An unusual presentation of AML with myeloid sarcoma
The present case has been reported in the American Journal of Medicine. A 70-year-old woman with a medical history of chronic obstructive pulmonary disease, hypertension, and hypothyroidism presented with progressively worsening left ocular proptosis and eyelid swelling for two weeks and diplopia for two days. On physical examination, she had left eye ptosis, proptosis, and limited upward, left, and right lateral extraocular movement (panel A).

Hemoglobin was 9.3g/dL, white blood cell count 16.1K/mcL, platelet count 78K/mcL, and lactate dehydrogenase 1681 units/L. Peripheral blood smear was reviewed (panel B). Computed tomography angiography of the head showed a retro-orbital mass. A whole-body positron emission tomography scan showed soft tissue lesions in the left posterolateral chest wall, iliac fossa, sacral and presacral regions, and a left extraconal mass, all with increased fluorodeoxyglucose uptake (panel C).

Bone marrow and chest wall mass were biopsied (panel D). The peripheral blood smear showed myeloblasts. The bone marrow aspirate and core biopsy were hypercellular for the age of the patient. Myeloblasts accounted for 30-40% of the bone marrow cellularity, with immunohistochemical staining for CD13, CD33, CD34, CD38, CD117, myeloperoxidase (MPO), CD56 and HLA-DR, but not CD10, CD19, CD30 or cTdT.
Cytogenetic analysis revealed a 46, XX, t(8;21)(q22;q22) karyotype in 20 metaphases examined.

Biopsy of the patient’s chest wall mass revealed sheets of mononuclear cells, intermediate to large in size with occasional nucleoli, confirmed myeloblasts by flow cytometry. A diagnosis of acute myeloid leukemia with myeloid sarcoma was made.

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