Myeloid sarcoma presenting with acute renal failure and bilateral ureteral obstruction: a case report and review of the literature.

Myeloid sarcoma (MS) is a very rare disease that either presents with acute myeloid leukemia or as relapse of acute myeloid leukemia. The common sites include the small intestine, skin, bone, and lymph nodes. We present an unusual case of MS presenting with acute renal failure (ARF) and bilateral ureteral obstruction. Ultrasonography showed bilateral hydronephrosis and a large pelvic mass displacing the uterus. Pelvic mass biopsy showed fibroadipose tissue with diffuse neoplastic cell infiltration and immunostaining was positive for leukocyte common antigen (LCA) and myeloperoxidase consistent with myeloid sarcoma. Bone marrow biopsy revealed 63% myeloblasts. The patient died the 17th day of induction therapy. We came across only four MS cases in English literature that presented with ARF. To our knowledge, this case is the first description of myeloid sarcoma presenting with ARF and bilateral ureteral obstruction not originating from urogenital system. Physicians should consider possible hematological malignancies in patients with similar presentation.