SHM Converge Scientific Abstract ePoster Gallery-Myeloid Sarcoma of the Gastrointestinal Tract in High Grade Myelodysplastic Syndrome

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This case describes a rare and serious cause of gastrointestinal bleeding in a patient with high-risk myelodysplastic syndrome (MDS): myeloid sarcoma of the gastrointestinal tract.<br /><br />The patient presented with severe pancytopenia, profound anemia, thrombocytopenia, and neutropenia, requiring urgent transfusion support. Initial imaging showed no active bleeding, but colonoscopy revealed diffuse terminal ileal ulceration and scattered colonic ulcers. Early biopsies were nondiagnostic, with no evidence of CMV, vasculitis, or lymphoma, so the differential diagnosis included inflammatory bowel disease, infectious colitis, and MDS-related Behçet syndrome.<br /><br />Despite antibiotics and transfusions, the patient continued to have neutropenic fevers and ongoing concern for disease progression. Repeat peripheral flow cytometry showed increasing CD34-positive myeloblasts with aberrant features and expanded monocytic populations, suggesting malignant transformation. Repeat endoscopic sampling with more extensive pathology ultimately demonstrated myeloid sarcoma, confirming extramedullary progression of the underlying myeloid neoplasm.<br /><br />The discussion emphasizes that myeloid sarcoma is the tissue counterpart of acute myeloid leukemia and may occur before or alongside marrow transformation. Gastrointestinal involvement is uncommon but can cause major complications such as bleeding, perforation, necrosis, obstruction, and transfusion dependence. Because initial biopsies may be inconclusive, repeat tissue sampling and reassessment for leukemic transformation are important when suspicion remains high.<br /><br />The patient declined repeat bone marrow biopsy, and after goals-of-care discussions, transitioned to comfort care and died peacefully.<br /><br />Overall, this case highlights the importance of considering myeloid sarcoma in MDS patients with unexplained gastrointestinal ulcers, bleeding, and rising peripheral blasts, since early recognition may guide consultation and prognostic discussions.

Asset Subtitle

Katherine G. Unger

Meta Tag

Author List Joseph Han, Kainaat Javed, Katherine G. Unger, Kevin Chen, Omar Moussa

Category Clinical Vignettes

Concept Gastrointestinal Myeloid Sarcoma

Concept High-Grade Myelodysplastic Syndrome

Concept Acute Myeloid Leukemia

Concept Gastrointestinal Bleeding

Concept Endoscopic Biopsy

Distinguished Non-Finalist

Presenter Organization NYU Grossman School of Medicine

Presenting Author Katherine G. Unger

Track Adult

Keywords

myeloid sarcoma

gastrointestinal bleeding

myelodysplastic syndrome

terminal ileal ulceration

colonic ulcers

pancytopenia

thrombocytopenia

neutropenia

extramedullary progression

acute myeloid leukemia

Gastrointestinal Myeloid Sarcoma

High-Grade Myelodysplastic Syndrome

Acute Myeloid Leukemia

Gastrointestinal Bleeding

Endoscopic Biopsy