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TO THE EDITOR: Granulocytic sarcoma (GS) or myeloid sarcoma (MS) is an extramedullary tumor comprising myeloblasts or immature myeloid cells. This type of tumor commonly occurs in subperiosteal bone structures of the skull, paranasal sinuses, as well as the sternum, ribs, vertebrae, pelvis, lymph nodes, and skin [1]. GS is frequently mistaken for non-Hodgkin lymphoma (NHL), small round cell tumors (neuroblastoma, rhabdomyosarcoma, Ewing's sarcoma/primitive neuroectodermal tumor, and medulloblastoma), or undifferentiated carcinoma. The diagnosis is overlooked in about 50% of the cases when immunohistochemistry (IHC) analysis is not performed [2]. The most common diagnosis, suggested in these situations, is NHL [3]. MS may be the first manifestation of AML, preceding it by months or years, or represent the initial manifestation of relapse in previously treated AML in the remission stage [4]. Isolated MS, defined by the absence of a history of leukemia, myelodysplastic syndrome (MDS), or myeloproliferative neoplasm along with a negative bone morrow biopsy has been described in only a few case reports [5].  Here we report a case of a small gut mass that presented with features of intestinal obstruction necessitating exploratory laparotomy and resection anastomosis of a segment of the small gut. The mass was evaluated for lineage differentiation by IHC and the results correlated with clinicopathologic findings as well as cytogenetic and molecular studies.

A rare case of isolated myeloid sarcoma of the small gut with inv(16)(p13;q22) without bone marrow involvement