Acute Myeloid Leukaemia Diagnosed by Intra-Oral Myeloid Sarcoma. A Case Report

Abstract

Myeloid sarcoma (MS) is a rare extramedullary malignant tumor composed of immature myeloid cells. It is strongly associated with a well known or covert acute myeloid leukaemia, chronic myeloproliferative diseases or myelodysplastic syndromes. Intraoral MS scarcely occurs. An unusual case of acute myeloid leukaemia, which was diagnosed by mandibular MS that was developed in the alveolar socket after a dental extraction, is reported. The histological examination (including immunohistochemical analysis) of a subsequent biopsy showed infiltration of the oral mucosa by neoplastic cells. This lesion was therefore classified as acute myeloid leukaemia. The patient was referred to oncologists that confirmed the initial diagnosis. The patient underwent chemotherapy and the mandibular tumor disappeared. Forty days later, a relapse of the disease, which appeared as a great-ulcerated lesion, was developed in the hard palate. Thirty days after the second chemotherapy had finished, a new intraoral tumor was developed in the vestibular maxillary gingiva. Review of the literature shows no report of intraoral relapse and particularly multiple relapse of a MS that involves the oral cavity. Even though MS is encountered infrequently in the oral cavity, it should be considered in the differential diagnosis of conditions (especially tumors) with a similar clinical appearance.

Myeloid sarcoma, a rarity of the head and neck region - A case report

“…As such, a high degree of suspicion is needed when dealing with a probable case of myeloid sarcoma [5]. The clinical diagnosis of MS is no doubt difficult, and definitive diagnosis warrants the use of immunohistochemical analyses [2]. An example of a specific immunohistochemical stain, which is a useful tool in clinching the diagnosis of myeloid sarcoma is myeloperoxidase [3].…”

“…An example of a specific immunohistochemical stain, which is a useful tool in clinching the diagnosis of myeloid sarcoma is myeloperoxidase [3]. Imaging studies like Magnetic Resonance Imaging (MRI) scans of MS exhibit low signal intensity on T2-weighted images, which helps to rule out inflammatory lesions [2]. However, it is worth taking note that a simple and relatively fast full blood count, is of paramount importance to narrow down the diagnostic process during the crucial initial stages of presentation.…”

“…The term MS has replaced the term granulocytic sarcoma and chloroma which were used in the past [2]. Some common extramedullary sites involved are skin, soft tissues, lymph nodes and the gastrointestinal tract [3].…”

“…Some common extramedullary sites involved are skin, soft tissues, lymph nodes and the gastrointestinal tract [3]. However, in only 16% of the cases the tumor was found in the head and neck region [2]. There is a predilection for males with the median age of 56 years.…”

Intraoral Myeloid sarcoma with bilateral involvement: Case report

“…The term MS has replaced the term granulocytic sarcoma and chloroma, which were used in the past 2 .…”