# Diagnostic Challenges of Aleukemic Myeloid Sarcoma

## TL;DR

This paper discusses the diagnostic difficulties of aleukemic myeloid sarcoma, a rare cancer that can appear in the skin and bile duct without affecting blood or bone marrow.

## Contribution

The novelty lies in presenting a rare case of aleukemic myeloid sarcoma with skin and bile duct involvement but no blood or bone marrow involvement.

## Key findings

- Aleukemic myeloid sarcoma can present with non-specific skin symptoms and no blood involvement.
- The case highlights the importance of rapid diagnosis for a condition with poor prognosis.
- MS was detected in the bile duct three months after initial skin diagnosis without bone marrow involvement.

## Abstract

Myeloid sarcoma (MS) represents a neoplastic proliferation characterized by immature myeloid precursor cells. Among its variants, aleukemic MS is an uncommon subtype, manifesting as skin involvement sparing the peripheral blood or bone marrow. The non-specific cutaneous presentation coupled with the lack of associated symptoms poses a diagnostic challenge for providers. In this report, we present a case of an 83-year-old woman who presented with violaceous nodules located in the center of her right shin. A biopsy of the lesion unveiled a diagnosis of MS, yet notably lacked peripheral blood involvement. Three months after the initial diagnosis, the MS was found in the common bile duct, still without bone marrow involvement. With a relatively poor prognosis, the rapid diagnosis and treatment of MS are crucial.