Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10227
Peer-review started: April 28, 2022
First decision: June 16, 2022
Revised: June 25, 2022
Accepted: August 23, 2022
Article in press: August 23, 2022
Published online: October 6, 2022
Processing time: 152 Days and 3.6 Hours
Myeloid sarcoma (MS) is relatively rare, occurring mainly in the skin and lymph nodes, and MS invasion of the ulnar nerve is particularly unusual. The main aim of this article is to present a case of MS invading the brachial plexus, causing ulnar nerve entrapment syndrome, and to further clinical understanding of the possibility of MS invasion of peripheral nerves.
We present the case of a 46-year-old man with a 13-year history of well-treated acute nonlymphocytic leukaemia who was admitted to the hospital after presenting with numbness and pain in his left little finger. The initial diagnosis was considered a simple case of nerve entrapment disease, with magnetic resonance imaging showing slightly abnormal left brachial plexus nerve alignment with local thickening, entrapment, and high signal on compression lipid images. Due to the severity of the ulnar nerve compression, we surgically investigated and cleared the entrapment and nerve tissue hyperplasia; however, subsequent pathological biopsy results revealed evidence of MS. The patient had significant relief from his neurological symptoms, with no postoperative complications, and was referred to the haemato-oncology department for further consultation about the primary disease. This is the first report of safe treatment of ulnar nerve entrapment from MS. It is intended to inform hand surgeons that nerve entrapment may be associated with extramedullary MS, as a rare presenting feature of the disease.
MS invasion of the brachial plexus and surrounding tissues of the upper arm, resulting in ulnar nerve entrapment and degeneration with significant neurological pain and numbness in the little finger, is uncommon. Surgical treatment significantly relieved the patient’s nerve entrapment symptoms and prevented further neurological impairment. This case is reported to highlight the rare presenting features of MS.
Core Tip: The main aim of this article is to present a rare case of myeloid sarcoma (MS) invading the ulnar nerve and causing ulnar nerve entrapment syndrome. The patient’s symptoms were relieved by surgical release of the nerve bundle and compressed tissue, and the disease was diagnosed definitively by pathological examination. The case illustrates the rare presenting features of extramedullary MS, enriches the clinical literature, and highlights that it is essential to suspect MS with a history of acute nonlymphocytic leukaemia.