Chronic myeloid leukemia manifested as myeloid sarcoma: Review of literature and case report

In this report, we present the case of a 50-year-old woman presenting with an intraparenchymal myeloid sarcoma manifesting as weakness. She has a history of chronic myeloid leukemia (CML) treated with imatinib not taken consistently with a relapse to blast crisis, and then an isolated relapse as a myeloid sarcoma manifesting as facial and extremity weakness. An MRI of the brain showed an enhancing, well-circumscribed mass within the frontal lobe with edema extending to the motor strip. Based on tumor size, focality, location, growth rate, and patient's symptoms, surgeons determined that the patient should undergo surgical resection. Postoperatively, the patient had full resolution of her acute neurological symptoms without post-operative complications. Post-operative MRI showed minimal enhancement suggesting post-surgical changes vs minimal residual tumor. The patient was scheduled to undergo whole brain radiotherapy with supplemental direct radiation to the site of resection. This is the first report of safe and complete resection of an intraparenchymal myeloid sarcoma. It is meant to inform neurosurgeons that brain tumors can be potentially CML-related; additionally, we review CML's manifestations in the central nervous system and how neurosurgeons can consider optimal management given as there are no guidelines on how to treat CML-related CNS disease.