Gastrointestinal Myeloid Sarcoma a Case Presentation and Critical Review of the Literature

Abstract

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. 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 are the most efficient strategies.

Solitary eosinophilic granulocytic sarcoma in a dog

“…Despite the negative lysosome staining, strongly positive cytoplasmic MPO expression was consistent with a myeloid tumour origin and, in combination with the HE findings, was sufficient to provide a diagnosis of GS. Indeed, these results are consistent with those described in other case reports (Brum et al, 2012;Kheirkhah et al, 2021;Rong et al, 2010;Traweek et al, 1993;Ye & Jiang, 2022).…”

A Rare Case of Partial Small Bowel Obstruction Secondary to Intestinal Myeloid Sarcoma

“…Surgical resection, while sometimes necessary due to complications such as obstruction, shows no actual improvement in overall survival [5]. Reports suggest that up to half of patients with MS are initially misdiagnosed, often as having a primary or metastatic malignant tumour, particularly malignant lymphoma [7][8][9][10][11][12][13][14][15][16][17]. This mis-or delayed diagnosis has been reported to occur both at initial primary differential diagnosis and even post-biopsy or resection with misinterpretation of histopathology [9][10][11]17].…”

Gastric Myeloid Sarcoma

“…4 It is extraordinarily rare with an incidence of less than 1% and can often be misdiagnosed as lymphoma. 5,6 Clinical presentation of AML as extramedullary disease or MS has been reported in 5%-25% of AML relapsing after SCT, often underdiagnosed, has been associated with poor outcomes and no standard of care in terms of treatment. [7][8][9] MS finding in the gastrointestinal tract is more commonly found in the small intestine and rarely in the stomach.…”

“…18 Although there are no randomized controlled trials, treatment typically consists of chemotherapy and hematopoietic stem cell transplantation. 6 Other treatment considerations include radiotherapy and targeted therapy. 19 Frequent cytogenetic alterations found in MS are predominantly t(8,21) (q22;q22), inv (16) and 11q23 rearrangement; mutations in the RAS pathway can be found in up to 85% of patients.…”

“…18 Although there are no randomized controlled trials, treatment typically consists of chemotherapy and hematopoietic stem cell transplantation. 6 Other treatment considerations include radiotherapy and targeted therapy. 19 …”