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Connecting the Dots: A Case of Myeloid Sarcoma

      A 73-year-old white gentleman with a medical history significant for stage IIA (pT3a, N0, M0) malignant melanoma managed by wide local excision from his right shoulder was referred to our cutaneous clinic for evaluation of locally recurrent disease. An excisional biopsy of the lesion 3 months prior had been interpreted as consistent with malignant melanoma, spindle cell type, with an invasive component and positive margins. Immunohistochemical staining was negative for pankeratin, desmin, HMB 45, and Melan A, yet positive for S100, supporting the assigned diagnosis. Positron emission tomography/computed tomography imaging ordered for staging reported no evidence of focal hypermetabolic activity but did note splenomegaly and diffuse enhancement throughout the skeletal system consistent with marrow stimulation. During his follow-up appointment to review the imaging, his examination revealed an interval appearance of multiple painless, nonpruritic erythematous nodules on the torso and arms. He denied any associated constitutional symptoms (eg, fevers, night sweats, unintended weight loss, excessive fatigue). Three years prior to presentation, he had undergone an extensive workup for thrombocytopenia and leukocytosis. This included a bone marrow biopsy that was negative for malignancy or myelodysplastic syndrome. The patient was otherwise healthy and active.

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      References

        • Avni B
        • Koren-Michowitz M
        Myeloid sarcoma: Current approach and therapeutic options.
        Ther Adv Hematol. 2011; 2: 309-316
        • Bakst RL
        • Tallman MS
        • Douer D
        • Yahalom J
        How I treat extramedullary acute myeloid leukemia.
        Blood. 2011; 118: 3785-3793
        • Pileri SA
        • Ascani S
        • Cox M
        • et al.
        Myeloid sarcoma: clinicopathologic, phenotypic and cytogenetic analysis of 92 adult patients.
        Leukemia. 2007; 21: 340-350
        • Meis JM
        • Butler JJ
        • Osborne BM
        • Manning JT
        Granulocytic sarcoma in nonleukemic patients.
        Cancer. 1986; 58: 2697-2709
        • Byrd JC
        • Edenfield WJ
        • Shields DJ
        • Dawson NA
        Extramedullary myeloid cell tumors in acute non- lymphocytic leukemia: a clinical review.
        J Clin Oncol. 1995; 13: 1800-1816
        • Falini B
        • Lenze D
        • Hasserjian R
        • et al.
        Cytoplasmic mutated nucleophosmin (NPM) defines the molecular status of a significant fraction of myeloid sarcomas.
        Leukemia. 2007; 21: 1566-1570
        • Ansari-Lari MA
        • Yang CF
        • Tinawi-Aljundi R
        • et al.
        FLT3 mutations in myeloid sarcoma.
        Br J Haematol. 2004; 126: 785-791
        • Paydas S
        • Zorludemir S
        • Ergin M
        Granulocytic sarcoma: 32 cases and review of the literature.
        Leuk Lymphoma. 2006; 47: 2527-2541
        • Lazzarotto D
        • Candoni A
        • Fili C
        • et al.
        Clinical outcome of myeloid sarcoma in adult patients and effect of allogeneic stem cell transplantation. Results from a multicenter survey.
        Leuk Res. 2017; 53: 74-81