A Rare Extramedullary Presentation of Acute Myeloid Leukemia: Myeloid Sarcoma Presenting as a Hard Scrotal Swelling.

Myeloid sarcoma is an uncommon extramedullary tumor composed of immature myeloid precursor cells that occurs in association with acute myeloid leukemia (AML) and other myeloid neoplasms. These tumors may arise before, concurrently with, or after the diagnosis of systemic leukemia and can involve numerous anatomical locations, including the skin, lymph nodes, gastrointestinal tract, and soft tissues. Involvement of the scrotum or testis is particularly rare and often presents diagnostic challenges due to its ability to mimic inflammatory or primary neoplastic conditions. We describe a case of a 68-year-old male who presented with persistent scrotal swelling initially treated as a scrotal abscess. Despite repeated incision and drainage procedures, the lesion persisted and was later accompanied by multiple cutaneous nodules involving the torso and lower extremities. Imaging demonstrated a heterogeneously enhancing lesion involving the scrotal wall with extension into the inguinal canal and associated lymphadenopathy. Histopathological examination with immunohistochemistry revealed tumor cells positive for myeloperoxidase and CD34 with a high Ki-67 proliferation index, confirming the diagnosis of multifocal myeloid sarcoma. The patient received induction chemotherapy with cytarabine and daunorubicin along with localized radiotherapy. However, the clinical course was complicated by febrile neutropenia and multiorgan failure, resulting in death four weeks after initiation of therapy. This case highlights the importance of considering hematologic malignancies in patients presenting with atypical or treatment-refractory scrotal swellings. Early biopsy and multidisciplinary evaluation are essential for timely diagnosis and appropriate management.