Volume 6, Issue 3, May 2020, Page: 35-40
A Rare Etiology of Small Intestinal Obstruction - Solitary Myelogenic Sarcoma of the Small Intestine: CT Findings and a Review of the Literature
Lesheng Huang, Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
Jun Chen, Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
Wei Peng, Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
Kaili Cai, Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
Hongyi Li, Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
Jinghua Jiang, Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
Wanchun Zhang, Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
Jiahui Tang, Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
Tianzhu Liu, Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
Received: May 11, 2020;       Accepted: Jun. 4, 2020;       Published: Jun. 16, 2020
DOI: 10.11648/j.ijcems.20200603.12      View  300      Downloads  86
Abstract
Background: Myelocytic sarcoma is a rare extramedullary tumor consisting of immature myeloid cells-granulocytes, mononuclear cells, or both. It usually occurs in patients with acute or chronic myeloid leukemia and is often found in the skin, bone, and lymphatic tissues. Isolated myeloid sarcomas are more uncommon in patients without leukemia in the small intestine. Case presentation: In the present study, a hospitalized case is discussed with intestinal obstruction as the primary symptom. During the CT examination, the local intestinal wall of the jejunum was found to possess ring thickening, intestinal lumen stenosis and proximal intestinal obstruction. The tumor presented with uniform and moderate progressive enhancement. The patient underwent emergency laparoscopic surgery in order to remove the tumor. Immunohistochemical staining on postoperative paraffin sections revealed myelosarcoma. The patient also underwent a bone marrow biopsy to exclude acute and chronic myeloid leukemia and the bone marrow smear indicated normal range. Conclusions: Myeloid sarcoma must be included in the differential diagnosis of small intestinal tumors, although the patient may not have history of leukemia. Radiologists should improve their imaging perception of myelosarcoma.
Keywords
Myeloid Sarcoma, Intestinal Obstruction, Tomography, X-ray Computer
To cite this article
Lesheng Huang, Jun Chen, Wei Peng, Kaili Cai, Hongyi Li, Jinghua Jiang, Wanchun Zhang, Jiahui Tang, Tianzhu Liu, A Rare Etiology of Small Intestinal Obstruction - Solitary Myelogenic Sarcoma of the Small Intestine: CT Findings and a Review of the Literature, International Journal of Clinical and Experimental Medical Sciences. Vol. 6, No. 3, 2020, pp. 35-40. doi: 10.11648/j.ijcems.20200603.12
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Pui MH, Fletcher BD, Langston JW. Granulocytic sarcoma in childhood leukemia: imaging features. Radiology 1994; 190 (3): 698-702.
[2]
Paydas S, Zorludemir S, Ergin M. Granulocytic sarcoma: 32 cases and review of the literature. Leuk Lymphoma 2006; 47 (12): 2527-41.
[3]
Pileri SA, Ascani S, Cox MC, Campidelli C, Bacci F, Piccioli M, et al. Myeloid sarcoma: clinico-pathologic, phenotypic and cytogenetic analysis of 92 adult patients. Leukemia 2007; 21 (2): 340-50.
[4]
Yilmaz AF, Saydam G, Sahin F, Baran Y. Granulocytic sarcoma: a systematic review. Am J Blood Res 2013; 3 (4): 265-70.
[5]
Neiman RS, Barcos M, Berard C, Bonner H, Mann R, Rydell RE, et al. Granulocytic sarcoma: a clinicopathologic study of 61 biopsied cases. Cancer 1981; 48 (6): 1426-37.
[6]
Messager M, Amielh D, Chevallier C, Mariette C. Isolated granulocytic sarcoma of the pancreas: a tricky diagnostic for primary pancreatic extramedullary acute myeloid leukemia. World J Surg Oncol 2012; 10: 13.
[7]
Kawamoto K, Miyoshi H, Yoshida N, Takizawa J, Sone H, Ohshima K. Clinicopathological, Cytogenetic, and Prognostic Analysis of 131 Myeloid Sarcoma Patients. Am J Surg Pathol 2016; 40 (11): 1473-83.
[8]
Meyer HJ, Ponisch W, Schmidt SA, Wienbeck S, Braulke F, Schramm D, et al. Clinical and imaging features of myeloid sarcoma: a German multicenter study. BMC Cancer 2019; 19 (1): 1150.
[9]
Williams EA, Bowman AW. Multimodality imaging of small bowel neoplasms. Abdom Radiol (NY) 2019; 44 (6): 2089-103.
[10]
Reynolds I, Healy P, McNamara DA. Malignant tumours of the small intestine. Surgeon 2014; 12 (5): 263-70.
[11]
Yu T, Xu G, Xu X, Yang J, Ding L. Myeloid sarcoma derived from the gastrointestinal tract: A case report and review of the literature. Oncol Lett 2016; 11 (6): 4155-9.
[12]
Catalano MF, Levin B, Hart RS, Troncoso P, DuBrow RA, Estey EH. Granulocytic sarcoma of the colon. Gastroenterology 1991; 100 (2): 555-9.
[13]
Kohl SK, Aoun P. Granulocytic sarcoma of the small intestine. Arch Pathol Lab Med 2006; 130 (10): 1570-4.
