An uncommon cause of small bowel obstruction: isolated primary granulocytic sarcoma

Gastrointestinal Myeloid Sarcoma a Case Presentation and Review of the Literature

Myeloid sarcomas can be detected in up to 30% of acute myeloid leukemia cases or occur de-novo without bone marrow involvement. The most frequent localization of myeloid sarcomas in the abdominal cavity is the small intestine, and gastric presentations are infrequent, frequently misdiagnosed, and a high level of suspicion should exist when the characteristic histomorphology features are present. The current review features a case report with gastric presentation of myeloid sarcoma in a patient with a diagnosis of acute myeloid leukemia with trisomy 8. In addition, a review of the literature of intestinal-type myeloid sarcomas shows that less than 15% of these cases have been reported in the stomach. The most common molecular aberrancy detected in intestinal myeloid sarcomas is the fusion protein CBFB-MYH11. A review of several large studies demonstrates that the presence of myeloid sarcoma does not constitute an independent prognostic factor. The therapeutic approach will be tailored to the specific genetic abnormalities present, and systemic chemotherapy with hematopoietic stem cell transplant is the most efficient strategy.

Acute Myeloid Sarcoma: An Unusual Cause of Diarrhea

A 62-year-old man with a past medical history of hypothyroidism was admitted for diarrhea and abdominal pain for three weeks. Initial workup for diarrhea was negative. His condition deteriorated after hospitalization. He underwent sigmoidoscopy which showed rectosigmoid mucosal ulceration. Pathology showed leukemic cells infiltration of the mucosa. The patient underwent bone marrow biopsy which confirmed the diagnosis of acute myeloid leukemia (AML). He received induction chemotherapy and his symptoms improved.

Isolated myeloid sarcoma presenting with small bowel obstruction: a case report

BACKGROUND

Myeloid sarcoma (MS) is a solid tumor consisting of myeloid blasts or immature myeloid cells, which are unusual outside the bone marrow.

CASE PRESENTATION

We present a rare case of isolated myeloid sarcoma of the small bowel in a 54-year-old man who was admitted to our hospital with repeated symptoms of intestinal obstruction. A small bowel series via an ileus tube revealed severe jejunal obstruction. Computed tomography revealed that the obstruction was likely caused by a jejunal tumor. The patient underwent laparoscopy-assisted partial resection of the jejunum with lymphadenectomy. Histopathological examination of the surgical specimen confirmed that MS had been responsible for the obstruction.

CONCLUSIONS

Patients with MS require systemic chemotherapy, as do patients with acute myeloid leukemia. Hence, an early, accurate diagnosis is imperative for treating this malignancy. It is also important to list MS in the differential diagnosis of a small bowel tumor, even in nonleukemic patients.

A myeloid sarcoma involving the small intestine, kidneys, mesentery, and mesenteric lymph nodes: A case report and literature review

RATIONALE

Myeloid sarcomas (MSs) are rare malignant hematological tumors. They most commonly occur in patients with acute or chronic myeloid leukemia. A de novo MS with no evidence of blood system disease is rare, but may represent the first sign of a systemic illness that precedes a full-blown disease. Herein, we report the computed tomography (CT) findings of an extremely rare case of a nonleukemic MS that progressed to acute myelogenous leukemia (AML) and simultaneously involved the small intestine, kidneys, mesentery, and mesenteric lymph nodes. Moreover, we provide CT findings before and after AML chemotherapy, which have not been reported previously.

PATIENT CONCERNS

A 25-year-old man with intermittent upper abdominal pain for 6 months was admitted to the hospital on November 28, 2015. Initial CT showed concentric wall thickening of the jejunum with an adjacent mesenteric soft tissue mass and mesenteric lymph nodes enlargement. Both kidneys were involved as indicated by the presence of well-defined mildly dilated lesions. During the laparoscopic surgery, the small intestinal tumor, mesenteric soft tissue mass, and mesenteric lymph nodes were removed.

DIAGNOSES

The pathological diagnosis was an MS.

