• grind the root of the meadowsweet - 100 g and pour vodka - 1 liter. Insist 3 weeks. Drink 2-4 tsp. 3 times a day with water.

The first three tinctures should be alternated after 1-2 weeks. The tincture of the meadowsweet is used as a spare. All tinctures last time taken before evening dinner. The course - 3 months, in the interval between the monthly course (2 weeks) - drink the meadowsweet. At the end of the 3-month course, drink meadowsweet or one of the tinctures once a day for another 30 days.

Nutrition for sarcoma

The diet for sarcoma should consist of the following products: vegetables, herbs, fruits, fermented milk, rich in bifidus and lacto bacteria, boiled (steam, stew) meat, cereals as a source of complex carbohydrates, nuts, seeds, dried fruits, bran and germinated cereals , wholemeal bread, cold-pressed vegetable oils.

To block metastases in the diet include:

• fatty sea fish: saury, mackerel, herring, sardine, salmon, trout, cod;
• green and yellow vegetables: zucchini, cabbage, asparagus, green peas, carrots and pumpkin;
• garlic.

You should not eat confectionery products, as they are stimulators of oncocell division, as sources of glucose. Also products with the presence of tannin: persimmon, coffee, tea, bird cherry. Tannin, as a hemostatic agent, promotes thrombosis. Smoked meats are excluded as sources of carcinogens. You can not drink alcohol, beer, the yeast of which feeds cancer cells simple carbohydrates. Sour berries are excluded: lemons, lingonberries and cranberries, since cancer cells actively develop in an acidic environment.

Life prognosis for sarcoma

A five-year survival rate for soft tissue and limb sarcoma can reach 75%, up to 60% for oncological processes on the body.
In fact, even the most experienced doctor does not know how long they live with sarcoma. According to studies, life expectancy with sarcoma is affected by forms and types, stages of the oncological process, and the general condition of the patient. With adequate treatment, a positive prognosis is possible in the most hopeless cases.

Disease prevention

Primary prevention of sarcoma includes active identification of patients with increased risk disease progression, including those infected with herpes virus VIII (HHV-8). Especially carefully it is necessary to monitor patients receiving. In prevention, conditions and diseases that cause sarcoma should be eliminated and treated.

Secondary prevention is carried out in patients in remission to prevent recurrence of sarcoma and complications after a course of treatment. As a preventive measure, you should drink brewed herbs instead of tea according to the Ilves method (p. 1) for 3 months, take a break for 5-10 days and repeat the intake. Sugar or honey can be added to tea.

Currently, according to the definition of the term, any extramedullary (extramedullary) manifestation of acute myeloid leukemia can be called myeloid sarcoma. However, according to the established historical tradition, some special leukemic lesions are called by their specific names:

• Skin leukemids, a term describing the infiltration of the skin by leukemic cells with the formation of specific infiltrate nodules, they are also called "cutaneous myeloid sarcoma" (formerly "cutaneous granulocytic sarcoma").
• « meningoleukemia" or " meningeal leukemia”, a term describing the invasion of leukemic cells into the subarachnoid space and the involvement of the meninges in the leukemic process, is usually considered separately from myeloid sarcoma (“chloroma”). However, those very rare cases in which a solid tumor of leukemic cells arises in the CNS may nevertheless, by definition, be called CNS myeloid sarcoma.

Frequency and typical clinical manifestations

For acute leukemia

Myeloid sarcomas are a rare disease. The exact frequency of their occurrence is unknown, but they are rarely observed even by hematologists who specialize in the treatment of acute myeloid leukemia.

Myeloid sarcomas may be somewhat more common in patients with the following disease features:

• Class M2 according to FAB, that is, Acute myeloid leukemia with maturation;
• Patients whose leukemic cells have certain specific cytogenetic abnormalities, such as t(8;21) or inv(16);
• Patients whose myeloblasts express CD13 or CD14 T-cell surface antigens
• Patients with a high number blast cells in the blood or a high level of LDH, that is, with a large total tumor mass.

However, even in patients with the above risk factors or a combination of them, myeloid sarcoma is rare complication AML.

Sometimes myeloid sarcoma can develop as the first (and for the time being the only) manifestation of recurrence after seemingly successful treatment of acute myeloid leukemia. In line with the clinical behavior of myeloid sarcomas, which always are a systemic disease from the very beginning (the concept of "metastasis" does not apply to them), all these cases should be considered and treated as early signs systemic recurrence of AML, and not as a localized process. Thus, in one review of 24 patients who, after seemingly successful treatment of AML, developed relapses in the form of isolated myeloid sarcomas, it was shown that the average time from the onset of myeloid sarcoma to ascertaining a clear bone marrow recurrence was only 7 months (range - from 1 up to 19 months). And this review was published in 1994, long before the invention of modern molecular techniques that can demonstrate the presence of bone marrow "molecular" recurrence much earlier than it becomes obvious histologically.

With myelodysplastic and myeloproliferative syndromes, including chronic leukemias

Myeloid sarcomas may occur in patients diagnosed with myelodysplastic syndrome or myeloproliferative syndrome such as chronic myeloid leukemia, polycythemia vera, essential thrombocytosis, or myelofibrosis. The discovery of myeloid sarcoma of any localization in a patient with such a diagnosis is considered de facto evidence that these premalignant or low-grade chronic diseases have transformed into acute myeloid leukemia, requiring immediate adequate treatment. For example, the appearance of myeloid sarcoma in a patient with chronic myeloid leukemia is sufficient evidence that this patient's CML has passed into the "blast crisis" phase. At the same time, the presence of other signs, such as bone marrow blastosis or blastosis in the blood, is not necessary to state the fact of a blast crisis.

