Myeloid sarcoma of the nasopharynx mimicking an aggressive lymphoma

Myeloid sarcoma (MS) is a rare extra-medullary tumour of the myeloid lineage, which can be a difficult diagnosis to make.

We report the case of a 73-year-old male with a right-sided nasopharyngeal mass revealed on CT scan and MRI.

An initial cytological and histological examination suggested a high-grade lymphoma. Nevertheless, the final diagnosis was a MS with an unusual involvement of the nasopharynx that was treated with a conventional induction leukemia therapy. Eight months later, the patient had persistent thrombocytopenia and a bone marrow aspiration showed the dysplasia of a high grade myelodysplastic syndrome and cytogenetics detected t(3;21). The patient was treated with a 5-Azacitidine (Vidaza) protocol until overt progression and disease evolution.

In conclusion few cases of MS involving the nasopharynx have been reported. Its diagnosis is often difficult and should be considered especially when a high index of suspicion is present and the immunophenotype of the malignant haematological cells is not clearly in favour of a lymphoma.