Obstructive Jaundice as Initial Presentation of Acute Myeloid Leukemia
Abstract
Introduction:Myeloid sarcoma is a rare extramedullary manifestation of Acute myeloid leukemia(AML). Primary involvement of the biliary tract with myeloid sarcoma is very rare.
Case Presentation:A 29 year old man presented with obstructive jaundice. Magnetic Resonance cholangiopancreatography showed intrahepatic biliary radicle dilatation involving both lobes of liver. There was a mass lesion involving the common hepatic duct, cystic duct and proximal common bile duct. He underwent laparotomy and excision of the mass, cholecystectomy and hepatojejunostomy for a mistaken diagnosis of cholangiocarcinoma. The histopathology was suggestive of myeloid sarcoma. Subsequent bone marrow examination showed AML. He received chemotherapy for AML and continues to be in remission at 2 years.
Conclusion:Isolated biliary involvement by myeloid sarcoma is extremely rare and may be misdiagnosed as as cholangitis or cholecystitis or as cholangiocarcinoma. Biliary myeloid sarcoma should also be included in the differential diagnosis of patients with obstructive jaundice and investigated for AML.
Keywords
References
Goor Y, Goor O, Michalewitcz R, Cabili S. Acute myeloid leukemia presenting as obstructive jaundice. J Clin Gastroenterol. 2002, 34:485-486
Neiman RS, Barcos M, Berard C, Bonner H, Mann R, Rydell RE, Bennett JM. Granulocytic sarcoma: a clinicopathologic study of 61 biopsied cases. Cancer. 1981, 48:1426-1437
Meis JM, Butler JJ, Osborne BM, Manning JT. Granulocytic sarcoma in nonleukemic patients. Cancer. 1986, 58:2697-2709
Morel F, Herry A, Le Bris MJ, Le Calvez G, Marion V, Berthou C, De Braekeleer M. Isolated granulocytic sarcoma followed by acute myelogenous leukemia type FAB-M2 associated with inversion 16 and trisomies 9 and 22. Leukemia. 2002, 16:2458-2459
Lee JY, Lee WS, Jung MK, Jeon SW, Cho CM, Tak WY, Kweon YO, Kim SK, Choi YH, Kim JG, and Sohn SK. Acute Myeloid Leukemia Presenting as Obstructive Jaundice Caused by Granulocytic Sarcoma. Gut Liver. 2007, 1:182-185
Sung CO, Ko YH, Park CK, Jang KT, Heo JS. Isolated Biliary Granulocytic Sarcoma Followed by Acute Myelogeneous Leukemia with Multilineage Dysplasia: A Case Report and Literature Review. J Korean Med Sci. 2006, 21:550-554
Ojima H, Hasegawa T, Matsuno Y, Sakamoto M. Extramedullary myeloid tumour (EMMT) of the gallbladder. J Clin Pathol. 2005, 8:211-213
Ascani S, Piccaluga PP, Pileri SA. Granulocytic sarcoma of main biliary ducts. Br J Haematol. 2003, 121: 534
Byrd JC, Edenfield WJ, Shields DJ, Dawson NA. Extramedullary myeloid cell tumors in acute nonlymphocytic leukemia: a clinical review. J Clin Oncol, 1995, 13:1800-1816
Tsimberidou AM, Kantarjian HM, Estey E, Cortes JE, Verstovsek S, faderl S, Thomas DA, Garcia- Manero G, Ferrajoli A, Manning JT, Keating MJ, Albitar M, O’Brien S, Giles FJ. Outcome in patients with nonleukemic granulocytic sarcoma treated with chemotherapy with or without radiotherapy. Leukemia. 2003, 17:1100-1103
Refbacks
- There are currently no refbacks.