Primary myeloid sarcoma

In very rare cases Myeloid sarcoma can occur in a patient without simultaneously meeting the criteria for the diagnosis of acute myeloid leukemia (by bone marrow and blood), myelodysplastic or myeloproliferative syndrome (including chronic myeloid leukemia) and without a previous history of suffering from these diseases. This condition is known as "primary myeloid sarcoma". Diagnosis in these cases can be particularly difficult. In almost all cases of primary myeloid sarcoma, classic, systemic ("bone marrow") acute myeloid leukemia soon develops. The median time from diagnosis of "primary myeloid sarcoma" to the development of overt acute myeloid leukemia is 7 months (range, 1 to 25 months). Therefore, the detection of primary myeloid sarcoma should be considered as an early initial manifestation of acute myeloid leukemia, and not as a localized process, and, accordingly, serve as the basis for the diagnosis of "acute myeloid leukemia" of the corresponding histological form and prescribing treatment appropriate to the histological form of AML, risk group, cytogenetics and immunophenotype of the tumor. In particular, if a myeloid sarcoma consisting of promyelocytes is detected (AML type M3 according to FAB, acute promyelocytic leukemia), then treatment should correspond to AML M3 and include not only and not so much chemotherapy, but, above all, the use of all-trans retinoic acid ( ATRA) and arsenic trioxide.

Location and symptoms

Myeloid sarcoma can occur in almost any organ or tissue. However, the most common localization of the process is the skin (a condition known as "skin leukemids", eng. leukemia cutis) and gums. Involvement of the skin in the leukemic process usually looks like pale, sometimes with purple or greenish tint, painless, raised plaques or nodules above the surface of the skin, which, when biopsied, are infiltrated by leukemic cells (myeloblasts). Cutaneous leukemids should be distinguished from the so-called "Sweet's syndrome", in which the skin is infiltrated by healthy (non-cancerous) mature neutrophils, which is a reactive paraneoplastic process. Involvement of the gums in the leukemic process results in the characteristic appearance of pale, swollen, hyperplastic, sometimes painful gums that bleed easily when brushing teeth or other minor trauma.

Other organs and tissues that may be involved in the leukemic process include, in particular, the lymph nodes, stomach, small and large intestines, abdominal cavity and mediastinum, lungs, epidural spaces, testicles, uterus and ovaries, orbit of the eye. Symptoms of myeloid sarcoma in this case depend on its anatomical localization. Myeloid sarcomas can also be asymptomatic and discovered incidentally during the examination of a patient, especially a patient with acute myeloid leukemia.

However, with the advent of modern diagnostic techniques, such as immunophenotyping and immunohistochemistry, the diagnosis of myeloid sarcoma today can be made much more reliably than before, with less delay in establishing correct diagnosis and with fewer initial diagnostic errors (misdiagnosis). Thus, Travek et al described the successful use of a commercially available panel of monoclonal antibodies against myeloperoxidase, CD68, CD43, and CD20 surface antigens for immunohistochemical tissue staining in order to accurately and correctly diagnose myeloid sarcomas and distinguish them from lymphomas. Today, in order to diagnose and differentiate myeloid sarcomas and lymphomas, immunohistochemical staining using monoclonal antibodies to CD33 and CD117 antigens is mainly used. The increasing availability and increasingly accurate and correct use of flow cytometry has also contributed to improving the early and correct diagnosis of these tumors.

predictive value

Experts disagree on the prognostic value of the presence of myeloid sarcomas in patients with acute myeloid leukemia. In general, it is generally accepted that the presence of myeloid sarcomas means a worse prognosis, with poorer response to therapy, less chance of remission, and worse overall and disease-free survival. However, other experts believe that the mere presence of myeloid sarcomas is associated with other unfavorable biological markers of the tumor, such as the expression of adhesion molecules, T-cell antigens, unfavorable cytogenetic abnormalities, a large tumor mass (high LDH level in the blood or high blast leukocytosis) and therefore the presence of myeloid sarcomas does not carry any additional prognostic information and is not an independent prognostic factor.

Treatment

As described above, myeloid sarcomas should always be considered as another manifestation of a systemic disease - acute myeloid leukemia, and not as an isolated local phenomenon, and therefore should be treated systemically according to the protocols intended for the treatment of acute myeloid leukemia. Accordingly, in a patient with both primary myeloid sarcoma and newly diagnosed acute myeloid leukemia, systemic chemotherapy according to protocols designed for the treatment of acute myeloid leukemia (such as 7+3, ADE, FLAG, etc.) should be used as first line therapy. Given the less favorable, on average, prognosis in patients with myeloid sarcoma compared to patients with AML without extramedullary manifestations, it may make sense to use more aggressive induction and consolidation chemotherapy regimens (for example, ADE or HDAC instead of "7 + 3") and early - in the first remission - high-dose chemotherapy and allogeneic transplantation of hematopoietic stem cells. Topical treatment is generally not indicated and is not necessary, as myeloid sarcomas tend to be quite sensitive to standard systemic antileukemic chemotherapy. In addition, local treatment (surgery or radiation therapy) is associated with the risk of complications (for example, in the case of surgery - infections and bleeding) and postponing the start of chemotherapy, which is dangerous in AML with its rapid progression. An exception is cases when the anatomical localization of myeloid sarcoma threatens the functioning of one or another vital important body(for example, causes compression of the spinal cord with dysfunction of the pelvic organs or the threat of rupture of the spleen, or intestinal obstruction). In this case, emergency surgery or radiation therapy to the affected area may be indicated in parallel with the earliest possible start of intensive anti-leukemic chemotherapy. Also, local radiation therapy or surgery can be a palliative measure for those who cannot receive chemotherapy of any kind (which is rare - there are alternative regimens for the elderly, debilitated) or who refuse it.

