title: Myeloid sarcoma of the extrahepatic bile ducts presenting as obstructive jaundice.
abstract: We report a rare case of myeloid sarcoma (MS) of the extrahepatic bile ducts presenting as obstructive jaundice in a patient without leukemia at time of diagnosis. A 75-year-old female presented with a one-month history of abdominal pain and jaundice. Computerized tomography scan of the abdomen showed stenosis of the extrahepatic bile ducts. Endoscopic retrograde cholangiography disclosed an irregular narrowing of the common biliary duct, suggestive of a cholangiocarcinoma, and resection was performed. Histologic examination showed diffuse transmural infiltration of malignant cells. These cells exhibited medium-sized round nuclei with central nucleoli and eosinophilic cytoplasm, and were strongly positive for myeloperoxidase, CD68, lysozyme, CD45, CD117 (c-kit protein) and CD43. Eight months following surgery the patient presented with multiple cutaneous nodules and bone marrow trephine biopsy showed acute myelomonocytic leukemia. A literature search identified two previously reported cases of MS of the extrahepatic biliary duct. MS should be taken into consideration in the differential diagnosis of a patient with obstructive jaundice. Immunohistochemistry is essential for a correct diagnosis.
authors.affiliation: Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Avda. Valdecilla s/n, ES-39008 Santander, Spain.
authors.forename: M Carmen
authors.initials: MC
authors.lastname: González-Vela
authors.forename: J Fernando
authors.initials: JF
authors.lastname: Val-Bernal
authors.forename: Marta
authors.initials: M
authors.lastname: Mayorga
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Cagigal
authors.forename: Fidel
authors.initials: F
authors.lastname: Fernández
authors.forename: Francisco
authors.initials: F
authors.lastname: Mazorra
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000473:pathology*; D017734:Bile Ducts, Extrahepatic; D002760:Cholangiopancreatography, Endoscopic Retrograde; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000473:pathology*; D023981:Sarcoma, Myeloid / Q000175:diagnosis / Q000473:pathology*; D014055:Tomography, Emission-Computed