PMC3350040_01
Upper GI endoscopy showing large area of nodular gastric mucosa, extending from GE junction to surrounding body.
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fig1
Upper GI endoscopy showed thickened nodular friable mucosa at cardia of stomach extending into the posterior wall (Figure 1).
H&E, 40x. Unremarkable foveolae and glands with expansion of lamina propria by atypical round cells, admixed with granulocytic precursors.
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fig2
Multiple deep biopsies from gastric cardia showed normal mucosal glands with expansion of lamina propria by infiltrates of atypical cells, intermixed with granulocytic precursor cells (Figure 2).
H&E, 400x. Sheets of atypical round cells IHC-CD 117 marker, 400x. Intense positivity in all atypical cells for immature myeloid marker CD 117.
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fig3
Immunohistochemistry panel showed that the cells were negative for CD20, CD5, CD3, CD10, and cytokeratin markers, with intense positivity for immature myeloid markers (myeloperoxidase, CD34, and CD117) (Figure 3), consistent with granulocytic sarcoma of the stomach.
Trephine bone marrow biopsy, H&E, 400x. Sheets of blasts replacing normal marrow elements.
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fig4
A bone marrow biopsy (Figure 4) and flow cytometry analysis showed features consistent with acute myeloid leukemia (AML-M4) with blast count of 77%.