BACKGROUND
Myeloid sarcoma is a rare extramedullary
soft tissue neoplasm composed of myeloblastic cells, usually associated to hematologic
tumor disorders and a poor prognosis. Its diagnosis is very difficult as radiological images are not specific. Histology and immunohistochemistry are necessary for an accurate diagnosis. CASE REPORT We report the case of 46-year-old, Caucasian, non-smoker male, treated in 2014 by
orchiectomy and systemic
chemotherapy for a stage IIB testicular
seminoma. Considering the rapid increase of
lactate dehydrogenase (LDH) levels without any evident medical reason, a computed tomography/positron emission tomography (CT/PET) scan was performed and revealing a diffuse, nodular, peritoneal
tumor infiltration associated with multiple mesenteric and mediastinal
adenopathies. Laparoscopy confirmed a diffuse
tumor infiltration of the peritoneum. Histology and immunohistochemistry were consisted with the diagnosis of a myeloid monoblastic
sarcoma. Cytology of bone marrow documented an monocytic
acute myeloid leukemia. The patient started a systemic
induction chemotherapy with high dose
cytarabine and
idarubicin that was complicated by an infectious
pneumonia and
colitis, and a grade IV
thrombocytopenia leading to a brain
subdural hemorrhage and quickly to patient's death. CONCLUSIONS We describe a rare, peritoneal,
myeloid sarcoma in a young patient who had been treated by systemic
chemotherapy for testicular
seminoma 4 years earlier. The patient was clinically asymptomatic and presented only elevated LDH levels without any evident clinical reason. Considering the persistence of this biochemical abnormality, more investigations were performed leading to a diagnosis of peritoneal
myeloid sarcoma associated with monocytic
acute myeloid leukemia, probably secondary to the past
chemotherapy.