title: Small-bowel myeloid sarcoma: Report of a case with atypical presentation.
abstract: BACKGROUND
  Small-bowel myeloid sarcoma is rare. Acute bowel obstruction is its usual clinical presentation.
  
  
  METHODS
  We report a case of small-bowel myeloid sarcoma that occurred in a 64-year-old woman who presented chronic secretory diarrhoea, hypokalaemia, and weight loss. Immature white blood cells in a peripheral smear and small-bowel capsule endoscopic features were the main diagnostic clues. The patient experienced capsule retention and developed acute bowel obstruction. Urgent laparotomy showed a stricturing ileal mass and pathology of the resected bowel specimen unveiled a CD34+, CD117+, and myeloperoxidase-positive myeloid sarcoma. The diarrhoea promptly resolved after surgery, and the patient is now undergoing chemotherapy.
  
  
  CONCLUSIONS
  Secretory diarrhoea can be the first manifestation of small-bowel myeloid sarcoma. Capsule endoscopy may provide a diagnostic clue, but it can trigger an acute bowel obstruction. Differential diagnosis of the pathologic specimen may be difficult and a high suspicion index of is mandatory to perform immunophenotyping to determine the correct management.
  
  
  CONCLUSIONS
  Chronic diarrhoea with alarm features can be the first manifestation of small-bowel myeloid sarcoma.
authors.affiliation: Department of Internal Medicine, Gastroenterology and Digestive Endoscopy Unit, Hospital of Busto Arsizio, Busto Arsizio, VA, Italy. Electronic address: cargirel@vodafone.it.
authors.forename: Carlo M
authors.initials: CM
authors.lastname: Girelli
authors.affiliation: Department of Surgery, Operative Unit of General Surgery, Hospital of Busto Arsizio, Busto Arsizio, VA, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Carsenzuola
authors.affiliation: Department of Internal Medicine, Operative Unit of Onco-haematology, Hospital of Busto Arsizio, Busto Arsizio, VA, Italy.
authors.forename: Marilù
authors.initials: M
authors.lastname: Latargia
authors.affiliation: Operative Unit of Anatomic Pathology, Hospital of Busto Arsizio, Busto Arsizio, VA, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Aguzzi
authors.affiliation: Operative Unit of Anatomic Pathology, Hospital of Busto Arsizio, Busto Arsizio, VA, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Serio
keywords: Acute leukaemia; Capsule endoscopy; Chloroma; Granulocytic sarcoma; Myeloid sarcoma; Small-bowel
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