If myeloid sarcoma persists (remains in place) after the completion of induction chemotherapy, the tactics should be the same as for resistant (refractory) acute myeloid leukemia - that is, try second and third line chemotherapy that does not have cross-resistance with the first regimen, high-dose chemotherapy and allogeneic hematopoietic stem cell transplantation. In addition to or as a palliative measure (for those who cannot continue chemotherapy) - but only in addition, not instead of systemic chemotherapy II or III line, allotransplantation - surgical removal of myelosarcoma or local radiation therapy may be considered. However, none of the local methods does not increase the survival of patients.

Patients with isolated primary myeloid sarcoma should also receive systemic antileukemic therapy rather than topical treatment, since the development of the typical "bone marrow" acute myeloid leukemia soon (measured in weeks or months) after the diagnosis of primary myeloid sarcoma is almost inevitable, and treatment for both conditions equally. In fact, such patients in most cases are diagnosed with acute myeloid leukemia, initial extramedullary manifestations of the corresponding histological form, and not with the diagnosis of primary myeloid sarcoma.

Patients treated for acute myeloid leukemia who relapse after treatment with isolated myeloid sarcoma should be treated in the same way as patients with systemic relapse (i.e., line II and III chemotherapy, allogeneic bone marrow transplantation). However, as with any relapse of acute myeloid leukemia, the prognosis is usually poor, especially if it is not the first recurrence (than more quantity already experienced relapses, the more difficult it is to achieve remission with chemotherapy, the shorter the remission, the more aggressive the behavior of the tumor and the higher its resistance to chemotherapy).

Patients with "pre-leukemic" conditions, such as myelodysplastic syndrome, chronic myeloid leukemia, polycythemia vera, and other myeloproliferative diseases, should be treated as if their disease had progressed to acute myeloid leukemia (or, in case of CML, suffered a "blast crisis"). That is, again, they should receive systemic antileukemic chemotherapy. Taking into account the fact that in patients with a history of myelodysplastic or myeloproliferative syndrome (in particular, with CML blast transformation), the prognosis is always worse than in patients with de novo AML, it makes sense for them to have more aggressive induction and consolidation chemotherapy and early - in the first remission - allogeneic transplantation of hematopoietic stem cells.

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Links

1. James, William D.; Berger, Timothy G.; et al. Andrews" Diseases of the Skin: clinical Dermatology. - Saunders Elsevier, 2006. - ISBN 0-7216-2921-0.
2. Karlin L, Itti E, Pautas C, et al.(December 2006). "". Haematologica 91 (12 Suppl): ECR54. PMID 17194660 .
3. Burns A. Observations of surgical anatomy, in Head and Neck. - London: Royce, 1811. - P. 364.
4. King A (1853). "A case of chloroma". Monthly J Med 17 : 17.
5. Dock G, Warthin AS (1904). "A new case of chloroma with leukemia". Trans Assoc Am Phys 19 (64): 115.
6. Rappaport H. Tumors of the hematopoietic system // Atlas of Tumor Pathology, Section III, Fascicle 8. - Washington DC: Armed Forces Institute of Pathology, 1967. - P. 241–7.
7. Chevallier P, Mohty M, Lioure B, et al.(July 2008). "". J.Clin. oncol. 26 (30): 4940. DOI:10.1200/JCO.2007.15.6315. PMID 18606981.
8. Byrd JC, Edenfield WJ, Shields DJ, Dawson NA (July 1995). "". J.Clin. oncol. 13 (7): 1800–16. PMID 7602369.
9. Byrd JC, Weiss R.B. (April 1994). "Recurrent granulocytic sarcoma. An unusual variation of acute myelogenous leukemia associated with 8;21 chromosomal translocation and blast expression of the neural cell adhesion molecule.” Cancer 73 (8): 2107–12. DOI:10.1002/1097-0142(19940415)73:8<2107::AID-CNCR2820730815>3.0.CO;2-W . PMID 7512442.
10. Yamauchi K, Yasuda M (March 2002). "Comparison in treatments of nonleukemic granulocytic sarcoma: report of two cases and a review of 72 cases in the literature". Cancer 94 (6): 1739–46. DOI:10.1002/cncr.10399. PMID 11920536.
11. Traweek ST, Arber DA, Rappaport H, Brynes RK (October 1993). "Extramedullary myeloid cell tumors. An immunohistochemical and morphologic study of 28 cases”. Am. J. Surg. Pathol. 17 (10): 1011–9. DOI:10.1097/00000478-199310000-00006 . PMID 8372941.
12. Byrd JC, Weiss RB, Arthur DC, et al.(February 1997). "". J.Clin. oncol. 15 (2): 466–75. PMID 9053467.
13. Bisschop MM, Revész T, Bierings M, et al.(January 2001). "Extramedullary infiltrates at diagnosis have no prognostic significance in children with acute myeloid leukaemia". Leukemia 15 (1): 46–9. DOI:10.1038/sj.leu.2401971. PMID 11243398 .
14. Imrie KR, Kovacs MJ, Selby D, et al.(September 1995). "". Ann. Intern. Med. 123 (5): 351–3. DOI:10.7326/0003-4819-123-5-199509010-00005 . PMID 7625623.

