Author: Cutts L.; Brown P.
Abstract: Myeloid sarcoma (MS) is an extramedullary solid tumour of myeloid precursor cells, which most commonly occurs in the presence of acute or chronic myeloid leukaemias. Cases where a diagnosis of MS precedes that of the haematological disease are known, and reports have shown that it can infiltrate a variety of sites such as the orbit, lungs and gastrointestinal tract (Klco JM, Welch JS, Nguyen TT et al. State of the art in myeloid sarcoma. Int J Lab Hematol 2011; 33: 555-65). We present the case of a 69-year-old man
with myelodysplastic syndrome (MDS), which was being managed with azacitidine and regular transfusions. The patient presented with a 1- month history of three necrotic leg ulcers. These were initially thought to be pyoderma gangrenosum (PD) and were treated with minocycline, given the increased risk of immunocompromisation. The initial skin biopsy was reported as inconclusive, and the lesions continued to be managed as PD. Four months later, after the ulcers showed no sign of resolution, a repeat biopsy was
performed, which demonstrated a leukaemic skin infiltrate, highly suggestive of MS. Once this diagnosis was confirmed, our patient was admitted for daunorubicin and cytarabine chemotherapy and the appearance of his lesions improved. This case highlights the importance of reinvestigation of skin disease associated with underlying MDS. This is of particular relevance with regards to MS, as cutaneous manifestations can precede the underlying haematological diagnosis. A diagnosis of MS can also indicate a relapse in patients previously treated for acute myeloid leukaemia, and can herald a blastic transformation of MDS that requires more intensive therapy (Campidelli C, Agostinelli C, Stitson R, Pileri SA. Myeloid sarcoma: extramedullary manifestations of myeloid disorder. Am J Clin Pathol 2009; 132: 426-37).
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