Granulocytic sarcoma of esophagus

GRANULOCYTIC SARCOMAOF ESOPHAGUS

A 60-year-old man presented with dysphagia and vomiting of blood-stained material of 1-week duration. He was undergoing chemotherapy for acute myeloid leukemia. Upper endoscopy revealed discrete ulcers in the oropharynx, epiglottis, and esophagus. Those in the esophagus were more confluent and covered with yellowish necrotic exudate (A). The distal esophagus was most severely affected. The intervening mucosa between ulcers was nodular. The stomach and the first and second parts of the duodenum appeared normal. Biopsy specimens from the nodular esophageal mucosa revealed hyperplastic surface squamous epithelium, subepithelial dense deposits of myeloid cells, and secondary lymphoplasmacytic infiltration (B; H&E,

238 G A S T R O I N T E S T I N A L E N D O S C O P Y

orig. mag. x20). Based on these findings, a diagnosis of granulocytic sarcoma (extramedullary myeloid tumorl of the esophagus was made. Because of the diffuse nature of the malignancy and the poor general condition of the patient, conservative management was continued. Mohammad Ibrarullah, MS, MCh Kuraparthy Sambasivaiah, MD, DM Mandyam Kumaraswamy Reddy, MD Gajanan Wagholikar, MS, MCh Departments of Gastroenterology, oncology, and Pathology SV Institute of Medical Sciences Tirupati, India doi: lO. 1067/rage.2003.77

VOLUME 57, NO. 2, 2003