Hepatic myeloid sarcoma preceding acute megakaryoblastic leukemia with t(1;22) in an infant: Case report

Abstract

Myeloid sarcoma (MS) is the tumor of immature myeloid cells involving extramedullary sites. Liver involvement of MS is rare in infant. Three months old female infant presented with hepatosplenomegaly and bicytopenia. Repeated bone marrow aspiration detected no blasts and flow cytometric analysis was normal. Abdominal magnetic resonance imaging revealed multiple nodular lesions in the liver. The biopsy results were consistent with MS. She presented with paleness and fever 8 months later. She had ongoing deep anemia, thrombocytopenia and hepatosplenomegaly. Bone marrow biopsy showed blast cell infiltration with 20% cells positive for CD61. The bone marrow karyotype investigation revealed complex quadruplet-translocation with the 46, X, t(X; 11; 22; 1) [15]/46, XX [1] karyotype. AML M7 was diagnosed and chemotherapy started. MS may occur as initial manifestation of AML with t(1;22) which is often associated with marrow fibrosis making sampling difficult. Hence cytogenetic analysis is of paramount importance in making an accurate diagnosis.

Keywords

• Myeloid sarcoma
• Liver
• Infant
• Acute megakaryoblastic leukemia
• t(1;22)