Liver Granulocytic Sarcoma With Megakaryocytic Differentiation: A Rare Extra Medullary Involvement That Warrants Liver Biopsy for Prompt Diagnosis

Abstract

Granulocytic sarcoma (GS) is an extramedullary manifestation of acute myeloid leukemia (AML), myelodysplastic syndrome (MDS) or myeloproliferative neoplasms. The diagnosis depends on morphology, immunohistochemistry and flow cytometry. An unusual location of this tumor may mask its primary source, therefore, a strategy involving immediate symptom control, and investigation is crucial in preventing clinical deterioration. We present a case of a 53-year-old man who initially presented with tumor lysis syndrome and transaminitis, with a subsequent CT Scan that revealed multiple liver lesions. This case describes a rare clinical entity of granulocytic sarcoma as multiple hypoattenuating liver lesions mimicking metastatic disease in its radiographic appearance. Since the imaging features of hepatic masses are nonspecific, and considering the aggressive nature of AML with concomitant tumor lysis syndrome, a confirmatory prompt biopsy should routinely be considered.

Acute hepatitis-like presentation with cholestasis of CBFB–MYH11-positive acute myeloid leukemia in an adult male: a case report

“…With concomitant bone marrow involvement, the more common extramedullary sites of leukemic cell infiltration include the skin and gingiva. On the other hand, MSs commonly involve the bone, lymph nodes, soft tissue, gastrointestinal tract, mediastinum, and gonads [ 1 ].…”

Myeloid Sarcoma: Features in Cytological Preparations and the Utility of Rapid On-Site Evaluation (ROSE) in Triage

“…Instead, they express histiocytic/monocytic markers such as CD68-KP1, CD4, lysozyme, and CD163 [8]. In addition to monocytic, MS with predominant or exclusive erythroid, megakaryocytic, and even trilineage differentiation have been described [9][10][11][12][13], and in all such cases, the neoplastic cells are morphologically and immunophenotypically analogous to their leukemic counterparts. Given this vast morphologic heterogeneity, immunophenotypic variability, overlap with other entities, and the overall rarity of the condition, MS remains a challenging diagnosis, especially in small biopsy specimens.…”

“…The cytologic features and results of ROSE, IHCs, FCI, cytogenetics/FISH, and concurrent bone marrow biopsies for cases with conventional myeloblastic cytology (cases[7][8][9][10][11][12][13][14][15] …”