An excerpt characterizing Myeloid Sarcoma

When they brought Nikolushka to Prince Andrei, who looked frightened at his father, but did not cry, because no one was crying, Prince Andrei kissed him and, obviously, did not know what to say to him.
When Nikolushka was taken away, Princess Marya went up to her brother again, kissed him, and, unable to restrain herself any longer, began to cry.
He looked at her intently.
Are you talking about Nikolushka? - he said.
Princess Mary, weeping, bowed her head affirmatively.
“Marie, you know Evan…” but he suddenly fell silent.
- What are you saying?
- Nothing. There is no need to cry here,” he said, looking at her with the same cold look.

When Princess Mary began to cry, he realized that she was crying that Nikolushka would be left without a father. With great effort on himself, he tried to go back to life and transferred himself to their point of view.
“Yes, they must feel sorry for it! he thought. “How easy it is!”
“The birds of the air neither sow nor reap, but your father feeds them,” he said to himself and wanted to say the same to the princess. “But no, they will understand it in their own way, they will not understand! They cannot understand this, that all these feelings that they value are all ours, all these thoughts that seem so important to us that they are not needed. We can't understand each other." And he was silent.

The little son of Prince Andrei was seven years old. He could hardly read, he knew nothing. He experienced a lot after that day, acquiring knowledge, observation, experience; but if he had then mastered all these later acquired abilities, he could not have better, deeper understood the full significance of the scene that he saw between his father, Princess Mary and Natasha than he understood it now. He understood everything and, without crying, left the room, silently went up to Natasha, who followed him, looked shyly at her with beautiful, thoughtful eyes; raised ruddy upper lip he trembled, he leaned his head against it and wept.
From that day on, he avoided Dessalles, avoided the countess who caressed him, and either sat alone or timidly approached Princess Marya and Natasha, whom he seemed to love even more than his aunt, and softly and shyly caressed them.
Princess Mary, leaving Prince Andrei, fully understood everything that Natasha's face told her. She no longer spoke to Natasha about the hope of saving his life. She took turns with her at his sofa and wept no more, but prayed incessantly, turning her soul to that eternal, incomprehensible, whose presence was now so palpable over the dying man.

Prince Andrei not only knew that he would die, but he felt that he was dying, that he was already half dead. He experienced a consciousness of alienation from everything earthly and a joyful and strange lightness of being. He, without haste and without anxiety, expected what lay ahead of him. That formidable, eternal, unknown and distant, the presence of which he had not ceased to feel throughout his whole life, was now close to him and - by that strange lightness of being that he experienced - almost understandable and felt.
Before, he was afraid of the end. He twice experienced this terrible tormenting feeling of fear of death, the end, and now he no longer understood it.
The first time he experienced this feeling was when a grenade was spinning like a top in front of him and he looked at the stubble, at the bushes, at the sky and knew that death was in front of him. When he woke up after the wound and in his soul, instantly, as if freed from the oppression of life that held him back, this flower of love blossomed, eternal, free, not dependent on this life, he no longer feared death and did not think about it.
The more he, in those hours of suffering solitude and semi-delusion that he spent after his wound, thought about the new beginning of eternal love revealed to him, the more he, without feeling it, renounced earthly life. Everything, to love everyone, to always sacrifice oneself for love, meant not to love anyone, meant not to live this earthly life. And the more he was imbued with this beginning of love, the more he renounced life and the more completely he destroyed that terrible barrier that, without love, stands between life and death. When, this first time, he remembered that he had to die, he said to himself: well, so much the better.
But after that night in Mytishchi, when the woman he desired appeared before him half-delirious, and when he, pressing her hand to his lips, wept quiet, joyful tears, love for one woman crept imperceptibly into his heart and again tied him to life. And happy and anxious thoughts began to come to him. Remembering that moment at the dressing station when he saw Kuragin, he now could not return to that feeling: he was tormented by the question of whether he was alive? And he didn't dare to ask.