INTERVENTIONS

The patient refused systemic chemotherapy and was rehospitalized with persistently aggravated abdominal distension on February 17, 2016. Follow-up CT showed diffuse small bowel wall thickening, widespread infiltration of the peritoneum, omentum, and mesentery, mesenteric lymph node enlargement, and large amounts of ascites fluid. The lesions in both kidneys were substantially larger and more numerous than on initial CT. Then the patient was treated with conventional AML chemotherapy.

OUTCOMES

The patient achieved complete hematological remission on bone marrow examination. Follow-up CT in September 4, 2016, showed none of the abnormalities seen on initial CT. Currently, the patient is in complete remission.

LESSONS

If the radiological examination shows lesions at multiple sites, and these lesions are soft tissue masses with homogenous enhancement, MS should be considered in the differential diagnosis, and an aspiration biopsy should be performed to provide a definitive pathological diagnosis. If MS is diagnosed, systemic chemotherapy is crucial to recovery; otherwise, the disease may progress rapidly. Medical imaging is helpful for diagnosing MS and for monitoring treatment response.

Allogeneic Hematopoietic Stem Cell Transplantation as Treatment for Primary Granulocytic Sarcoma of the Breast

Primary granulocytic sarcoma (GS) is an uncommon, extramedullary proliferation of myeloid cells, occurring in the absence of antecedent myeloproliferative disorder. Breast involvement is uncommon. A diagnosis of GS portends a poor prognosis. Even with intensive chemotherapy for AML, progression to overt leukemia can be delayed for 2-3 years. We, report a 29-year-old man who presented with a painless, left breast lump. A modified radical mastectomy followed by histopathological and immunohistochemical testing confirmed a granulocytic sarcoma. There was no evidence of a concurrent leukemia. Intensive chemotherapy for acute myelogenous leukemia was instituted. Allogenic hematopoietic stem cell transplantation was successfully given. The patient remains in complete remission at follow-up. We highlight the importance of timely diagnosis of this uncommon entity with institution of intensive therapy. Early use of allogenic bone marrow transplantation in the treatment of primary GS may be warranted.

A rare case of myeloid sarcoma presenting as an anorectal ulcer

Myeloid Sarcoma is a rare tumor composed of myeloblasts occurring at an extramedullary site like bones, or various soft tissues. Myeloid sarcoma may involve the gastrointestinal tract very rarely either solitarily, or occurring simultaneously with acute myeloid leukemia. Its diagnosis is challenging and needs biopsy and immunohistochemical staining. We are describing a case of myeloid sarcoma which presented as a painful anal ulcer mimicking an atypical fissure. Its appearance resembled crohn's disease on sigmoidoscopy. A biopsy of the ulcer along with histochemical staining led to the diagnosis of myeloid sarcoma. Our case demonstrates the need for aggressive evaluation of any common gastrointestinal complaint with an atypical presentation.

Granulocytic sarcoma of the small bowel, greater omentum and peritoneum associated with a CBFβ/MYH11 fusion and inv(16) (p13q22): a case report

Introduction

Granulocytic sarcoma (GS) is an extramedullary disease which is composed of immature myeloid cells or myeloblasts and usually occurs in association with acute myeloid leukemia (AML), as an initial presentation or a relapse. GS has been associated with various cytogenetic abnormalities, particularly with the t(8;21) translocation and less frequently the inv(16) type.

Case presentation

We present a rare case of GS of the small bowel, greater omentum and peritoneum, which caused obstruction, in a patient with AML associated with a CBFβ/MYH11 fusion gene and an inv(16) (p13q22). In this patient there was only mild myeloid hyperplasia in bone marrow aspiration but molecular analysis identified a CBFβ-MYH11 fusion and inv(16) (p13;q22).

Conclusion

Because of its nonspecific clinical and radiologic findings, this entity can be misdiagnosed and can mimic other solid neoplasms, making it a diagnostic challenge. In a GS with no or minimal morphological changes in bone marrow aspiration it is very important to perform a cytogenetic analysis to benefit from the diagnosis and therapeutic strategy.