Spinal cord compression secondary to spinal extradural myeloid sarcoma in acute myeloid leukaemia: A case report and literature review

• Myeloid sarcoma develops from immature myeloid cell progenitors which is an uncommon extra-medullary solid tumor. • Our case is a patient with acute myeloid leukemia (AML) that developed from myelofibrosis who had acute spinal cord compression and was discovered to have myeloid sarcoma (MS) of the thoracic spinal cord. • We address the need for early detection of myeloid sarcoma complications and treatment with appropriate neurosurgical intervention and timing of surgery, much like any other tumor producing spinal cord compression. Myeloid sarcoma (MS) is a rare pathology that includes immature myeloid progenitor cells and is an infrequent form of acute myeloid leukemia (AML). It may occur de novo or be associated with other myeloproliferative disorders. Spinal involvement is rare but has the potential to result in catastrophic neurological consequences if not diagnosed promptly. Here, we present a young patient initially diagnosed with myelofibrosis whose disease evolved to AML and then thoracic extradural MS and acute spinal cord compression. A 27-year-old woman came with paraparesis and worsening upper back pain. MRI demonstrated an extradural mass in the thoracic spine, causing compression of the spinal cord. Urgent decompressive laminectomy and subtotal resection were performed. Histopathology was positive for myeloid precursor cell sheets with myeloperoxidase, CD68, and CD43, which diagnosed MS. Postoperative course was uneventful, and adjuvant chemotherapy was initiated in her. Thoracic spinal MS represents a diagnostic and therapeutic emergency that may arise during leukemic transformation of chronic myeloproliferative neoplasms such as myelofibrosis. Early radiologic evaluation, tissue diagnosis, and immediate surgical decompression are crucial for achieving optimal neurological outcomes. This case highlights maintaining a high suspicion of spinal MS in patients with evolving myeloid diseases since early multimodal treatment can avoid permanent neurological damage and may improve survival.