His illness followed its own physical order, but what Natasha called it happened to him, happened to him two days before Princess Mary's arrival. It was that last moral struggle between life and death in which death triumphed. It was an unexpected realization that he still cherished life, which seemed to him in love for Natasha, and the last, subdued fit of horror before the unknown.
It was in the evening. He was, as usual after dinner, in a slight feverish state, and his thoughts were extremely clear. Sonya was sitting at the table. He dozed off. Suddenly a feeling of happiness swept over him.
“Ah, she came in!” he thought.
Indeed, Natasha, who had just entered with inaudible steps, was sitting in Sonya's place.
Ever since she'd followed him, he'd always had that physical sensation of her closeness. She was sitting on an armchair, sideways to him, blocking the light of the candle from him, and knitting a stocking. (She had learned to knit stockings ever since Prince Andrei had told her that no one knows how to look after the sick as well as old nannies who knit stockings, and that there is something soothing in knitting a stocking.) Her thin fingers quickly fingered from time to time spokes colliding, and the thoughtful profile of her lowered face was clearly visible to him. She made a move - the ball rolled from her knees. She shuddered, looked back at him, and shielding the candle with her hand, with a careful, flexible and precise movement, bent over, picked up the ball and sat down in her former position.
He looked at her without moving, and saw that after her movement she needed to take a deep breath, but she did not dare to do this and carefully caught her breath.
In the Trinity Lavra they talked about the past, and he told her that if he were alive, he would thank God forever for his wound, which brought him back to her; but since then they have never talked about the future.
“Could it or couldn’t it be? he thought now, looking at her and listening to the light steely sound of the spokes. “Is it really only then that fate brought me so strangely together with her in order for me to die? .. Was it possible that the truth of life was revealed to me only so that I would live in a lie?” I love her more than anything in the world. But what should I do if I love her? he said, and he suddenly groaned involuntarily, out of a habit he had acquired during his suffering.
Hearing this sound, Natasha put down her stocking, leaned closer to him, and suddenly, noticing his luminous eyes, went up to him with a light step and bent down.
- You are not asleep?
- No, I have been looking at you for a long time; I felt when you entered. Nobody like you, but gives me that soft silence... that light. I just want to cry with joy.
Natasha moved closer to him. Her face shone with ecstatic joy.
“Natasha, I love you too much. More than anything.
- And I? She turned away for a moment. - Why too much? - she said.
- Why too much? .. Well, what do you think, how do you feel to your heart, to your heart's content, will I be alive? What do you think?
- I'm sure, I'm sure! - Natasha almost screamed, passionately taking him by both hands.
He paused.
- How nice! And taking her hand, he kissed it.
Natasha was happy and excited; and at once she remembered that this was impossible, that he needed calmness.
"But you didn't sleep," she said, suppressing her joy. “Try to sleep…please.”
He released her, shaking her hand, she went to the candle and again sat down in her previous position. Twice she looked back at him, his eyes shining towards her. She gave herself a lesson on the stocking and told herself that until then she would not look back until she finished it.
Indeed, soon after that he closed his eyes and fell asleep. He didn't sleep long and suddenly woke up in a cold sweat.
Falling asleep, he thought about the same thing that he thought about from time to time - about life and death. And more about death. He felt closer to her.
"Love? What is love? he thought. “Love interferes with death. Love is life. Everything, everything that I understand, I understand only because I love. Everything is, everything exists only because I love. Everything is connected by her. Love is God, and to die means for me, a particle of love, to return to the common and eternal source. These thoughts seemed to him comforting. But these were only thoughts. Something was lacking in them, something that was one-sidedly personal, mental - there was no evidence. And there was the same anxiety and uncertainty. He fell asleep.
He saw in a dream that he was lying in the same room in which he actually lay, but that he was not injured, but healthy. A lot of different persons, insignificant, indifferent, appear before Prince Andrei. He talks to them, argues about something unnecessary. They are going to go somewhere. Prince Andrei vaguely recalls that all this is insignificant and that he has other, most important concerns, but continues to speak, surprising them, with some empty, witty words. Little by little, imperceptibly, all these faces begin to disappear, and everything is replaced by one question about the closed door. He gets up and goes to the door to slide the bolt and lock it. Everything depends on whether or not he has time to lock it up. He walks, in a hurry, his legs do not move, and he knows that he will not have time to lock the door, but all the same, he painfully strains all his strength. And a tormenting fear seizes him. And this fear is the fear of death: it stands behind the door. But at the same time as he helplessly awkwardly crawls to the door, this is something terrible, on the other hand, already, pressing, breaking into it. Something not human - death - is breaking at the door, and we must keep it. He grabs the door, exerting his last efforts - it is no longer possible to lock it - at least to keep it; but his strength is weak, clumsy, and, pressed by the terrible, the door opens and closes again.
Once again, it pressed from there. The last, supernatural efforts are in vain, and both halves opened silently. It has entered, and it is death. And Prince Andrew died.
But at the same moment he died, Prince Andrei remembered that he was sleeping, and at the same moment he died, he, having made an effort on himself, woke up.
“Yes, it was death. I died - I woke up. Yes, death is an awakening! - suddenly brightened in his soul, and the veil that had hidden the unknown until now was lifted before his spiritual gaze. He felt, as it were, the release of the previously bound strength in him and that strange lightness that had not left him since then.
When he woke up in a cold sweat, stirred on the sofa, Natasha went up to him and asked what was wrong with him. He did not answer her and, not understanding her, looked at her with a strange look.
This was what happened to him two days before Princess Mary's arrival. From that very day, as the doctor said, the debilitating fever took on a bad character, but Natasha was not interested in what the doctor said: she saw these terrible, more undoubted, moral signs for her.
From that day on, for Prince Andrei, along with the awakening from sleep, the awakening from life began. And in relation to the duration of life, it did not seem to him more slowly than awakening from sleep in relation to the duration of a dream.

There was nothing terrible and sharp in this relatively slow awakening.
His last days and hours passed in an ordinary and simple way. And Princess Marya and Natasha, who did not leave him, felt it. They did not cry, did not shudder, and lately, feeling it themselves, they no longer followed him (he was no longer there, he left them), but for the closest memory of him - for his body. The feelings of both were so strong that they were not affected by the outer, terrible side of death, and they did not find it necessary to exasperate their grief. They did not cry either with him or without him, but they never talked about him among themselves. They felt that they could not put into words what they understood.
They both saw him sinking deeper and deeper, slowly and calmly, away from them somewhere, and both knew that this was how it should be and that it was good.
He was confessed, communed; everyone came to say goodbye to him. When they brought him his son, he put his lips to him and turned away, not because he was hard or sorry (Princess Marya and Natasha understood this), but only because he believed that this was all that was required of him; but when they told him to bless him, he did what was required and looked around, as if asking if there was anything else to be done.
When the last shudders of the body left by the spirit took place, Princess Marya and Natasha were there.
- Is it over?! - said Princess Marya, after his body had been motionless for several minutes, growing cold, lying in front of them. Natasha came up, looked into the dead eyes and hurried to close them. She closed them and did not kiss them, but kissed what was the closest memory of him.
“Where did he go? Where is he now?..”

