Gastric Myeloid Sarcoma

摘要

A 64-year-old man was admitted with severe, symptomatic microcytic anemia. There was no visible blood loss, but the patient had noticed significant weight loss and increasing asthenia in the preceding 2 months. He had a past medical history of compensated alcoholic liver cirrhosis with portal hypertension. His family history was unremarkable. Admission laboratory examination revealed anemia (hemoglobin 7.2 g/dL), mild thrombocytopenia (chronic, secondary to hypersplenism), normal white blood cell count, and iron deficiency. Esophagogastroduodenoscopy revealed an extensive, ulcerated neoplasm with a central yellow hue occupying the entire posterior wall of the gastric antrum without any signs of active or recent bleeding (Fig. ). Endoscopic biopsies revealed an undifferentiated proliferation of malignant blast cells arranged in cohesive nests and single files, which disrupted the underlying gastric tissue architecture (Fig. ). Immunohistochemistry was positive for CD43, CD117, and vimentin but negative for cytokeratins (AE1/AE3 and MNF116), chromogranin A, NSE, S100, HMB45, Melan A, CD29, CD79a, CD3, CD5, BCL6, CD30, CD10, TdT, CD34, CD56, and myeloperoxidase (Fig. ). More than 70% of the cells were Ki-67 positive. These histological and immunostaining findings indicated gastric myeloid sarcoma. Computed tomography did not reveal any lesions in other organs. The peripheral blood smear and a bone marrow biopsy excluded leukemia. fusion gene transcripts were not detected. Based on these findings, a diagnosis of isolated gastric myeloid sarcoma was established, and chemotherapy was initiated. However, despite best care, the patient developed tumor lysis syndrome early in the treatment, resulting in multiorgan failure, and he died after a few days.