Primary myeloid sarcoma of small bowel

A 45-year-old woman presented with severe lower abdominal pain and vomiting. On physical examination, she was found to have tenderness in the suprapubic region and right iliac fossa. An ultrasound abdomen performed to rule out acute appendicitis and pelvic inflammatory disease was not contributory. Blood parameters were within normal limits. As the patient continued to be symptomatic, a contrast-enhanced CT of the abdomen was performed. It revealed eccentric focal bowel wall thickening involving the ileum measuring 3.3×2.4 cm, with homogeneous enhancement on postcontrast images causing mild luminal compromise (figures 1, figure 2). Oral contrast was noted to pass distally with no proximal hold-up. Mild dilatation of proximal ileal loops with diffuse wall thickening was noted (figure 3). No perifocal mesenteric fat infiltration was identified. Few discrete enlarged perifocal lymph nodes were noted (figure 4). There was no retroperitoneal lymphadenopathy. In view of the imaging findings, a differential diagnosis of lymphoma and carcinoma …