Diagnosis in subdural myeloid sarcoma.

Diagnosing intracranial lesions in patients with a history of leukemia remains challenging. While subdural hematomas are a common concern in such cases, distinguishing them from solid neoplasms is critical for treatment planning. Prior research has shown that imaging alone may not reliably differentiate between these entities. No prior work had resolved the specific diagnostic dilemma of myeloid sarcoma presenting as a subdural lesion. This gap motivated the need for a detailed case report. The context of a patient with a known hematologic malignancy adds complexity to lesion interpretation. Standard imaging techniques may miss subtle features of non-hemorrhagic tumors. Contrast-enhanced MRI has been proposed as a more accurate diagnostic tool in similar cases. This case highlights the importance of integrating clinical and radiological findings in complex neurological presentations.

The aim of this case report is to illustrate the diagnostic challenges in distinguishing myeloid sarcoma from subdural hematoma in a patient with a history of leukemia. The specific problem involves the difficulty of interpreting subdural lesions in the context of a known hematologic malignancy. The motivation stems from the need to improve diagnostic accuracy in neurologically deteriorating patients. The case emphasizes the limitations of preoperative imaging in such scenarios. It also highlights the role of histopathology in confirming ambiguous findings. The report serves as a learning tool for clinicians managing similar cases. The goal is to raise awareness of myeloid sarcoma as a potential differential diagnosis. This contributes to the broader field of neuro-oncology and diagnostic imaging.

This study is a single-case report involving a 74-year-old man with a history of acute monocytic leukemia. The patient presented with a headache, thrombocytopenia, and acute cognitive decline. Preoperative imaging included computed tomography and limited magnetic resonance imaging. These modalities revealed a subdural lesion with significant midline shift. A craniotomy was performed to evacuate the presumed subdural hematoma. Histopathological analysis was conducted on the resected tissue. Postoperative MRI with contrast was used to further characterize the lesion. The study combines clinical, radiological, and pathological data to inform the diagnosis.

Preoperative CT and limited MRI showed a subdural lesion with marked midline shift. The lesion was initially interpreted as a subdural hematoma. Craniotomy revealed a solid tumor-like mass rather than a hematoma. Histopathology confirmed the presence of myeloid sarcoma (chloroma). Postoperative contrast-enhanced MRI demonstrated the solid nature of the mass. The lesion was not hemorrhagic, which is typical of myeloid sarcomas. The patient's clinical history of leukemia in remission supported this finding. The contrast-enhanced MRI was critical in distinguishing the lesion from a hematoma.

The authors propose that contrast-enhanced MRI is essential for differentiating myeloid sarcoma from subdural hematoma in patients with a history of leukemia. The case suggests that preoperative imaging alone may be insufficient for accurate diagnosis. Histopathology remains the gold standard for confirming the presence of myeloid sarcoma. The study highlights the importance of integrating clinical and radiological findings. The authors emphasize the need for caution in interpreting subdural lesions in neurologically deteriorating patients. The findings may suggest that myeloid sarcomas can present in atypical locations. The case illustrates the limitations of standard imaging techniques in such scenarios. The use of contrast is proposed as a critical step in the diagnostic process.