Cervical Spinal Cord Compression Syndrome Secondary to Spinal Epidural Myeloid Sarcoma

Abstract

Introduction: Myeloid sarcoma is a rare neoplastic condition characterized by the appearance of one or several tumor masses, consisting of immature myeloid cells in an extramedullary site. Its presentation in the central nervous system is very infrequent.

Objective: To describe the clinical, imaging and pathological characteristics that allowed the diagnosis of spinal epidural myeloid sarcoma.

Clinical case: A 24-year-old male patient, with a personal history of myopia, who had presented a left axillary furuncle two months earlier, came to the clinic due to cervical pain radiating to the upper limbs and spastic quadriparesis. The complete blood count showed leukocytosis with predominance of polymorphonuclear neutrophils and accelerated erythrocyte sedimentation rate. Magnetic resonance imaging of the cervical and dorsal spine showed an intraspinal extradural lesion in contact with the posterior face of the spinal cord from C3-T4. It was surgically approached posteriorly and a biopsy sample was taken. A medullogram and immunophenotype by flow cytometry were performed with results consistent with acute myeloid leukemia. Induction treatment with adriamycin and cytarabine was started. The biopsy of the cervical lesion revealed a myeloid sarcoma. There was slight initial improvement in neurological symptoms. On day 13 of treatment, the patient died as a result of hemorrhagic cerebrovascular disease.

Conclusions: Myeloid sarcoma was the cause of cervical spinal cord compression in this case, with no known history of hematological disease. It was diagnosed in the course of acute myeloid leukemia, complicating the treatment and prognosis of the patient.