Diagnostic and therapeutic challenges of myeloid sarcoma in the oral cavity

Table 1 Cases of myeloid sarcoma

Ref.	Age (years)	Gender	Tumor location	Symptoms and signs	Imaging examinations	Results from histological examination	Immunohistochemical staining	Diagnosis	Treatment
Kurdoğlu et al[5], 2013	29	Female	Gingiva	Painful buccal gingival swelling and bilateral submandibular lymphadenopathy, no gingival bleeding on probing	Radiological examinations did not show any bone pathology	Monomorphous diffuse infiltrate. Extramedullary myeloblastic malignancy	Positive reaction to CD117 and myeloperoxidase (MPO)	MS	Idarubicin and ARA-C chemotherapy regimen at first treatment phase. Second chemotherapy session 3-5-7 (daunorubicin, etoposide, and ARA-C)
de Andrade et al[7], 2017	24	Female	Gingiva	Fast growing painful gingival swelling, fever, fatigue, and cervical lymphadenopathy. Bluish swelling on the right posterior lower gingiva exhibiting necrotic surface	Radiographic examination of the mandible showed no bone involvement	Undifferentiated tumor cells with granulocytic appearance	CD99, MPO, and Ki-67 (60%)	MS associated with AML	Chemotherapy, but the patient died of the disease one month later
Shen et al[2], 2018	41	Female	Gingiva	Gingival swelling. No pain or pyorrhea, a blue-gray discoloration, and gingival masses	In the panoramic radiograph, the palatal bone was intact, and an ill-defined radiolucency was found in the left maxillary edentulous region. In addition, there was generalized mild horizontal alveolar bone loss, and a band-like radiolucent area was found in the alveolar bone crest from the left mandibular canine to the second premolar	Diffuse infiltration in the submucosa with small to medium sized blastic-like cells with increased nucleocytoplasmic ratio, round to oval, irregular nuclei, and fine chromatin. Rare mitotic figures were observed	Positive for myeloperoxidase	MS	Chemotherapy regimen based on anthracycline and cytarabine was instituted. The patient received 3 + 7 induction chemotherapy with doxorubicin and cytarabine, followed by 4 courses of consolidation therapy with cytarabine, L-asparaginase, and methotrexate
Wang et al[6], 2021	82	Female	Gingiva	Painless swelling on the right maxillary posterior gingiva, tender lump of the right neck, firm mass without purulence	Computed tomography imaging revealed increased fluorodeoxyglucose uptake via the maxillary sinuses bilaterally and the right submandibular lymph node	NA	NA	MS	Radiation therapy (25 Gy over 12 fractions) and subsequent chemotherapy (decitabine)
	65	Male	Palate	2.0-0.8 cm craterform ulcer with diffuse erythema, induration, and swelling on the left soft palate, extending into the oropharynx	NA	NA	Bone marrow biopsy confirmed relapsed AML	MS associated with AML	Localized radiation therapy (24 Gy over 14 fractions) and immunotherapy (ipilimumab)
	58	Female	Lip	0.3-0.3 cm indurated, nontender ulcer with surrounding erythema, scaling, and crusting on the midvermillion border of the lower lip	NA	NA	Bone marrow biopsy confirmed relapsed AML	MS associated with AML	Investigational chemotherapeutic drugs, including mitoxantrone, etoposide, and cytarabine and lenalidomide
Kole et al[10], 2023	29	Male	Gingiva	Swelling, paresthesia	CECT showed an osteolytic lesion extending from teeth 35 to 37	Fibro-collagenous tissue infiltrated by nests and trabeculae of intermediate size mononuclear cells having dispersed nuclear chromatin and irregular nuclear margin	Positive for MPO and CD15	MS	Segmental mandibulectomy
Li et al[9], 2024	32	Male	Gingiva	Gingival swelling	No extensive bone loss	Diffuse infiltration of abnormal cells	Neoplastic cells were MPO positive, and the Ki-67 staining rate was 80%	MS	Idarubicin (IDA) regimen (IDA hydrochloride 10 mg/1 d-3 d, Cytarabine 100 mg/1 d-7 d) treatment, supplemented with gastric protection and antiemetic therapy

MS: Myeloid sarcoma; AML: Acute myeloid leukemia; NA: Not available.