Myeloid sarcoma derived from the gastrointestinal tract: A case report and review of the literature

Chameleonic Chloroma: A Case of Myeloid Sarcoma Presenting as a Pancreatic Head Mass

We report a case of pancreatic myeloid sarcoma (MS), an extremely rare manifestation of acute myeloid leukemia (AML), in a 35-year-old male who presented with epigastric pain and watery stools. Initial diagnostic testing was inconclusive; however, following an extensive evaluation, endoscopic biopsies suggested AML, which was confirmed by a bone marrow biopsy. Given that few cases are documented in the literature, pancreatic MS without a preexisting hematologic malignancy poses a significant diagnostic challenge.

Rapid progression from MDS to AML with gastric submucosal tumour as an extramedullary infiltration

We present a rare case of myeloid sarcoma in the stomach of an elderly woman initially diagnosed with anaemia. Myeloid sarcoma, an unusual extramedullary manifestation of acute myeloid leukaemia (AML), primarily affects lymph nodes, bones, spine and skin, with gastrointestinal involvement being infrequent. Despite normal results from the initial endoscopy, a follow-up examination after 4 months revealed multiple submucosal gastric tumours. These developments coincided with worsening of anaemia and an increase in peripheral myeloblasts. Pathological evaluation and immunohistochemical staining confirmed gastric extramedullary infiltration associated with AML. This case highlights the importance of comprehensive diagnostic processes when suspecting leukaemic transformations, especially in myelodysplastic syndrome (MDS). Due to financial constraints, additional critical studies such as cytogenetics and next-generation sequencing were not performed. Nonetheless, this rare case demonstrates the visual observation of rapid progression from MDS to AML and concurrent early myeloid sarcoma development in an elderly patient.

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.

Gastric myeloid sarcoma: A case report

BACKGROUND

Myeloid sarcoma (MS) is a rare hematologic malignancy defined as an extramedullary tumor of immature granulocytic cells. It can occur as primary or de novo and be associated with myelodysplasia or myeloproliferative neoplasms. The most frequent locations are the skin, lymph nodes and bones. The case of a patient with a diagnosis of primary granulocytic de novo gastric MS is reported.

CASE SUMMARY

A 19-year-old female patient with MS, whose abdominal computed tomography showed a bulky tumor of 16.5 cm in the gastric chamber with infiltration in the retroperitoneal, pancreatic and bile duct region; the histological study showed gastric mucosa diffusely infiltrated by mononucleated cells and the immunohistochemistry expressed myeloperoxidase. After receiving induction chemotherapy based on the 3 + 7 regimen (daunorubicin/cytarabine), the patient developed severe hematological toxicity and neutropenic typhlitis which required a prolonged medical treatment. She presented a rapid disease progression. Although she received supportive treatment, the patient died.

CONCLUSION

Gastric primary de novo MS is a rare and aggressive course neoplasm, fostering knowledge is very important to decide its management and to promote more approaches focused on understanding this pathology and its particularities in our population.

Myeloid Sarcoma Presenting as Obstructive Jaundice

Myeloid sarcoma (MS) is a rare solid neoplasm that consists of extramedullary myeloid precursor cells. Generally, it is associated with underlying acute myeloid leukemia (AML) or AML yet to manifest clinically. It can present as isolated, also known as primary MS without evidence of AML or other myeloproliferative neoplasms. We present the case of a previously healthy 36-year-old male, who was admitted to hospital with new-onset painful obstructive jaundice and final diagnosis of isolated MS was made after through investigations. We are pleased to report that he had favorable response to the treatment and remains well.

Effects of stored autotransfusion on electrolytes and postoperative complications in patients undergoing elective orthopedic surgery

OBJECTIVE

To ivestigate the effect of stored autotransfusion on the electrolytes and postoperative complications in patients undergoing elective orthopedic surgery.

METHODS

A total of 76 cases of patients undergoing elective orthopedic surgery were randomly divided into an observation group (38 cases, taking stored autotransfusion) and a control group (38 cases, taking allogeneic blood transfusion) according to a random number table method. The intraoperative-related indexes (intraoperative blood loss, autologous or allogeneic blood transfusion volume, urine volume, and length of hospital stay), electrolyte levels before and 48 hours after the operation, routine blood and coagulation function were compared between the two groups, and the postoperative complications related to blood transfusion were recorded.

RESULTS

The length of hospital stay of the observation group was significantly lower than that of the control group (P<0.05). The concentrations of K⁺ and Na⁺ in the control group 48 h after the operation were higher than those before the operation and than those in the observation group, while the concentration of Ca²⁺ was lower than that before the operation and that in the observation group (all P<0.05). The levels of Hb, RBC, and HCT in the control group 48 h after the operation were lower than those before the operation and those in the observation group (all P<0.05). The levels of WBC in the two groups 48 h after the operation were significantly higher, but those in the observation group were lower than those in the control group (all P<0.05). There were no significant changes in Pt, APTT, D-D, and FIB levels between the two groups. There were no significant changes in Pt, APTT, D-D, and FIB levels 48 hours after the operation compared with those before the operation (P>0.05). The incidence of postoperative complications caused by blood transfusion in the observation group was lower than that in the control group (P<0.05).

CONCLUSION

Storage autotransfusion can effectively balance the electrolyte level and reduce the incidence of complications in patients undergoing elective orthopedic surgery. This is worthy of clinical application.

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.

An Unexpected Cause of Recurrent Jaundice after Resolution of Acute Hepatitis E

In this report, we describe a rare case of liver enzyme disturbance caused by myeloid sarcoma of the gallbladder and biliary tract. A 63-year-old man with progressive chronic myeloid leukemia presented with acute hepatitis. Viral serology revealed an infection with hepatitis E virus. The liver enzymes and bilirubin improved gradually under treatment with ribavirin, but there was a flair up shortly after. Imaging including CT and echo-endoscopy showed a thickened infiltrated gallbladder wall and dilated bile ducts, suspected for myeloid sarcoma. Biopsy of an atypical skin lesion, present at the same time, confirmed the diagnosis of acute extramedullary leukemia. After induction chemotherapy, hematological improvement was seen together with a decrease of bilirubin and liver enzymes and a normalization of the bile ducts and gallbladder on imaging. However, three months later, myeloid leukemia progressed again, and the patient deceased.

Acute Myelogenous Leukemia as a Rare Cause of Duodenal Ulcers

Acute myelogenous leukemia (AML) is the most prevalent acute leukemia and is defined by the presence of myeloid blasts in the blood or bone marrow. Rarely, AML can be present in the gastrointestinal tract. We present a patient with AML undergoing treatment with decitabine who presented with hematemesis. He underwent endoscopy which revealed two 5 mm duodenal ulcers that were biopsied, and pathology was consistent with AML. Endoscopy should be considered in patients with leukemia who present with nausea, vomiting, or signs of bleeding to evaluate for gastrointestinal involvement. Patients diagnosed with AML are treated with chemotherapy.