Diagnostic Challenges of Aleukemic Myeloid Sarcoma

Myeloid sarcoma (MS) represents a neoplastic proliferation characterized by immature myeloid precursor cells. Among its variants, aleukemic MS is an uncommon subtype, manifesting as skin involvement sparing the peripheral blood or bone marrow. The non-specific cutaneous presentation coupled with the lack of associated symptoms poses a diagnostic challenge for providers. In this report, we present a case of an 83-year-old woman who presented with violaceous nodules located in the center of her right shin. A biopsy of the lesion unveiled a diagnosis of MS, yet notably lacked peripheral blood involvement. Three months after the initial diagnosis, the MS was found in the common bile duct, still without bone marrow involvement. With a relatively poor prognosis, the rapid diagnosis and treatment of MS are crucial.