A Heart of Myeloid: Extramedullary Chronic Myelomonocytic Leukemia-2 Presenting as a Myeloid Sarcoma of the Pericardium Causing Recurrent Pericardial Effusions
Bibliographic record
Abstract
Chronic myelomonocytic leukemia (CMML) is a rare neoplasm that has a roughly 15-30% chance of transforming into acute myeloid leukemia (AML). Acute leukemias have been known to cause pleural or pericardial effusions but having CMML transform into AML while presenting as a cardiac myeloid sarcoma causing pericardial effusions makes this case unique. A 59-year-old patient presented to the emergency room with shortness of breath and was found to be in cardiac tamponade requiring urgent care. The thoracic surgery team performed a pericardiectomy and placed a window drain. Cardiac tissue biopsy proved cardiac myeloid sarcoma with immature blasts and myeloid cells. Initial bone marrow biopsy on admission showed hypercellularity with 19% blasts and abnormal monocytes with multilineage dysplasia on aspirate differential, with positive KRAS and TET2 mutations on next-generation sequencing analysis. There was no evidence of a BCR/ABL1 fusion on fluorescence in situ hybridization (FISH), and chromosomal analysis demonstrated a normal karyotype. At this time, the patient met the WHO criteria for a CMML-2 diagnosis. A follow-up bone marrow biopsy closer to discharge showed a 33% blast count pointing towards a CMML-2 transformation into AML. Remarkably, he was able to improve and was discharged from the hospital. He was admitted again to the hospital to initiate chemotherapy. Such complex cases are rarely reported. Here we discuss the diagnosis and treatment of CMML transformed into AML as well as the rarity of cardiac myeloid sarcomas with an in-depth literature review.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".