An initial presentation of chronic myelogenous leukemia as myeloid sarcoma in a young female patient

Introduction: Myeloid sarcoma is defined as a localized tumor of primitive myeloid cells. This tumor can occur prior to, synchronously with, or after the diagnosis of acute myeloid leukemia with a predilection for males and older individuals. On rare occasions, it may represent the first sign of blastic transformation of myelodysplastic syndrome or chronic myeloproliferative disorder. If it is unrecognized, appropriate chemotherapy may be delayed and survival endangered. Case Presentation: We present here a case of myeloid sarcoma in a 24-year-old woman presented with generalized weakness, abdominal pain, diarrhea, fever and leukocytosis. Further radiologic evaluation, demonstrated a large heterogeneous mass with the size of 421x140mm in pelvic cavity. The patient first had undergone bone marrow biopsy and aspiration with clinical impression of acute leukemia, but morphological findings, flow cytometry and molecular study confirmed a diagnosis of chronic myeloid leukemia (CML). A week later, the patient underwent core needle biopsy of the pelvic mass which in microscopic examination, a spectrum of myeloid cells in all stages of maturation with predominance of blasts was seen. Immunohistochemical study supported a diagnosis of myeloid sarcoma and treatment with a higher doses of imatinib was begun. Conclusion: This case illustrates granulocytic sarcoma as an unusual concurrent manifestation of CML in a young patient and reviews the associated literature, in order to improve the understanding of the disease and characterizes poor risk patients and more aggressive therapy.

Keywords:

Myeloid Sarcoma , Granulocytic sarcoma , Chronic Myeloid Leukemia