Myeloid sarcoma cases with varied presentations leading to diagnostic delay: A case series

Abstract

Myeloid sarcoma (MS) is an extramedullary tumor, which may be isolated or associated with acute myeloid leukemia (AML). In isolated MS, diagnosis may be challenging. Although it may develop at any site, isolated MS of the spine and parotid region are very rare. We found such rare presentations in our patients, so we wanted to highlight the importance of early suspicion and proper evaluation of such cases. To find out cases of MS, we searched clinical records of our patients of AML/MS, who were treated in the past 1 year in our department at All India Institute of Medical Sciences Raipur. We found 20 such cases of AML/MS who were treated with standard 3 + 7 induction chemotherapy and out of them 3 had isolated or associated MS. We selected these three patients for this case series. In this report, we have described the presentations and treatment of these three cases. One of the patients had isolated MS of the spine, who presented initially with paraparesis. Due to atypical presentation, there was a diagnostic delay, but after treatment, he recovered fully. In another case of isolated parotid swelling, initially suspected to be lymphoma, later diagnosed as MS and also found to have bone marrow involvement with detection of t (8;21) consistent with AML. In another typical presentation, the patient had AML associated with orbital MS. With all these three cases, we want to bring to notice the rare presentations of this entity and which may help clinicians to suspect and diagnose it early and which can improve the overall outcome of such patients.