Acute Myeloid Leukemia Presenting as Obstructive Jaundice Caused by Granulocytic Sarcoma

Lee, Joo Young; Lee, Wan Suk; Jung, Min Kyu; Cho, Chang Min; Tak, Won Young; Kweon, Young Oh; Kim, Sung Kook; Choi, Yong Hwan; Kim, Jong Gwang; Sohn, Sang Kyun

doi:10.5009/gnl.2007.1.2.182

Cited by 11 publications

(6 citation statements)

References 8 publications

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“…It usually develops in the bones, skin, or lymph nodes. Presentation in the gastrointestinal tract, in particular in the biliary tract, is extremely rare, demonstrated by the lack of studies on this matter [7][8][9][10]. Nevertheless, given the clinical importance, MS should be excluded in case of an obstructive jaundice in a patient with a history of leukemia.…”

Section: Discussionmentioning

confidence: 99%

An Unexpected Cause of Recurrent Jaundice after Resolution of Acute Hepatitis E

Verbeeck

Becker

Reynaert

2020

Case Rep Gastroenterol

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In this report, we describe a rare case of liver enzyme disturbance caused by myeloid sarcoma of the gallbladder and biliary tract. A 63-year-old man with progressive chronic myeloid leukemia presented with acute hepatitis. Viral serology revealed an infection with hepatitis E virus. The liver enzymes and bilirubin improved gradually under treatment with ribavirin, but there was a flair up shortly after. Imaging including CT and echo-endoscopy showed a thickened infiltrated gallbladder wall and dilated bile ducts, suspected for myeloid sarcoma. Biopsy of an atypical skin lesion, present at the same time, confirmed the diagnosis of acute extramedullary leukemia. After induction chemotherapy, hematological improvement was seen together with a decrease of bilirubin and liver enzymes and a normalization of the bile ducts and gallbladder on imaging. However, three months later, myeloid leukemia progressed again, and the patient deceased.

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Section: Discussionmentioning

confidence: 99%

An Unexpected Cause of Recurrent Jaundice after Resolution of Acute Hepatitis E

Verbeeck

Becker

Reynaert

2020

Case Rep Gastroenterol

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“…On the other hand, isolated MSs commonly involve the bone, soft tissue, lymph nodes, gastrointestinal tract, mediastinum and gonads (7,10,15). Several other anatomic sites of MSs have been reported, but the liver has only been involved in a minority of cases (10,(16)(17)(18). Previous case reports have described MS mimicking hepatobiliary malignancies in their presentation.…”

Section: Discussionmentioning

confidence: 99%

“…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: 99%

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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“…Lee et al . [ 3 ] described a case of AML with granulocytic sarcoma obstructing the biliary tract. Granulocytic sarcoma represents masses of granulocytic cells.…”

Section: Discussionmentioning

confidence: 99%

Precursor B-cell acute lymphoblastic leukemia presenting as obstructive jaundice: a case report

et al. 2011

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IntroductionAcute leukemias very rarely present with jaundice. Herein we report a case of precursor B-cell acute lymphoblastic leukemia that presented with jaundice in an adult.Case presentationA 44-year-old Hispanic man presented with right upper quadrant abdominal pain and jaundice. His initial blood work revealed pancytopenia and hyperbilirubinemia. Direct bilirubin was more than 50% of the total. His imaging studies were unremarkable except for hepatomegaly. All blood screening tests for various hepatocellular etiologies were normal. A diagnosis of precursor B-cell acute lymphoblastic leukemia was made upon liver biopsy. It also showed lymphocytic infiltration of the hepatic parenchyma leading to bile stasis. The diagnosis was subsequently confirmed upon bone marrow biopsy. The patient was treated with a hyperfractionated cyclophosphamide/vincristine/doxorubicin/dexamethasone regimen.ConclusionAcute lymphoblastic leukemia should be one of the differential diagnoses that should be considered when initial work-up for jaundice is inconclusive. Some cases of acute lymphoblastic leukemia have been reported in both adults and children to have presented with the initial manifestation of jaundice, but only a few had no radiographic evidence of biliary obstruction. Such presentation can pose a serious diagnostic dilemma for clinicians. This manuscript attempts to highlight it. Moreover, we believe that if acute lymphoblastic leukemia presentations similar to this case continue to be reported in adults or children, a specific immunophenotypic expression and cytogenetic abnormality may be found to be associated with hepatic infiltration by leukemia. This may substantially contribute to the further understanding of the pathophysiology of this hematologic disease.

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Acute Myeloid Leukemia Presenting as Obstructive Jaundice Caused by Granulocytic Sarcoma

Cited by 11 publications

References 8 publications

An Unexpected Cause of Recurrent Jaundice after Resolution of Acute Hepatitis E

An Unexpected Cause of Recurrent Jaundice after Resolution of Acute Hepatitis E

Acute myeloid leukemia masquerading as hepatocellular carcinoma

Precursor B-cell acute lymphoblastic leukemia presenting as obstructive jaundice: a case report

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