Abstract
The relative rarity of myeloid sarcoma and its propensity for varied presentation is a source of diagnostic hazard, for novice and experienced pathologists alike. This report illustrates a case submitted as a ‘back carbuncle’ saucerisation specimen to the pathology laboratory. Initial tissue survey disclosed a mixed cellular infiltrate within the dermis, closely mimicking an inflammatory process, adhering to the clinical impression. Review of the clinical notes revealed a history of myelofibrosis and worrisome contemporaneous haematological parameters, including anaemia, thrombocytopenia, and monocytosis. Careful microscopic scrutiny distinguished an atypical leukocytic population within the polymorphous background, prompting extensive immunohistochemical studies that lead to recognition of a myeloid sarcoma with monocytic differentiation, a diagnosis of great clinical import. The histological interpretation was corroborated by flow cytometric detection of myeloid blasts and an expanded monocytic population on a marrow aspirate, as well as blasts and immature precursors with monocytic/monoblastic differentiation on marrow biopsy. Sustained diagnostic vigilance and clinico-pathological correlation, even in ostensibly ‘pedestrian’ cases, are vital elements of good pathology practice.
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