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• W2978631640 abstract "Introduction: Extramedullary myeloid leukemia (EML) is a rare presentation of myeloid neoplasia in solid form that is a harbinger of acute myeloid leukemia (AML). This is the case of an immunosuppressed patient with ulcerative colitis who developed EML of the sigmoid colon, an uncommon site for this rare malignancy. Case: We present a 79-year-old man with ulcerative pancolitis and a remote history of esophageal squamous cell carcinoma treated with chemoradiation and prostate cancer treated with surgery who presented with three weeks of weakness and fatigue. He failed multiple therapies for ulcerative pancolitis (including thiopurines), but his disease was well controlled for three years with infliximab monotherapy until he developed dose-limiting pancytopenia. A bone marrow biopsy demonstrated myeloid dysplasia and 5% blasts, consistent with myelodysplastic syndrome (MDS) with a 5q deletion. Infliximab was discontinued, and the patient began treatment with lenalidomide for del(5q) MDS. Chromoendoscopy revealed a large sessile polyp in the sigmoid colon; it was completely resected and pathologic examination showed extramedullary myeloid leukemia. Surveillance chromoendoscopy after two months of lenalidomide therapy showed no residual tumor, but repeat bone marrow biopsy exhibited clonal evolution and progression to AML. The patient transitioned therapy to azacitidine and has declined colectomy to date; his colitis is in clinical remission with mesalamine monotherapy. Discussion: EML refers to neoplastic expansion of myeloid cell lines with involvement of extramedullary organs. Myeloid sarcomas or chloromas occur when these cells form a macroscopic collection resembling a soft tissue mass, most often seen in the lymph nodes, skin, or eyes. Primary EML may be the initial manifestation; the appearance of EML simultaneously with the initial diagnosis of MDS, particularly del(5q) MDS, is rare. The pathogenesis of EML may differ from that of AML. Immunosuppression is a possible risk factor, and patients who have received cytotoxic chemotherapy may be at greater risk. Inflammatory bowel disease, thiopurine use, and TNF-α antagonist use are risk factors for malignancy, with thiopurines increasing the risk of myeloid neoplasm seven-fold. EML should be considered in patients with polypoid lesions of the colon, hematologic abnormalities, and multiple risk factors." @default.
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• W2978631640 date "2016-10-01" @default.
• W2978631640 modified "2023-09-27" @default.
• W2978631640 title "Colonic Extramedullary Leukemia: A Liquid Tumor Solidified" @default.
• W2978631640 doi "https://doi.org/10.14309/00000434-201610001-01449" @default.
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