Chronic myelogenous leukemia presenting with Morel Lavallée lesion: A case report of a rare presentation

Abstract

Chronic myelogenous leukemia (CML) is a myeloproliferative disorder characterized by increased proliferation of the granulocytic cell line within the bone marrow without losing cells' capacity to differentiate, which is reflected by the increased number of granulocytes and their immature precursor in the peripheral blood. 1 The clinical presentation of CML varies, up to 40% of the patients are asymptomatic at presentation. symptomatic patients can present with different complaints such as fatigue, malaise, weight loss, excessive sweating, abdominal fullness, and bleeding episodes due to platelet dysfunction. 2 On a few rare occasions, CML can present initially with soft tissue hematoma, this can be managed by treatment with tyrosine kinase inhibitors as well as conservative measures. 3

Chronic myelogenous leukemia presenting with Morel Lavallee lesion -- case report

“…very rarely, soft tissue hematoma can be the first manifestation of CML. The soft tissue hematoma may be explained by platelet dysfunction, acquired Von Willebrand disease, or acquired Glanzmann's thrombasthenia (3).…”

“…The clonal expansion of dysfunctional megakaryocytes can explain platelet dysfunction in CML, which explains the anticipated improvement in their function following the initiation of tyrosine kinase inhibitors (3,(10)(11)(12).…”

“…This damage is the result of the separation of the hypodermis from the fascial tissue due to a shearing force. Hematoma collection forms due to disruption of the soft tissue's perforating blood and lymphatic vessels (3,13). The subcutaneous tissues beside the greater trochanter are the most frequently affected areas by the Morel-Lavallee lesion (13).…”

“…Systemic symptoms such as fatigue (34 %), malaise (3 %), weight loss (20 %), drenched sweating (15 %), abdominal fullness (15 %), and bleeding episodes due to platelet dysfunction (21%) are the commonest manifestations (2). CML can rarely present with soft tissue hematoma which can be treated with both tyrosine kinase inhibitors and conservative management (3,4). The Morel Lavallee lesion is a close spontaneous soft tissue injury resulting in hematoma collection between fascial layers.…”