Acute myelogenous leukemia and acute leukemic appendicitis: a case report

Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan, China.
World Journal of Gastroenterology (Impact Factor: 2.37). 11/2009; 15(44):5624-5.
Source: PubMed


Acute myelogenous leukemia (AML) can involve the gastrointestinal tract but rarely involves the appendix. We report a male patient who had 1 year partial remission from AML and who presented with apparent acute appendicitis as the initial manifestation of leukemia relapse. Pathological findings of the appendix revealed transmural infiltrates of myeloblasts, which indicated a diagnosis of leukemia. Unfortunately, the patient died from progression of the disease on the 19th d after admission. Although leukemic cell infiltration of the appendix is uncommon, patients with leukemia relapse can present with symptoms mimicking acute appendicitis.

Full-text preview

Available from:
  • Source
    • "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]. The four cases described by Prolla all died within days and autopsies revealed hemorrhagic appendicitis. "
    [Show abstract] [Hide abstract]
    ABSTRACT: 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.
    Full-text · Article · Jun 2013
  • Source
    • "CT imaging might show focal bowel wall thickening, a single mass, polyps, multiple masses obstructing the gut lumen, or exophytic lesions involving the peritoneum [12]. There have been cases of myeloid sarcoma localized to the oral cavity [13], esophagus, stomach, jejunum [14–16], gallbladder [17], bile ducts [18], pancreas [19, 20], colon [21], liver [21], or appendix [22] or may diffusely involve the GI tract [23–25] including the abdominal wall [26]. When small and large bowels are involved, it is more likely to spread to the mesentery and peritoneum. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Myeloid Sarcoma is a rare tumor composed of myeloblasts occurring at an extramedullary site like bones, or various soft tissues. Myeloid sarcoma may involve the gastrointestinal tract very rarely either solitarily, or occurring simultaneously with acute myeloid leukemia. Its diagnosis is challenging and needs biopsy and immunohistochemical staining. We are describing a case of myeloid sarcoma which presented as a painful anal ulcer mimicking an atypical fissure. Its appearance resembled crohn's disease on sigmoidoscopy. A biopsy of the ulcer along with histochemical staining led to the diagnosis of myeloid sarcoma. Our case demonstrates the need for aggressive evaluation of any common gastrointestinal complaint with an atypical presentation.
    Full-text · Article · May 2012 · Case Reports in Medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: In neutropenic patients with acute leukemia, acute abdomen which is usually attributed to typhlitis may be encountered. However, the diagnosis of acute appendicitis is rarely described or confirmed. Methods and Materials: A retrospective study of acute appendicitis in adult patients with acute leukemia was conducted at the Riyadh Armed Forces Hospital between January 1991 and December 2002 and then the study was continued at King Faisal Specialist Hospital and Research Centre in Riyadh between January 2004 and December 2006. Results: Acute appendicitis developed in three out of 408 patients with acute leukemia treated at both institutions. The incidence of acute appendicitis in adult patients with acute leukemia was 0.74%. Acute appendicitis was encountered during the neutropenic periods following the courses of cytotoxic chemotherapy given to control the leukemia. The three study patients were males and they presented with the classical clinical manifestations of acute appendicitis and they underwent successful appendicectomies. The radiological inves- tigations were helpful in confirming the clinical diagnoses. Compared to the control group of patients, the study patients developed acute leukemia at a younger age and they also had higher rates of: infectious complications, relapse and mortality but lower rate of cytogenetic abnormalities and extramedullary disease. Conclusions: The development of acute appendicitis in neutropenic patients with acute leukemia is an extremely rare event. The combination of the classical clinical manifestations as well as the compatible radiological features is essential diagnostically. Taking a decision to operate on these immunocompromised patients during the periods of severe pancytopenia is a real challenge to surgeons and hematologists. However, surgical intervention may be associated with long term complications such as relapse of the leukemia, infec- tious complications and decreased survival.
    No preview · Article ·
Show more