Objective: Myeloid sarcomas (MS) also called as granulocytic sarcomas, myeloblastoma or chloromas are the representatives of extramedullary infiltrates of immatur myeloid cells. According to 2016 revısıon to the World Health Organization classification of myeloid neoplasms and acute leukemia; it is classified a subgroup of Acute myeloid leukemia (AML) and related neoplasms. MS has more aggressive clinical course than AML. MS may present simultaneously with or precede bone marrow disease or may be seen in relapse. Isolated myeloid sarcoma involvement is most frequently detected in the bone, periosteum, soft tissues and lymph nodes. Herein we reported an unusual case of a 44 year old man who presented to appendicitis and diagnosed with MS with appendicitis pathology report.
Case report: A 44 year-old man who had no history of smoking, alcohol or any chronic disease, was admitted to the hospital with sudden abdominal pain, nause and vomiting. The patient, who was diagnosed with appendicitis and was underwent appendectomy. The patient's appendectomy result was reported as MS. In the blood test examination; white blood cells (WBC): 43.2×103/μL; neutrophil: 36.3×103/μL; monocyte: 2×103/μL, hemoglobin:11.5g/dL, and plateletes:100×103/μL were detected. Peripheral smear was applied to the patient due to leukocytosis. Blastic cell infiltration was detected in peripheral smear and the patient underwent bone marrow biopsy. More than 20% monoblasts were observed in bone marrow aspiration. Flowcytometric examination was performed and immunfenotypic finding MS of the patient were interpreted of AML M5. Remission induction chemotherapy (daunorubucin 60mg/m2 110mg/daily throughout 3 days and ARA-C 100mg/m2 180mg/daily, throughout 7 days) was planned.
Conclusion: Hematological malignancies could involve extramedullary soft tissue in relatively rare cases. MSs are rare extramedullary tumors, most commonly occur in patient with acute or chronic myeloid leukemia (1–3). De novo MS may represent the first sign of systemic disease. Untreated MS usually progress to AML in about 1 year. The clinical presentation of MS depends on location, size of mass. In the current case a sudden right lower abdominal pain, nause and vomiting due to blastic infiltraion and obstruction of appendix were initial symptoms. Total excision of the mass is to gold standard for diagnosis. In the current case, appendix patology results showed that monoblastic and localize inflitration of cell form of monocytoid with large nucleolus, prominent nucleoli, wide cytoplasm, Ki 67 proliferative activity >. There is no consensus of MS treatment. Recommended treatment regimen for isolated MS or MS with AML is conventional AML protocols. In conclusion, MS is a subgroup of AML present with myeloblastic infiltration of soft tissue. MS may present at any time of disease process and any localization. It should be kept in mind that hematological malignancies may be seen all over the body and may be present atypically because early diagnosis and treatment are very important cause of MS's aggressive clinical course.
