Gastric myeloid sarcoma mimicking pseudoachalasia in non-leukemic context - a singular case report

Abstract

Introduction and Importance: Myeloid sarcoma (MS) is a rare tumor associated with acute myeloid leukemia (AML) and occasionally occurs independently. It typically affects skin, bone, lymph nodes, and rarely the gastrointestinal tract, with gastric cases being extremely rare. Notably, no reported instances associate pseudoachalasia with gastric myeloid sarcoma. Case Presentation: A 20-year-old male presented with severe dysphagia, refractory vomiting, and weight loss. Diagnosed with type III achalasia via esophageal tests, subsequent gastroscopy revealed a large gastric mass, later identified as gastric myeloid sarcoma through histopathology. Clinical Discussion: MS, characterized by immature blast cells, poses diagnostic challenges without typical leukemia symptoms. Diagnosis involves immunohistochemistry, employing markers like CD33, CD34, and CD43. Optimal treatments, such as chemotherapy or stem cell transplantation, aim to delay leukemia progression. Gastric primary de novo myeloid sarcoma is exceedingly rare, emphasizing the need for tailored treatment strategies. Conclusion: Gastric myeloid sarcoma is an exceptionally rare tumor, especially without concurrent acute myeloid leukemia (AML), complicating its diagnosis. This case represents the first globally documented instance of gastric myeloid sarcoma causing pseudo-achalasia. Documenting this unique clinical presentation is crucial for a better grasp of gastric myeloid sarcoma’s diverse manifestations.