Rare Intramedullary Myeloid Sarcoma Mistaken as Acute Transverse Myelitis

Abstract

Myeloid sarcoma is a rare extramedullary tumor of immature myeloid cells. It more often develops with the underlying acute myeloid leukemia, but it can also occur with chronic myeloid leukemia (CML), myelodysplastic syndrome and rarely even with the absence of marrow involvement. Spinal epidural myeloid sarcoma is uncommon, and intramedullary presentation is exceptionally rare. In this report the authors report an unusual case of spinal intramedullary myeloid sarcoma after completer remission from CML several years ago. He was mistakenly diagnosed as acute transverse myelitis and treated with high-dose steroid and plasmaparesis without improvement. Magnetic resonance imaging revealed intramedullary mass-like lesion with hyper-intensity in T2-weighted image and mild homogeneous enhancement. Myeloid sarcoma should be considered as a possible differential diagnosis when patient with history of myeloid leukemia present intramedullary tumor and pathologic confirmation with open biopsy is mandatory for the exact diagnosis.

Unusual presentations of central nervous system myeloid sarcoma

“…Spinal cord lesions can occur with MS, but these tend to be leptomeningeal and present with lesions on the cord surface on MRI. With bony spinal involvement, MS tends to occur as an epidural mass from extra‐osseous extension, resulting in cord compression 10 . Very rarely, as in case 2, MS lesions are intramedullary and to our knowledge, there have been only two case reports of intramedullary presentation of MS over the past 30 years 10,11 .…”

“…With bony spinal involvement, MS tends to occur as an epidural mass from extra‐osseous extension, resulting in cord compression 10 . Very rarely, as in case 2, MS lesions are intramedullary and to our knowledge, there have been only two case reports of intramedullary presentation of MS over the past 30 years 10,11 . The first case report from 2018 describes a 58‐year‐old man who presented with a diagnosis suspicious for acute transverse myelitis 10 .…”

“…Very rarely, as in case 2, MS lesions are intramedullary and to our knowledge, there have been only two case reports of intramedullary presentation of MS over the past 30 years 10,11 . The first case report from 2018 describes a 58‐year‐old man who presented with a diagnosis suspicious for acute transverse myelitis 10 . Similar to our case, this patient had chronic myeloid leukaemia and presented with progressive paraparesis and urinary retention, and MRI demonstrating a longitudinally extensive intramedullary lesion in the thoracic region 10 .…”

“…10,11 The first case report from 2018 describes a 58-year-old man who presented with a diagnosis suspicious for acute transverse myelitis. 10 Similar to our case, this patient had chronic myeloid leukaemia and presented with progressive paraparesis and urinary retention, and MRI demonstrating a longitudinally extensive intramedullary lesion in the thoracic region. 10 The second historical case describes a teenage patient with AML presenting with a few weeks of progressive paraparesis, with MRI demonstrating a spinal intramedullary lesion in the mid-thoracic region.…”

Acute myeloid leukaemia masquerading as transverse myelitis

“…et al reported a rare case of an intramedullary myeloid sarcoma mimicking transverse myelitis. 9 Leukaemia associated bleeding or ischemia, vitamin B12 or copper deficiency, infections or post-infectious states, and post-radiotherapy or chemotherapy can involve the spinal cord causing myelitis or myelopathy. 3,4 There have been several reports of acute leukaemia presenting as para-neoplastic transverse myelitis.…”