When the dressed, washed body lay in a coffin on the table, everyone came up to him to say goodbye, and everyone wept.
Nikolushka wept from the pained bewilderment that tore at his heart. The Countess and Sonya wept with pity for Natasha and that he was no more. The old count wept that soon, he felt, he was about to take the same terrible step.
Natasha and Princess Mary were weeping now too, but they were not weeping from their own personal grief; they wept from the reverent tenderness that seized their souls before the consciousness of the simple and solemn mystery of death that took place before them.

The totality of the causes of phenomena is inaccessible to the human mind. But the need to find causes is embedded in the human soul. And the human mind, not delving into the innumerability and complexity of the conditions of phenomena, each of which separately can be represented as a cause, grabs at the first, most understandable approximation and says: here is the cause. In historical events (where the subject of observation is the actions of people), the most primitive rapprochement is the will of the gods, then the will of those people who stand in the most prominent historical place - historical heroes. But one has only to delve into the essence of each historical event, that is, into the activity of the entire mass of people who participated in the event, in order to be convinced that the will of the historical hero not only does not direct the actions of the masses, but is itself constantly guided. It would seem that it is all the same to understand the meaning of a historical event one way or another. But between the man who says that the peoples of the West went to the East because Napoleon wanted it, and the man who says that it happened because it had to happen, there is the same difference that existed between people who said that the land stands firmly and the planets move around it, and those who said that they did not know what the earth was based on, but they knew that there were laws governing the movement of both her and other planets. There are no and cannot be causes of a historical event, except for the single cause of all causes. But there are laws that govern events, partly unknown, partly groping for us. The discovery of these laws is possible only when we completely renounce the search for causes in the will of one person, just as the discovery of the laws of the motion of the planets became possible only when people renounced the representation of the affirmation of the earth.

After the battle of Borodino, the occupation of Moscow by the enemy and burning it, historians recognize the movement of the Russian army from the Ryazan to the Kaluga road and to the Tarutino camp - the so-called flank march behind Krasnaya Pakhra as the most important episode of the war of 1812. Historians attribute glory to this ingenious feat various persons and argue about who actually owns it. Even foreign, even French, historians recognize the genius of the Russian generals when they speak of this flank march. But why military writers, and after them all, believe that this flank march is a very thoughtful invention of some one person that saved Russia and ruined Napoleon is very difficult to understand. In the first place, it is difficult to understand what is the profoundness and genius of this movement; for in order to guess what the most best position army (when not attacked) to be where there is more food - no great mental effort is needed. And everyone, even a stupid thirteen-year-old boy, could easily guess that in 1812 the most advantageous position of the army, after retreating from Moscow, was on the Kaluga road. So, it is impossible to understand, firstly, by what conclusions historians reach the point of seeing something profound in this maneuver. Secondly, it is even more difficult to understand in what exactly historians see this maneuver as saving for the Russians and harmful for the French; for this flank march, under other, preceding, accompanying and subsequent circumstances, could be detrimental to the Russian and saving for the French army. If from the time this movement was made, the position of the Russian army began to improve, then it does not follow from this that this movement was the cause.

