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Figure 1: Patient 4. Contrast-enhanced transverse CT scan in 38-year-old man with no known history of leukemia and abdominal pain and diarrhea at presentation shows an exophytic mass (arrowheads) with bowel wall thickening causing small-bowel obstruction in the jejunum with a dilated duodenum (D) and proximal jejunum. This patient never had blood or bone marrow evidence of acute leukemia during 3 years of follow-up and was therefore considered to have isolated granulocytic sarcoma of the small bowel. Microscopic examination (results not shown) revealed leukemic tumor cell infiltration of mucosal surface. Immunohistochemical staining was positive for myeloperoxidase but negative for T-cell and B-cell markers (ie, CD3, CD20), indicating that the tumor cells were of myeloid origin and thus compatible with the diagnosis of granulocytic sarcoma.
