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Myeloid sarcoma without circulating leukemia mimicking gastrointestinal malignancy and lymphoma

Sravanthi Ravulapati, Craig Siegel, Ameesh Dara, Jack M. Lionberger
  • Sravanthi Ravulapati
    Division of Hematology and Oncology, St. Louis University School of Medicine, MO, United States
  • Craig Siegel
    Division of Hematology and Oncology, St. Louis University School of Medicine, MO, United States
  • Ameesh Dara
    Division of Hematology and Oncology, St. Louis University School of Medicine, MO, United States
  • Jack M. Lionberger
    Division of Hematology and Oncology, St. Louis University School of Medicine, MO, United States | jlionber@slu.edu

Abstract

We present an unusual case of myeloid sarcoma with ascites and abdominal pain in which initial clinical, laboratory, and imaging studies suggested a gastrointestinal malignancy or lymphoma. Subsequent detection of leukemic ascites and blasts in a gastric, small bowel, and skin biopsy supported a diagnosis of myeloid sarcoma. Bone marrow biopsy revealed 15% blasts, and cytogenetics with an inversion 16 rearrangement was diagnostic of acute myeloid leukemia (AML). Positron emission tomography-computed tomography performed at presentation to stage a presumptive lymphoma found later utility in following the burden of extramedullary disease. Standard AML induction chemotherapy resulted in complete remission and was followed by three rounds of high dose cytarabine consolidation. The patient unfortunately relapsed leading to re-induction followed by allogeneic stem cell transplantation. This report describes the presentation, assessment, and management of myeloid sarcoma.

Keywords

Myeloid sarcoma; granulocytic sarcoma; acute myeloid leukemia.

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Submitted: 2017-01-10 17:19:26
Published: 2018-06-14 10:39:59
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Copyright (c) 2018 Sravanthi Ravulapati, Craig Siegel, Ameesh Dara, Jack M. Lionberger

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