Laparoscopic management of an obstructing granulocytic sarcoma of the jejunum causing intussusception in a nonleukemic patient: Report of a case

Abstract

Granulocytic sarcoma is an extramedullary tumor of immature myeloid cells which is often a forerunner to the development of acute myelogenous leukemia. Granulocytic sarcoma of the gastrointestinal tract frequently involves the small intestine and often presents with abdominal pain and obstruction. Our patient presented with a proximal jejunal mass causing intussusception and obstruction. This type of manifestation has never before been reported. A laparoscopy-assisted resection of the affected portion of jejunum was performed for him. The initial pathological findings were high-grade non-Hodgkin's lymphoma; immunohistochemistry confirmed a diagnosis of granulocytic sarcoma. After a follow-up of 14 months, there was no evidence of leukemia. This condition is often mistaken for lymphoma and confirmation is necessary by immunohistochemistry. Chemotherapy is the treatment of choice and surgery is indicated only in the event of complications, such as bowel obstruction, bleeding, or perforation. The prognosis of granulocytic sarcoma is similar to that of myeloid leukemia.

Adenomyoma of the small intestine in an adult: Report of a case

“…In our patient, the tumor caused intestinal obstruction accompanied by ileus, and pathological examination revealed marked dilatation of the proximal intestine, suggesting that the obstruction was long-standing. Whether intussusception occurred is unclear, although it is possible, as in the case reported by Palanivelu et al 28 To our knowledge, ours is only the second report of an adenomyoma of small intestine causing intestinal obstruction in an adult. Considering that very few benign tumors in the small intestine are symptomatic, the actual frequency of adenomyoma in small intestine might be greater than thought.…”

Granulocytic sarcoma of the small bowel, greater omentum and peritoneum associated with a CBFbeta/MYH11 fusion and inv(16) (p13q22): a case report

“…In patients with GS involving the small bowel, the age of presentation varies from 8 to 69 years, with the majority occurring in male [4]. Ileum is the most frequently involved region of the gastrointestinal tract [4,9], while its presence in the jejunum is rare [10]. Even more rare is the synchronous involvement of the jejunum and the greater omentum [11], or as in the patient reported here, who had a concomitant involvement of jejunum, greater omentum and peritoneum.…”

“…In contrast, GS in the gastrointestinal tract generally produces symptoms that are often non-specific, as abdominal pain, vomiting, fever, diarrhea, and weight loss [9]. The patients may also present with intussusception [10], gastrointestinal bleeding [13], perforation [9], anasarca and chronic anemia [14], and obstruction [8,11]. Initially, our patient presented with non-specific symptomatology until he was adimitted for obstruction.…”

“…However, it remains uncertain what constitutes the best treatment in GS-associated AML patients. Surgery is not usually the first option, and it is only indicated in the event of complications like bleeding or obstruction [10], as in our patient. Although only a few large series comparing treatment modalities of GS are available in the literature [2,20], systemic chemotherapy for AML seems to offer the most benefit.…”

Granulocytic sarcoma: An uncommon cause of systemic inflammatory response syndrome

“…Granulocytic sarcoma usually involves the skin, lymph node, bone, soft tissue, and testis, while involvement of the gastrointestinal tract is rare . Gastrointestinal GS usually involves the small intestine presenting with abdominal pain and obstruction and has been managed successfully using both laparoscopic‐assisted and open surgical approaches . Other rare presentations include GS presenting as a rectal mass and GS causing spinal cord compression .…”