Acute myelogenous leukemia and acute leukemicappendicitis: A case report

Hsiao, Po-Jen; Kuo, Shih-Ming; Chen, Jiahong; Lin, Hsuen-Fu; Chu, Pauling; Lin, Shih‐Hua; Ho, Ching-Liang

doi:10.3748/wjg.15.5624

Cited by 21 publications

(21 citation statements)

References 8 publications

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“…However, there have been reported cases of acute appendicitis as the initial presentation of some leukemia and lymphoma. [1,2] AML can involve the gastrointestinal tract, and has been known to also involve the appendix, as demonstrated by prior reported cases, [1][2][3] but the involvement of the appendix in the subtype APL is rare. [4,5] The involvement of extramedullary sites in APL seen in prior cases have been related to relapse of disease, and it is estimated that approximately 3-5% of patients have an extramedullary relapse [4][5][6] involving the skin, testes, ear lung, pleura, lymph nodes, mediastinum, thymus, vertebrae, breast, pelvic bones, mandible, gingivae, central nervous system specifically with cases being reported with third cranial nerve palsy and another with involvement of the spinal cord with a paravertebral mass.…”

Section: Discussionmentioning

confidence: 88%

Acute leukemic appendicitis in a patient with acute promyelocytic leukemia

et al. 2012

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Leukemic and lymphomatous infiltration of the appendix is a rare complication. We present the case of a 31-year-old male with acute promyelocytic leukemia who developed acute abdomen on day 11 of induction chemotherapy with idarubicin and cytarabine. After appropriate work-up, a clinical diagnosis of acute appendicitis was made. Despite severe pancytopenia, he successfully underwent laparoscopic appendectomy. The final pathology revealed leukemic infiltration of the appendix. It is hypothesized that the leukemic infiltration may play a role in the development of acute appendicitis. Further, this case demonstrates the need to maintain a high index of suspicion and prompt surgical intervention for surgical pathologies in neutropenic patients.

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Section: Discussionmentioning

confidence: 88%

Acute leukemic appendicitis in a patient with acute promyelocytic leukemia

et al. 2012

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“…In the setting of known AML, the differential for acute abdominal pain typically includes acute appendicitis versus typhlitis. Prior case reports typically describe patients receiving chemotherapy who develop abdominal pain and are found to have suppurative appendicitis with surgical intervention [2, 5]. Of the limited cases described of acute appendicitis in patients with leukemia, less than 10 patients were noted to have nonsuppurative leukemic infiltration of the appendix proven on pathological review [2, 7, 10, 11].…”

Section: Discussionmentioning

confidence: 99%

“…Acute appendicitis has infrequently been described in the setting of known acute leukemia and is generally associated with patients receiving active chemotherapy [2]. Leukemic cell infiltration of the appendix, first reported by Rappaport in 1967, is even less-well described [3].…”

Section: Introductionmentioning

confidence: 99%

“…Leukemic cell infiltration of the appendix, first reported by Rappaport in 1967, is even less-well described [3]. Despite the infrequent occurrence, appendicitis in leukemic patients is associated with a higher mortality rate [2, 4]. While appendectomy is accepted as the treatment of choice for appendicitis in patients with acute leukemia [5], diagnosis and prompt management of the leukemia have a greater impact on achieving a complete remission and, thus, overall survival.…”

Section: Introductionmentioning

confidence: 99%

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Acute Myeloid Leukemia Presenting as Acute Appendicitis

Rauenzahn

Armstrong

Curley

et al. 2013

Case Reports in Hematology

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Appendicitis in leukemic patients is uncommon but associated with increased mortality. Additionally, leukemic cell infiltration of the appendix is extremely rare. While appendectomy is the treatment of choice for these patients, diagnosis and management of leukemia have a greater impact on remission and survival. A 59-year-old Caucasian female was admitted to the surgical service with acute right lower quadrant pain, nausea, and anorexia. She was noted to have leukocytosis, anemia, and thrombocytopenia. Abdominal imaging demonstrated appendicitis with retroperitoneal and mesenteric lymphadenopathy for which she underwent laparoscopic appendectomy. Peripheral smear, bone marrow biopsy, and surgical pathology of the appendix demonstrated acute myeloid leukemia (AML) with nonsuppurative appendicitis. In the setting of AML, prior cases described the development of appendicitis with active chemotherapy. Of these cases, less than ten patients had leukemic infiltration of the appendix, leading to leukostasis and nonsuppurative appendicitis. Acute appendicitis with leukemic infiltration as the initial manifestation of AML has only been described in two other cases in the literature with an average associated morbidity of 32.6 days. The prompt management in this case of appendicitis and AML resulted in an overall survival of 185 days.

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“…Although surgical intervention is the standard management for acute appendicitis whether it is leukemic or suppurative, for AML patients, appendectomy is indicative of high operative morbidity and subsequent life-threatening infection even with successful previous cases. [23] Our patient was successfully operated and was given cyto-reductive chemotherapy in time. However, just like the above-mentioned concern, he did not survive the postoperative sepsis due to continuous immuno-impairment status of AML.…”

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confidence: 99%