Extrahepatic Biliary Myeloid Sarcoma: Surprise Diagnosis on Suspicious Obstructive Jaundice

This is the authors' abstract. We don't add key points for this paper.

A man presents with appetite loss and jaundice with no further complaints. Computed tomography (CT) finds a stenosis of the common bile duct (CBD) compatible with a type II Bismuth tumor. After discussion in a multidisciplinary team meeting, the patient was referred to a Reference Center of Oncological Hepatobiliary Surgery, and left hepatectomy with biliary reconstruction was proposed. Before the patient was submitted to surgery, a blood smear showed blastic cells and the patient was diagnosed with acute myeloid leukemia (AML). Intraoperatively, extemporaneous analysis of the biliary margin after left hepatectomy showed it was invaded by leukemic cells. Final anatomopathological analysis revealed a myeloid sarcoma with medullary extent with NPM1 mutation and the patient was referred to Hematology for further treatment.