Lymphosarcoma is the most common form of hematosarcoma. The latter are solid tumors, consisting of blast elements, represented by different types of hematopoietic cells. The transition of leukemia to sarcoma reflects one of the typical manifestations tumor progression. There are frequent cases of malignancy of one form or another of leukemia, complicated malignant lymphoma(lymphosarcoma, histiocytic sarcoma, lymphogranulomatosis).
Cytochemical methods make it possible to establish the nature of sarcoma in each individual case, its origin from one or another hematopoietic germ. A sarcoma whose cells are positive for peroxidase or chloroacetate-terase should be classified as a granulocytic sarcoma. Sarcomas consisting of cells with a positive reaction to α-naphthylesterase, of a monocytic nature, they are called reticulosarcomas or histiocytic sarcomas. Lymphoblastic sarcomas are lymphocytic in nature and complicate chronic lymphocytic leukemia and other leukemias derived from lymphopoiesis cells.
Hematosarcomas are not associated with the duration of the course of leukemia. In some cases, sarcoma is diagnosed along with the first signs of leukemia, and in others - after several years of illness. The links between the severity of the leukemic process, its exacerbation and the appearance of sarcoma have also not been established.
Thus, in their malignancy, leukemias evolve from differentiated forms to undifferentiated ones. Then the cells of this tumor lose the need for their usual environment - lymph nodes and bone marrow, in connection with which metastases appear in non-hematopoietic organs. Further, these tumors also lose their syncytial connections, and a flood of peripheral blood blast cells occurs. Observations also show the transition of one nosological form to another.
A variety of cytomorphological changes in the dynamics of the development of the process indicates that metastases of pathological cells in previously unaffected organs are associated with the appearance of new tumor cell bugs, and not the result of an accidental introduction of the same elements that were at the beginning of the disease.
With lymphosarcoma, the tumor process comes from the lymphatic elements of the lymph nodes, spleen and other organs. The disease can occur with the defeat of any one group of lymph nodes or organs (lymphosarcoma) or in the form of a disseminated tumor process (lymphosarcomatosis), the latter is often the result of generalization of local lymphosarcoma or a manifestation of a primary multiple neoplasm.
Lymphosarcoma is relatively common in large cattle. It has also been noted in other animal species - dogs, horses, pigs, mice.
Since the disease in various animal species manifests itself in many ways similarly, the description of pampas is based on bovine lymphosarcoma, which has been found in dozens of animals. Sick animals were subjected to complex clinical, hematological and cytomorphological studies in dynamics for 1-7 years. In the moment forced slaughter or case, their age was 1.5-14 years. The disease in the early stages had a chronic course. With the appearance of the first tumor changes in the organs, the process progressed rapidly, acquiring a generalized character. Often observed cases with local lesions individual bodies without a tendency to further spread the process. In almost half of the cases, tumor growths in the organs occurred at the age of 6-10 years.
peripheral blood. Morphological changes in the blood depended mainly on the stage and severity of the process. At the onset of the disease, lymphocytosis was noted at the subleukemic level, and in the advanced and final stages, in some cases, the content of leukocytes (lymphocytes) decreased to the normal range. The number of leukocytes in the group of sick animals studied by us averaged 24.8 thousand / μl with fluctuations from 9.8 to 51.4 thousand / μl, the content of erythrocytes - 4.7 million / μl, hemoglobin - 8.6 g% c fluctuation limits, respectively, from 3.6 to 6 million/μl and from 6.2 to 10.9 g%. Tumor progression was often accompanied by anemia. The leukocyte formula was characterized mainly by lymphocytosis (72.1%). However, the limits of fluctuation (from 21 to 95.5%) simultaneously reflect cases with lymphonation, when the lymphoid tissue is replaced by the tumor tissue, lymphocytosis and the flow of malignant cells into the peripheral blood decrease. The spread of tumor growths in the organs leads to intoxication of the body, which irritates the myeloblastic germ of the bone marrow. Therefore, at the end of the disease in leukocyte formula the number of stab and segmented neutrophils increases (by an average of 19.3% with fluctuation limits from 1.5 to 45% for the entire group of animals), eosinophils (by an average of 2.3% with fluctuation limits from 0 to 12%), and also monocytes (on average, 1.7% with fluctuation limits of 0-6%).
It is pathogiomonious for lymphosarcoma - the appearance in the blood of young cells such as prolymphocytes and lymphoblasts (up to 21.5%) and especially atypical so-called lymphosarcoma cells (up to 36%). Depending on the stage of the course of the disease in the studied animals, the number of leukocytes was at the leukemic level in 11.6% of cases, subleukemic - 80.7 and aleukemic - 7.7% of cases. In 61.5% of animals, the number of lymphocytes was increased, in 7.7% it was reduced, and in 30.8% it was within the normal range. The decrease in the number of lymphocytes occurred at the expense of other types of cells. Based on this, on late stages lymphosarcomas often did not have quantitative changes in the blood diagnostic value. The diagnosis was made by the presence of clinical symptoms and pathological cells in the blood and hematopoietic organs.
Clinical symptoms with lymphosarcoma, they are very poorly represented, their appearance depends on the nature of the course and prevalence pathological process. The most frequently affected in the later stages of the disease are individual lymph nodes, mainly internal ones. Only later does a generalized process develop with tumor growths in many organs, causing a variety of nonspecific and specific clinical symptoms. Relatively often deep inguinal lymph nodes, the state of which is determined rectal examination during the life of the animal. Enlargement of lymph nodes often occurs asymmetrically, they are of unequal size (the size of individual lymph nodes reaches 15 * 22 cm), dense in consistency, motionless, often soldered to surrounding tissues.
Pathological changes, according to our observations, only in 15.4% of cases were of a generalized nature, in the rest they had a focal or significant distribution. Attention was drawn to the unequal degree of damage to the lymph nodes, spleen and other internal organs. In the same animal, some of the lymph nodes were enormous, others were moderately enlarged, and still others remained unchanged. Most often, deep inguinal, mesenteric, mesenteric, portal, mediastinal and other lymph nodes were affected. Packets of lymph nodes fused with each other and with surrounding tissues, forming huge tumor conglomerates weighing 10-15 kg. Tumor growths were found in the proventriculus, intestines, heart muscle, uterus, etc. The steps of the affected organs were thickened, lard-like in the cut. The spleen in most cases remained not enlarged, it was dry on the incision, with a slight scraping and poorly visible follicles.
Bone marrow hematopoiesis in the early stages of the course of the disease with local lesions of individual lymph nodes or organs remains unchanged. Changes in the bone marrow usually occur in the second half of the disease. In some cases, the number of myeloblastic cells decreases, and in others - erythroblastic cells with signs of anemia in the peripheral blood. The number of lymphocytes increases up to 14-32.7%.
