title: Myeloid Sarcoma: An Unusual Case of Mediastinal Mass and Malignant Pleural Effusion with Review of Literature.
abstract: Myeloid sarcoma is an extramedullary tumor seen most commonly in patients with acute myeloid leukemia and less frequently in chronic myeloid leukemia, myelodysplastic syndrome and rarely, in an isolated form without any other underlying malignancy. Malignant pleural effusion in hematological malignancies is rare when compared with solid tumors. We present an unusual case of myeloid sarcoma in which a mediastinal mass with pleural effusion was the initial presentation. A 27 year old gentleman presented with complaints of fever, chest pain and swelling in the anterior chest wall for 6 months. Examination revealed a lump measuring 5 × 5 cm on the left side of the chest wall. Hematological evaluation showed hemoglobin-14.2 g/dL, platelet count-233 × 10(9)/L, TLC-117 × 10(6)/L with normal differential counts. Contrast enhanced computerised tomography (CECT) confirmed the presence of a soft tissue mass in the superior mediastinum abutting against the chest wall. Core biopsy was suggestive of myeloid sarcoma and immunohistochemistry was positive for myeloperoxidase and negative for CD3, CD 20 and CD 23. Pleural fluid analysis showed the presence of malignant cells. Bone marrow examination did not show an excess of blasts. A final diagnosis of extramedullary myeloid sarcoma with malignant pleural effusion was made. The patient was given induction chemotherapy (3 + 7 regimen) with daunorubicin and cytosine arabinoside. Repeat CECT done on day 28 showed complete resolution of pleural effusion and significant reduction in the size of mediastinal mass. The patient has successfully completed three cycles of consolidation therapy following which there has been complete resolution of the mass. He remains asymptomatic on close follow up.
authors: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors: Kamal Kant
authors: KK
authors: Sahu
authors: Department of Cytology and Gynecologic pathology, Postgraduate institute of Medical Education and Research, Chandigarh, 160012 India.
authors: Ruchita
authors: R
authors: Tyagi
authors: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors: Arjun Datt
authors: AD
authors: Law
authors: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors: Alka
authors: A
authors: Khadwal
authors: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors: Gaurav
authors: G
authors: Prakash
authors: Department of Cytology and Gynecologic pathology, Postgraduate institute of Medical Education and Research, Chandigarh, 160012 India.
authors: Arvind
authors: A
authors: Rajwanshi
authors: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors: Subhash Chander
authors: SC
authors: Varma
authors: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors: Pankaj
authors: P
authors: Malhotra
keywords: Acute myeloid leukemia; Malignant cytology; Myeloid sarcoma