Gastric Granulocytic Sarcoma as a Localized Blastic Crisis in a Patient With Polycythemia Vera

Main Article Content

Likhasit Sanglutong
Somchai Insiripong


Granulocytic sarcoma is a tumor of immature granulocytic cell that can be found at any organ outside the bone marrow. It has been rarely reported and most cases are associated with leukemia. This report presented a case of granulocytic sarcoma originating from the stomach of a polycythemia vera patient. He was a 66-year-old Thai patient who passed melena for many times in 2 days. Two years prior this presentation, he had been diagnosed as having polycythemia vera and treated with occasional phlebotomy and hydroxyurea. The gastroscopy showed multiple sessile polyps at gastric body of which the pathology showed diffuse infiltration by myeloblasts; the tumor cells diffusely marked with LCA, CD34, CD117, sparsely marked with MPO, compatible with blastic phase of myeloproliferative neoplasm. The diagnosis of gastric granulocytic sarcoma or localized blastic transformation at the stomach with underlying polycythemia vera was concluded.


Article Details

How to Cite
Sanglutong, L., & Insiripong, S. (2022). Gastric Granulocytic Sarcoma as a Localized Blastic Crisis in a Patient With Polycythemia Vera. Ramathibodi Medical Journal, 45(2), 52–57.
Case Reports


Yilmaz AF, Saydam G, Sahin F, Baran Y. Granulocytic sarcoma: a systematic review. Am J Blood Res. 2013;3(4):265-270.

Paydas S, Zorludemir S, Ergin M. Granulocytic sarcoma: 32 cases and review of the literature. Leuk Lymphoma. 2006;47(12):2527-2541. doi:10.1080/10428190600967196

Guermazi A, Feger C, Rousselot P, et al. Granulocytic sarcoma (chloroma): imaging findings in adults and children. AJR Am J Roentgenol. 2002;178(2):319-325. doi:10.2214/ajr.178.2.1780319

Klco JM, Welch JS, Nguyen TT, et al. State of the art in myeloid sarcoma. Int J Lab Hematol. 2011;33(6):555-565. doi:10.1111/j.1751-553X.2011.01361.x

Magdy M, Abdel Karim N, Eldessouki I, Gaber O, Rahouma M, Ghareeb M. Myeloid sarcoma. Oncol Res Treat. 2019;42(4):224-229. doi:10.1159/000497210

Noh BW, Park SW, Chun JE, Kim JH, Kim HJ, Lim MK. Granulocytic sarcoma in the head and neck: CT and MR imaging findings. Clin Exp Otorhinolaryngol. 2009;2(2):66-71. doi:10.3342/ceo.2009.2.2.66

He T, Guo Y, Wang C, et al. A primary myeloid sarcoma involving the small intestine and mesentery: case report and literature review. Int J Clin Exp Pathol. 2018;11(8):4158-4162.

Goh BS, Tang CL, Tan GC. Myeloid sarcoma of temporal bone: a rare manifestation of relapse acute myeloid leukemia. Indian J Otolaryngol Head Neck Surg. 2019;71(Suppl 2):1023-1026. doi:10.1007/s12070-015-0930-8

Jelić-Puskarić B, Kardum-Skelin I, Sustercić D, et al. Izolirani mijeloidni sarkom medijastinuma [Isolated myeloid sarcoma involving the mediastinum]. Acta Med Croatica. 2011;65(Suppl 1):133-138.

Jelić-Puskarić B, Ostojić-Kolonić S, Planinc-Peraica A, Obad-Kovacević D, Kardum-Skelin I, Jaksić B. Myeloid sarcoma involving the breast. Coll Antropol. 2010;34(2):641-644.