With intoxication of the body, the number of mature cells of the myeloblastic germ increases - neutrophils and eosinophils, respectively, up to 60.8 and 22.2%. An analysis of each myelogram separately shows that with a long course of the pathological process and significant damage to organs, foci of lymphoid cells form in the bone marrow. At the same time, it is not always possible to differentiate lymphocyte-like (lymphosarcoma) cells from mature lymphocytes. An increased number of such cells is pathogiomonious for hematosarcomas. If a small number of lymphosarcoma cells in the myelogram suggests that they enter the bone marrow with the blood flow, then an increased percentage indicates damage to the bone marrow. This is confirmed by viewing smears-imprints from the sternum and histological analysis of the material.
Cytomorphological changes. According to many studies, the main elements of the proliferating tissue in lymphosarcoma are lymphoid cells. In some cases, cellular elements similar to typical lymphocytes grow, while in others - large cells with a large light nucleus and poor cytoplasm. The latter are morphologically similar to lymphoblasts. Such cells, both small and large, differ from typical lymphocytes and lymphoblasts in the peculiar arrangement of nuclear chromatin. The nucleus is usually light, with a chaotic interlacing of chromatin threads, often with the presence of small nucleoli. The cytoplasm is narrow, basophilic, sometimes light blue in color. Small generations of cells have a relatively dense nuclear chromatin, so their differentiation from lymphocytes is difficult. The peculiar structure of the chromatin of the nucleus of these ancient cells is difficult to describe, however, with great skill in well-prepared smears, it is possible to recognize such cellular elements. They are differentiated in smears from the lymph nodes and affected organs.
Cells in size are micro-, meso- and microgeneration, have a rounded shape with a narrow basophilic or light blue cytoplasm. The nucleus contained one large or several small blue nucleoli.
The main distinguishing feature of these cells is a peculiar top-reticulate or reticulate-granular arrangement of nuclear chromatin.
Depending on the population of proliferating cells, small-celled, large-celled and mixed variants are distinguished. In the small cell variant, cells have compact nuclear chromatin, which makes it difficult to differentiate them from lymphocytes. Their subtle, barely perceptible morphological differences made it possible to classify such cells as atypical lymphocytes. However, along with them, smears from organs often reveal younger forms, i.e. large cells with relatively loose chromatin of the nucleus and the presence of nucleoli in the nuclei, called lymphosarcoma cells, the number of prolymphocytes and lymphoblasts noticeably increases. At the same time, all cellular elements have a delicate structure of nuclear chromatin, but differ from each other in a thin, barely perceptible morphological structure. The structure of the nucleus chromatin in lymphosarcoma cells occupies, as it were, an intermediate position between those of lymphoblasts and hemocytoblasts. If in the latter it has a delicate mesh structure, in lymphoblasts it has a weak spotting, that in lymphosarcoma cells there is a uniform, but coarsely looped weave of chromatin threads.
Along with lymphoid cells, reticular cells were also often found, but in smaller numbers than in reticulosarcoma. Their number increases with a tumor lesion of the internal organs, in which lymphosarcoma becomes similar to reticulosarcoma.
Along with the above-described cellular elements, atypical cells of irregular shape, with abundant, light, uniform and foamy cytoplasm, were encountered.
In smears from organs, a large number of mitotic and sometimes amitotic figures were also found.
In cases of an increased number of lymphosarcoma and reticular cells in the affected organs, the diagnosis was established by the predominant type of cells. With the same number of them, the term "lymphoreticulosarcoma" was used.
The detection of lymphosarcoma or reticular cells in the peripheral blood reflects the development of a pathological process in one or more hematopoietic organs, even in the absence of clinical symptoms of the disease.
More significant cytomorphological changes occur in the lymph nodes. The number of lymphosarcoma cells depends on the duration and severity of the pathological process in them. In a malignant course, their number is 90% or more. In the early stages of lymph node damage, mature lymphocytes predominate, later they are replaced by lymphosarcoma cells, as well as prolymphocytes and lymphoblasts.
Along with the typical forms of cells, various transitional forms appear from lymphoid elements to lymphosarcoma and from the latter to reticular cells. Depending on the nature of the course of the pathological process, the ratio of these cellular elements was different.
Quite often, giant reticular, sometimes binuclear cells, as well as eosinophils, mature neutrophils, plasma cells, and macrophages were found in the lymph nodes. However, unlike the lymphogranulomatous process, the number of these cells was limited.
Considering the diversity of intramorphological changes in the blood and hematopoietic organs, we consider it appropriate to bring data from several of the most demonstrative animals.
So, the cow Brune at the age of 4 years, with a moderate enlargement of the lymph nodes, had an adenogram: Lf - 21, Prl - 28, Lb - 8, reticular cells - 8.5, C - 13, Eosis - 1 and lymphosarcoma cells - 20.
Most of the cells had a light nucleus with delicate chromatin and 1-2 nucleoli. Reticular cells were round, atypical forms of mail were absent. The adenogram of this cow characterizes a moderate lesion.
In the cow Krasavka with a generalized enlargement of all lymph nodes, the bulk of the cellular elements were lymphosarcoma cells. Reticular cells and lymphocytes were presented in single specimens. In cow Verba, along with hemocytoblasts, lymphosarcoma and lymphoid cells, the number of neutrophils, atypical, monocyte-like and plasma cells was increased. An increased number of neutrophils in the affected lymph node was often accompanied by an increase in their number in the peripheral blood and bone marrow. So, in cow No. 3055 with a subleukemic blood composition, the percentage of mature neutrophils in the leukoformula will be 45, and in the myelogram - 25.4. Adenogram: Lf - 22, Prl - 10, reticular and atypical cells - 13, lymphosarcoma cells - 25, Lb - 1, C - 29.
In some cases, in the same animal, lymphosarcoma cells were represented by all generations. So, in cow No. 3404 with a generalized increase in all lymph nodes and tumor formations in the internal organs, 37% of the cells in the leukoformula were lymphosarcoma (micro-, meso- and macrogenerations), reticular and atypical cells. In the bone marrow, the number of these cells was slightly increased (4%), and in the lymph nodes, spleen and liver it reached 90%.
Cytomorphological changes in the spleen are almost similar to those in the lymph nodes. Cell rejuvenation due to prolymphocytes and lymphoblasts, an increase in the number of lymphosarcoma, reticular and plasma cells, as well as neutrophils and eosinophils, are observed. In smears from the non-enlarged spleen, lymphosarcoma cells are almost not detected or found in single copies. A similar picture was observed in the liver.
Quite often there are cases with tumor growths in the internal organs. Morphological changes in the cellular composition resemble those in the lymph nodes. The cytological composition is represented by almost one lymphosarcoma cells with a delicate structure of nuclear chromatin and multiple nucleoli. The number of reticular and typical cells is somewhat increased, some of them reach enormous sizes.
Thus, lymphosarcoma is characterized mainly by lesions of the lymph nodes with tumor growths in the internal organs and peculiar cytomorphological changes that are pathogiomonious for this form of hematosarcoma.