Acute myeloid leukaemia presenting as cholestatic hepatitis

Wandroo, Farooq; Murray, J.A.; Mutimer, D.J.; Hübscher, Stefan G.

doi:10.1136/jcp.2003.013565

Cited by 22 publications

(13 citation statements)

References 7 publications

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“…Healthy volunteers (HV) and acute myelogenous leukemia (AML) were taken as control groups with no liver disease. Liver dysfunction is a rare complication of AML (43) and in one study of AML and acute lymphoblastic leukemia in Nepal (44), abnormal liver function tests (LFTs) were recorded in a subset of the patients. LFTs were within normal ranges for the 22 AML patients described in this study.…”

Section: Discussionmentioning

confidence: 99%

Aberrant Lipid Metabolism in Hepatocellular Carcinoma Revealed by Plasma Metabolomics and Lipid Profiling

et al. 2011

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There has been limited analysis of the effects of hepatocellular carcinoma (HCC) on liver metabolism and circulating endogenous metabolites. Here we report the findings of a plasma metabolomic investigation of HCC patients using ultraperformance liquid chromatography-electrospray ionization-quadrupole mass spectrometry (UPLC-ESI-QTOFMS), random forests machine learning algorithm and multivariate data analysis. Control subjects included healthy individuals as well as patients with liver cirrhosis or acute myeloid leukemia. We found that HCC was associated with increased plasma levels of glycodeoxycholate, deoxycholate 3-sulfate and bilirubin. Accurate mass measurement also indicated upregulation of biliverdin and the fetal bile acids 7α-hydroxy-3-oxochol-4-en-24-oic acid and 3-oxochol-4,6-dien-24-oic acid in HCC patients. A quantitative lipid profiling of patient plasma was also performed using ultra-performance liquid chromatography-electrospray ionization-triple quadrupole mass spectrometry (UPLC-ESI-TQMS). Using this method we found that that HCC was associated also with reduced levels of lysophosphocholines (LPC) and in 4/20 patients with increased levels of lysophosphatidic acid (LPA(16:0)), where it correlated with plasma α-fetoprotein levels. Interestingly, when fatty acids were quantitatively profiled by gas chromatography-mass spectrometry (GCMS), we found that lignoceric acid (24:0) and nervonic acid (24:1) were virtually absent from HCC plasma. Overall, this investigation illustrates the power of the new discovery technologies represented in the UPLC-ESI-QTOFMS platform combined with the targeted, quantitative platforms of UPLC-ESI-TQMS and GCMS for conducting metabolomic investigations that can engender new insights into cancer pathobiology.

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Section: Discussionmentioning

confidence: 99%

Aberrant Lipid Metabolism in Hepatocellular Carcinoma Revealed by Plasma Metabolomics and Lipid Profiling

et al. 2011

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“…Previous case reports have described MS mimicking hepatobiliary malignancies in their presentation. While some cases had an extra-hepatic biliary ductal lesion appearing similar Klatskin tumors (16)(17)(18), others were associated with diffuse myeloid infiltration of liver sinusoids without a definitive liver mass (19)(20). To our knowledge, there are no reported cases of de novo AML presenting as a MS that mimics focal HCC in its radiographic appearance.…”

Section: Discussionmentioning

confidence: 79%

Acute myeloid leukemia masquerading as hepatocellular carcinoma

Abu‐Zeinah

Weisman

Ganesh

et al. 2016

J. Gastrointest. Oncol.

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A 64-year-old Caucasian man developed progressive fatigue, abdominal distension, and 25 pounds weight loss (10% of his body weight) over a month period. His outpatient workup included an abdominal ultrasound that revealed a large liver mass. Magnetic resonance imaging confirmed a solitary 11 cm mass with central necrosis within segments 6 and 7 of the right hepatic lobe. The patient had no history of excessive alcohol intake, viral hepatitis, steatosis or liver cirrhosis. An alpha-fetoprotein (AFP) level was 7.9 ng/mL. Given the features of the liver mass on imaging, and despite the lack of cirrhosis and elevated AFP, a diagnosis of hepatocellular carcinoma (HCC) was presumed and the patient was considered for hepatobiliary surgery.In the interim, the patient had rapid functional decline. He was admitted for fever (39 ℃), confusion and back pain. The physical exam was notable for altered mental status and flapping tremor without meningismus, lower extremity weakness or focal neurologic findings. Laboratory studies revealed a white blood count (WBC) of 3.0×10 3 /µL, Abstract: Hepatocellular carcinoma (HCC) is often diagnosed on the basis of high quality imaging without a biopsy in the cirrhotic liver. This is a case of a 64-year-old Caucasian man with no history of liver disease or cirrhosis that presented with fatigue, weight loss, and abdominal distension and was found to have a large, isolated liver mass with arterial enhancement and portal venous washout on triple-phase computed tomography (CT) suspicious for HCC. The patient was initially referred for a surgical evaluation.Meanwhile, he developed fevers, pancytopenia, and worsening back pain, and a subsequent spinal MRI revealed a heterogeneous bone marrow signal suspicious for metastatic disease. A bone marrow biopsy that followed was diffusely necrotic. A core biopsy of the patient's liver mass was then performed and was diagnostic of acute monocytic-monoblastic leukemia. Findings from peripheral flow cytometry and a repeat bone marrow biopsy were also consistent with this diagnosis, and induction chemotherapy with cytarabine and idarubicin was initiated. This case describes a rare presentation of myeloid sarcoma (MS) as an isolated, hypervascular liver mass that mimics HCC in its radiographic appearance. Due to the broad differential for a liver mass, a confirmatory biopsy should routinely be considered prior to surgical intervention.

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“…Wandroo et al presented infiltrates leading to cholestatic hepatitis [6]. Leukemic infiltration of the bowel [4, 7] and pulmonary infiltration have frequently been described [1, 8, 9].…”

Section: Discussionmentioning

confidence: 99%

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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Acute myeloid leukaemia presenting as cholestatic hepatitis

Cited by 22 publications

References 7 publications

Aberrant Lipid Metabolism in Hepatocellular Carcinoma Revealed by Plasma Metabolomics and Lipid Profiling

Aberrant Lipid Metabolism in Hepatocellular Carcinoma Revealed by Plasma Metabolomics and Lipid Profiling

Acute myeloid leukemia masquerading as hepatocellular carcinoma

Acute Myeloid Leukemia Presenting as Acute Appendicitis

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