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To elucidate features of leukemic tumors that render them resistant to agents effective against marrow leukemia, we analyzed a series of AML breast tumors by histology, immunohistochemistry, and RNA sequencing. Striking histologic similarities to solid cancers were found: a single\u2010filing architectural pattern virtually identical to that of invasive lobular breast carcinoma and dense desmoplastic keloid\u2010like fibrosis similar to colon, gallbladder, and pancreas carcinomas. Sequencing found 2157 genes significantly downregulated in AML breast tumors compared to normal breast. Comparison to triple\u2010negative breast cancer found 859 genes similarly downregulated. At least 30 of these genes have been associated with poor prognosis in breast cancers. Five were reported in AML marrow studies to correlate with poor prognosis. The findings of this pilot study suggest the seed\u2010and\u2010soil interaction recognized in solid cancer growth may help explain how leukemic cells, in some patients, adopt solid tumor behavior in non\u2010marrow sites. Transformed cells that metastasize from tumor to marrow can impart chemoresistance and be an unrecognized cause of treatment failure and death. Further studies comparing leukemic tumor to simultaneous marrow could potentially identify biomarkers that predict extramedullary resistance and lead to new therapeutic targets. Recognizing the potential for leukemia to adopt solid tumor phenotype, and implementation of body scanning and ablative tumor treatment, could decrease the persistently high rates of marrow resistance and treatment failure.<\/jats:p>","DOI":"10.1002\/ajh.25594","type":"journal-article","created":{"date-parts":[[2019,7,29]],"date-time":"2019-07-29T05:33:44Z","timestamp":1564378424000},"page":"1200-1207","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Extramedullary leukemia behaving as solid cancer: clinical, histologic, and genetic clues to chemoresistance in organ sites"],"prefix":"10.1002","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0882-4501","authenticated-orcid":false,"given":"Isabel","family":"Cunningham","sequence":"first","affiliation":[{"name":"Division of Hematology Oncology Columbia University Vagelos College of Physicians and Surgeons  New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane","family":"Hamele\u2010Bena","sequence":"additional","affiliation":[{"name":"Department of Pathology and Cell Biology Columbia University Vagelos College of Physicians and Surgeons  New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Guo","sequence":"additional","affiliation":[{"name":"Bioinformatics University of New Mexico  Albuquerque New Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takayuki","family":"Shiomi","sequence":"additional","affiliation":[{"name":"Department of Pathology International University of Health and Welfare  Chiba Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Audrey C.","family":"Papp","sequence":"additional","affiliation":[{"name":"Center for Pharmacogenomics Ohio State University  Columbus Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bandana","family":"Chakravarti","sequence":"additional","affiliation":[{"name":"Department of Pharmacology University of Iowa  Iowa City Iowa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianqi","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pharmacology University of Iowa  Iowa City Iowa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Shyr","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University  Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rory A.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Department of Pharmacology University of Iowa  Iowa City Iowa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,8,27]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"64","article-title":"A new case of chloroma with leukemia. 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