title: Hypercalcemia and diffuse osteolytic lesions in a 45-year-old patient with myeloid sarcoma with megakaryocytic differentiation.
abstract: Acute megakaryocytic leukemia is a rare form of acute myeloid leukemia that carries a poor prognosis. As most cases of osteolytic lesions are due to plasma cell and myeloid malignancies, maintaining a broad differential directly influences clinical course. We document a 45-year-old patient with progressive constitutional symptoms, osteolytic bone lesions in the setting of hypercalcemia, who developed acutely worsening pancytopenia. The diagnosis of myeloid sarcoma with megakaryocytic differentiation was made after obtaining tissue from osteolytic bone that stained strong for CD34. Immunohistochemical testing underscores the importance of how serologic and urine testing remains limited and can delay early diagnosis in this disease.
authors.affiliation: Department of Internal Medicine, MedStar Franklin Square Medical Center, Baltimore, MD, USA; aditya.goud@medstar.net.
authors.forename: Aditya
authors.initials: A
authors.lastname: Goud
authors.affiliation: Department of Internal Medicine, MedStar Franklin Square Medical Center, Baltimore, MD, USA.
authors.forename: Abdelhai
authors.initials: A
authors.lastname: Abdelqader
authors.affiliation: Department of Internal Medicine, MedStar Franklin Square Medical Center, Baltimore, MD, USA.
authors.forename: Chanukya
authors.initials: C
authors.lastname: Dahagam
authors.affiliation: Department of Internal Medicine, MedStar Franklin Square Medical Center, Baltimore, MD, USA.
authors.forename: Ramez
authors.initials: R
authors.lastname: Jabaji
authors.affiliation: Department of Hematology and Oncology, MedStar Franklin Square Medical Center, Baltimore, MD, USA.
authors.forename: Pallavi
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Department of Orthopedic Oncology, MedStar Franklin Square Medical Center, Baltimore, MD, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Aboulafia
authors.affiliation: Department of Pulmonary and Critical care Medicine, MedStar Franklin Square Medical Center, Baltimore, MD, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Selinger
keywords: AML; acute megakaryoblastic leukemia; acute panmyelosis; myelofibrosis