Asymptomatic Nasopharyngeal Myeloid Sarcoma Presenting With Cervical Lymphadenopathy: A Case Report.

Myeloid sarcoma (MS) is a rare extramedullary myeloid malignancy that may occur with or without bone marrow involvement. Nasopharyngeal cases are exceedingly rare, making diagnosis challenging, and most reported cases present with local symptoms caused by a bulky mass. We report a 64-year-old man with a history of myelodysplastic syndrome who presented with cervical lymphadenopathy without any nasal or otologic symptoms. Endoscopic examination revealed a small, smooth bulging lesion on the left nasopharyngeal wall. Contrast-enhanced computed tomography demonstrated a polypoid mass with bilateral cervical lymphadenopathy. Histopathological and immunohistochemical analyses confirmed MS. Bone marrow evaluation revealed leukemic transformation to acute myeloid leukemia. The patient received combination chemotherapy with venetoclax and azacitidine but died 2 months after treatment initiation. This asymptomatic presentation emphasizes the diagnostic difficulty of MS arising in atypical anatomical locations. Early tissue biopsy and prompt hematologic assessment are essential for accurate diagnosis and timely management. Nasopharyngeal MS should be considered in the differential diagnosis of nasopharyngeal masses, particularly in patients with a history of myelodysplastic or myeloproliferative disorders.