Myeloid sarcoma of the nasal septum following invasive fungal sinusitis: report of a case and review of the relevant literature

Abstract

Myeloid sarcoma is an uncommon extramedullary manifestation of myeloproliferative malignancies, such as acute myeloid leukemia (AML). This sarcoma most often involves structures such as subperiosteal bone, peritoneum, or pericardium, and has only rarely been reported in the nose and paranasal sinuses. The signs and symptoms of myeloid sarcoma can overlap with those of acute invasive fungal sinusitis (AIFS), a life-threatening surgical emergency. This report describes a 75-year-old male with a known history of AML who developed both AIFS and myeloid sarcoma. Several months after successful treatment for biopsy proven AIFS, this patient developed a new soft tissue mass of the nasal septum. A new biopsy was obtained which revealed infiltrating blast cells with evidence of monocytic differentiation diagnostic of myeloid sarcoma. Given symptoms of severe nasal obstruction, this patient received palliative radiotherapy to the nasal septum, which provided temporary improvement prior to the patient succumbing to his underlying malignancy. We review the existing reports of mucosal myeloid sarcomas, diagnostic overlap of myeloid sarcoma and AIFS, as well as currently available treatment strategies.