Koehler M. Granulocytic sarcoma of the stomach. Gastrointest Endosc. 1998;48(2):190. doi:10.1016/s0016-5107(98)70162-2

Sekaran A, Darisetty S, Lakhtakia S, Ramchandani M, Reddy DN. Granulocytic sarcoma of the stomach presenting as dysphagia during pregnancy. Case Rep Gastrointest Med. 2011;2011:627549. doi:10.1155/2011/627549

Huang XL, Tao J, Li JZ, et al. Gastric myeloid sarcoma without acute myeloblastic leukemia. World J Gastroenterol. 2015;21(7):2242-2248. doi:10.3748/wjg.v21.i7.2242

Gadage V, Zutshi G, Menon S, Shet T, Gupta S. Gastric myeloid sarcoma--a report of two cases addressing diagnostic issues. Indian J Pathol Microbiol. 2011;54(4):832-835. doi:10.4103/0377-4929.91544

Mesa RA, Verstovsek S, Cervantes F, et al. Primary myelofibrosis (PMF), post polycythemia vera myelofibrosis (post-PV MF), post essential thrombocythemia myelofibrosis (post-ET MF), blast phase PMF (PMF-BP): consensus on terminology by the international working group for myelofibrosis research and treatment (IWG-MRT). Leuk Res. 2007;31(6):737-740. doi:10.1016/j.leukres.2006.12.002

Tefferi A, Barbui T. Polycythemia vera and essential thrombocythemia: 2017 update on diagnosis, risk-stratification, and management. Am J Hematol. 2017;92(1):94-108. doi:10.1002/ajh.24607

Nafil H, Tazi I, Mahmal L. Myeloid sarcoma developing in prexisting hydroxyurea-induced leg ulcer in a polycythemia vera patient. Case Rep Med. 2013;2013:497593. doi:10.1155/2013/497593

MacCallum PK, Newbould MJ, Sambrook PS, Burton IE. Extramedullary haemopoietic tumours complicating polycythaemia vera. J Clin Pathol. 1988;41(6):609-614. doi:10.1136/jcp.41.6.609

Finazzi G, Caruso V, Marchioli R, et al. Acute leukemia in polycythemia vera: an analysis of 1638 patients enrolled in a prospective observational study. Blood. 2005;105(7):2664-2670. doi:10.1182/blood-2004-09-3426

Masarova L, Bose P, Daver N, et al. Patients with post-essential thrombocythemia and post-polycythemia vera differ from patients with primary myelofibrosis. Leuk Res. 2017;59:110-116. doi:10.1016/j.leukres.2017.06.001

Singh I, Mikita G, Green D, Risquez C, Sanders A. Pulmonary extra-medullary hematopoiesis and pulmonary hypertension from underlying polycythemia vera: a case series. Pulm Circ. 2017;7(1):261-267. doi:10.1177/2045893217702064

Cerquozzi S, Tefferi A. Blast transformation and fibrotic progression in polycythemia vera and essential thrombocythemia: a literature review of incidence and risk factors. Blood Cancer J. 2015;5(11):e366. doi:10.1038/bcj.2015.95

Karaoglu AO, Kadikoylu G, Yukselen V, Yasa MH, Bolaman Z. Gastrointestinal lesions and helicobacter pylori in patients with myeloproliferative disorders. Saudi Med J. 2004;25(12):1913-1916.

Soylu AR, Buyukasik Y, Cetiner D, et al. Overt gastrointestinal bleeding in haematologic neoplasms. Dig Liver Dis. 2005;37(12):917-922. doi:10.1016/j.dld.2005.07.017

Rebora P, Czene K, Antolini L, Gambacorti Passerini C, Reilly M, Valsecchi MG. Are chronic myeloid leukemia patients more at risk for second malignancies? a population-based study. Am J Epidemiol. 2010;172(9):1028-1033. doi:10.1093/aje/kwq262

Hu B, El Hajj N, Sittler S, Lammert N, Barnes R, Meloni-Ehrig A. Gastric cancer: classification, histology and application of molecular pathology. J Gastrointest Oncol. 2012;3(3):251-261. doi:10.3978/j.issn.2078-6891.2012.021