Discovery of A Myeloid Sarcoma in A Hemodialysis Patient: Don’t Miss the Prior Hematological History!

Abstract

Myeloid sarcoma (MS) is a rare tumor consisting of immature cells from granulocytic lineage and usually affecting bones. Other localizations are exceptional. We report the case of a 63 years old woman treated by chronic hemodialysis (HD) for end-stage kidney disease of multifactorial origin (diabetes and hypertension). She has being successfully treated for acute myeloplastic leukemia by intensive chemotherapy (induction with daunorubicin and aracytin, followed by FLT3 inhibitors as consolidation), for 11 months. After 9 months of complete remission, the patient presented with bilateral lymph nodes attributed to dental extraction. Further exams highlighted a solid submandibular mass, which was further biopsied. Histological analyzes detected the presence of myeloid cells (optical microscopy) with a positive immunostaining for myeloperoxidase, leading to the diagnosis of MS. A craniofacial CT scan did not exhibit local extension of the tumor. However, a hematological control revealed medullar blastic invasion (52% of blastic cells), confirming the diagnosis of leukemia relapse. The evolution was pejorative despite local radiotherapy and the patient deceased two months later. MS is an uncommon proliferation of immature myeloid cells occurring in any extramedullary organ. According to WHO 2016, it is considered as a form of myelodysplastic syndrome. Its incidence is similar in both genders and frequently seen in young patients under the age of 15 years. MS may precede or be concomitant to myeloproliferative/myelodysplastic syndromes, or even reveal these hematological disorders. Diagnosis is based on histological data, in particular myeloperoxidase immunofluorescence. To our knowledge, this is the first case reported in a HD patient. The diagnosis of MS must be considered by the clinician faced to any clinical or radiological lesion in a patient with a prior history of myeloproliferative syndrome.