Minagi Hitoshi, Kanaya Nobuhiko, Kondo Yoshitaka, Kakiuchi Yoshihiko, Kuroda Shinji, Shoji Ryohei, Kashima Hajime, Matsumi Yuki, Kikuchi Satoru, Shigeyasu Kunitoshi, Teraishi Fuminori, Kagawa Shunsuke, Fujiwara Toshiyoshi
Department of Gastroenterological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
Surg Case Rep. 2024 Oct 4;10(1):229. doi: 10.1186/s40792-024-02030-5.
Myeloid sarcoma (MS) is an extramedullary tumor constituted by myeloid blasts or immature myeloid cells. It frequently occurs in conjunction with acute myeloid leukemia (AML); however, it can exceptionally manifest in patients without leukemia. Here, we present a rare case of primary MS originating in the small bowel without evidence of bone marrow involvement.
A 33 year-old female with no relevant medical history was admitted to our hospital with recurrent abdominal pain. Computed tomography (CT) revealed bowel obstruction due to thickening of the ileum wall, which was suspected to be an ileal tumor. Initially, ectopic endometriosis was suspected because of abdominal pain associated with the menstrual cycle and changes observed on a follow-up CT scan. The lesion could not be detected by double-balloon endoscopy. Despite conservative treatment, the obstruction persisted, and laparoscopic partial ileal resection was performed, which revealed extensive involvement of the ileum and mesentery. Additionally, the mesentery of the resected ileum was extremely thickened. Histopathological and immunohistochemical examinations of the surgical specimen indicated ileal MS. Bone marrow aspiration after discharge was negative for cytological findings of leukemia, leading to a final diagnosis of primary ileal MS. Her postoperative course was uneventful, and she is currently undergoing systemic chemotherapy tailored to AML at another hospital.
Even though MS of the small bowel is rare and may not be considered preoperatively, similar surgical treatment to that of other small bowel malignancies can ensure proper postoperative diagnosis and appropriate chemotherapy. Given the potential need for chemotherapy, ensuring surgical safety that allows for its rapid initiation is critical.
髓系肉瘤（MS）是一种由髓母细胞或未成熟髓细胞构成的髓外肿瘤。它常与急性髓系白血病（AML）同时发生；然而，它也可能在无白血病的患者中罕见地出现。在此，我们报告一例罕见的原发性小肠MS病例，无骨髓受累证据。
一名33岁无相关病史的女性因反复腹痛入院。计算机断层扫描（CT）显示因回肠壁增厚导致肠梗阻，怀疑是回肠肿瘤。最初，由于与月经周期相关的腹痛以及随访CT扫描中观察到的变化，怀疑为异位子宫内膜异位症。双气囊内镜未检测到病变。尽管进行了保守治疗，梗阻仍持续存在，遂进行腹腔镜部分回肠切除术，术中发现回肠和肠系膜广泛受累。此外，切除回肠的肠系膜极度增厚。手术标本的组织病理学和免疫组化检查显示为回肠MS。出院后骨髓穿刺白血病细胞学检查结果为阴性，最终诊断为原发性回肠MS。她术后恢复顺利，目前正在另一家医院接受针对AML的全身化疗。
尽管小肠MS罕见且术前可能未被考虑，但与其他小肠恶性肿瘤类似的手术治疗可确保术后正确诊断和适当化疗。鉴于可能需要化疗，确保手术安全以便能迅速开始化疗至关重要。