[14]
Kitagawa Y, Sameshima Y, Shiozaki H, Ogawa S, Masuda A, Mori SI, et al. Isolated granulocytic sarcoma of the small intestine successfully treated with chemotherapy and bone marrow transplantation. Int J Hematol 2008; 87 (4): 410-3.
[15]
Meis JM, Butler JJ, Osborne BM, Manning JT. Granulocytic sarcoma in nonleukemic patients. Cancer 1986; 58 (12): 2697-709.
[16]
Yamauchi K, Yasuda M. Comparison in treatments of nonleukemic granulocytic sarcoma: report of two cases and a review of 72 cases in the literature. Cancer 2002; 94 (6): 1739-46.
[17]
Antic D, Elezovic I, Milic N, Suvajdzic N, Vidovic A, Perunicic M, et al. Is there a "gold" standard treatment for patients with isolated myeloid sarcoma? Biomed Pharmacother 2013; 67 (1): 72-7.
[18]
Hossfeld DK. World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. Annals of Oncology 2002; 13 (3).
[19]
Kumar B, Bommana V, Irani F, Kasmani R, Mian A, Mahajan K. An uncommon cause of small bowel obstruction: isolated primary granulocytic sarcoma. QJM 2009; 102 (7): 491-3.
[20]
Meyer HJ, Beimler M, Borte G, Ponisch W, Surov A. Radiological and clinical patterns of myeloid sarcoma. Radiol Oncol 2019; 53 (2): 213-8.
[21]
Ooi GC, Chim CS, Khong PL, Au WY, Lie AK, Tsang KW, et al. Radiologic manifestations of granulocytic sarcoma in adult leukemia. AJR Am J Roentgenol 2001; 176 (6): 1427-31.
[22]
Singh A, Kumar P, Chandrashekhara SH, Kumar A. Unravelling chloroma: review of imaging findings. Br J Radiol 2017; 90 (1075): 20160710.
[23]
Choi EK, Ha HK, Park SH, Lee SJ, Jung SE, Kim KW, et al. Granulocytic sarcoma of bowel: CT findings. Radiology 2007; 243 (3): 752-9.
[24]
Shinagare AB, Krajewski KM, Hornick JL, Zukotynski K, Kurra V, Jagannathan JP, et al. MRI for evaluation of myeloid sarcoma in adults: a single-institution 10-year experience. AJR Am J Roentgenol 2012; 199 (6): 1193-8.
[25]
Aschoff P, Hantschel M, Oksuz M, Werner MK, Lichy M, Vogel W, et al. Integrated FDG-PET/CT for detection, therapy monitoring and follow-up of granulocytic sarcoma. Initial results. Nuklearmedizin 2009; 48 (5): 185-91.
[26]
Ueda K, Ichikawa M, Takahashi M, Momose T, Ohtomo K, Kurokawa M. FDG-PET is effective in the detection of granulocytic sarcoma in patients with myeloid malignancy. Leuk Res 2010; 34 (9): 1239-41.
[27]
Chandra P, Dhake S, Purandare N, Agrawal A, Shah S, Rangarajan V. Role of FDG PET/CT in Diagnostic Evaluation of Granulocytic Sarcomas: A Series of 12 Patients. Indian J Nucl Med 2017; 32 (3): 198-202.
[28]
Palanivelu C, Rangarajan M, Senthilkumar R, Annapoorni S. Laparoscopic management of an obstructing granulocytic sarcoma of the jejunum causing intussusception in a nonleukemic patient: report of a case. Surg Today 2009; 39 (7): 606-9.
[29]
Yoldas T, Erol V, Demir B, Hoscoskun C. A rare cause of mechanical obstruction: Intestinal myeloid sarcoma. Ulus Cerrahi Derg 2014; 30 (3): 176-8.
[30]
Lee SY, Park SJ, Kim YH, Lee JH. Nonleukemic granulocytic sarcoma presenting as intussusception of small bowel. Int J Clin Oncol 2008; 13 (5): 467-70.
[31]
S. Cicilet, F. K. Tom, B. Philip, A. Biswas. Primary myeloid sarcoma of small bowel. BMJ Case Rep 2017.
[32]
Wang P, Li Q, Zhang L, Ji H, Zhang CZ, Wang B. A myeloid sarcoma involving the small intestine, kidneys, mesentery, and mesenteric lymph nodes: A case report and literature review. Medicine (Baltimore) 2017; 96 (42): e7934.
[33]
Aslan B, Tuney D, Ercetin Y, Bozkurt SU, Uprak TK. De novo myeloid sarcoma as a rare cause of small bowel obstruction: CT findings and histopathologic correlation. Radiol Case Rep 2019; 14 (12): 1487-90.
[34]
Mizumoto R, Tsujie M, Wakasa T, Kitani K, Manabe H, Fukuda S, et al. Isolated myeloid sarcoma presenting with small bowel obstruction: a case report. Surg Case Rep 2020; 6 (1): 2.
[35]
Plowman RS, Nguyen BD. Gastrointestinal: Small bowel and mesenteric primary myeloid sarcoma: PET/CT imaging. J Gastroenterol Hepatol 2016; 31 (5): 907.
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