LIVER INVOLVEMENT IN ACUTE MYELOID LEUKEMIA: A CASE REPORT
Objective: Although rare, extramedullary involvement can be observed in patients with acute myeloid leukemia (AML). These extramedullary involvements are also known as myeloid sarcoma, granulocytic sarcoma, or chloroma. The most common sites of involvement are soft tissues, bone, periosteum, and lym...
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Elsevier
2024-12-01
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| Series: | Hematology, Transfusion and Cell Therapy |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2531137924028761 |
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| author | Nida Akgül Ali Doğan Cihan Ural Ramazan İpek |
| author_facet | Nida Akgül Ali Doğan Cihan Ural Ramazan İpek |
| author_sort | Nida Akgül |
| collection | DOAJ |
| description | Objective: Although rare, extramedullary involvement can be observed in patients with acute myeloid leukemia (AML). These extramedullary involvements are also known as myeloid sarcoma, granulocytic sarcoma, or chloroma. The most common sites of involvement are soft tissues, bone, periosteum, and lymph nodes. Patients with extramedullary involvement may exhibit a more aggressive clinical course. In this case report, we evaluated an AML patient with liver involvement at the time of diagnosis. Case Report: A 66-year-old female patient presented to our hospital with complaints of fatigue, bruising on the skin, and yellowing of the eyes for about a month. Physical examination revealed icterus in the sclera, and widespread ecchymoses on the arms and abdomen. Laboratory findings showed a hemoglobin level of 7.8 g/dL, a leukocyte count of 4.4 × 10^9/L, a neutrophil count of 1.1 × 10^9/L, a platelet count of 30 × 10^9/L, CRP at 29 mg/L, and direct bilirubin at 5.8 mg/dL. Peripheral blood smear revealed notable myeloblasts and auer rods. Bone marrow aspiration smear showed over 20% myeloblasts, supporting the diagnosis of acute myeloid leukemia. Flow cytometry analysis was evaluated as consistent with AML. Abdominal ultrasonography revealed the liver was 19.5 cm and the spleen was 16 cm in size. The patient underwent 7+3 remission induction chemotherapy. After chemotherapy, bilirubin levels returned to normal, and the patient was diagnosed with liver involvement of AML. Conclusion: The clinical presentation of extramedullary involvement varies depending on the affected organ and region. A definitive diagnosis is made through biopsy. In patients with AML, as in our case, a biopsy may not always be feasible due to the risk of bleeding. Therefore, in cases where hepatomegaly, abnormalities in liver function tests, and elevated bilirubin levels cannot be explained by other diseases, liver involvement should be considered. |
| format | Article |
| id | doaj-art-f6ab5e6b9c3643c6bee4f60e9df14ee9 |
| institution | Kabale University |
| issn | 2531-1379 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Hematology, Transfusion and Cell Therapy |
| spelling | doaj-art-f6ab5e6b9c3643c6bee4f60e9df14ee92024-12-26T08:57:02ZengElsevierHematology, Transfusion and Cell Therapy2531-13792024-12-0146S45S46LIVER INVOLVEMENT IN ACUTE MYELOID LEUKEMIA: A CASE REPORTNida Akgül0Ali Doğan1Cihan Ural2Ramazan İpek3Van Yuzuncu Yıl University Faculty of Medicine, Department of Hematology; Corresponding author.Van Yuzuncu Yıl University Faculty of Medicine, Department of HematologyVan Yuzuncu Yıl University Faculty of Medicine, Department of HematologyVan Yuzuncu Yıl University Faculty of Medicine, Department of HematologyObjective: Although rare, extramedullary involvement can be observed in patients with acute myeloid leukemia (AML). These extramedullary involvements are also known as myeloid sarcoma, granulocytic sarcoma, or chloroma. The most common sites of involvement are soft tissues, bone, periosteum, and lymph nodes. Patients with extramedullary involvement may exhibit a more aggressive clinical course. In this case report, we evaluated an AML patient with liver involvement at the time of diagnosis. Case Report: A 66-year-old female patient presented to our hospital with complaints of fatigue, bruising on the skin, and yellowing of the eyes for about a month. Physical examination revealed icterus in the sclera, and widespread ecchymoses on the arms and abdomen. Laboratory findings showed a hemoglobin level of 7.8 g/dL, a leukocyte count of 4.4 × 10^9/L, a neutrophil count of 1.1 × 10^9/L, a platelet count of 30 × 10^9/L, CRP at 29 mg/L, and direct bilirubin at 5.8 mg/dL. Peripheral blood smear revealed notable myeloblasts and auer rods. Bone marrow aspiration smear showed over 20% myeloblasts, supporting the diagnosis of acute myeloid leukemia. Flow cytometry analysis was evaluated as consistent with AML. Abdominal ultrasonography revealed the liver was 19.5 cm and the spleen was 16 cm in size. The patient underwent 7+3 remission induction chemotherapy. After chemotherapy, bilirubin levels returned to normal, and the patient was diagnosed with liver involvement of AML. Conclusion: The clinical presentation of extramedullary involvement varies depending on the affected organ and region. A definitive diagnosis is made through biopsy. In patients with AML, as in our case, a biopsy may not always be feasible due to the risk of bleeding. Therefore, in cases where hepatomegaly, abnormalities in liver function tests, and elevated bilirubin levels cannot be explained by other diseases, liver involvement should be considered.http://www.sciencedirect.com/science/article/pii/S2531137924028761 |
| spellingShingle | Nida Akgül Ali Doğan Cihan Ural Ramazan İpek LIVER INVOLVEMENT IN ACUTE MYELOID LEUKEMIA: A CASE REPORT Hematology, Transfusion and Cell Therapy |
| title | LIVER INVOLVEMENT IN ACUTE MYELOID LEUKEMIA: A CASE REPORT |
| title_full | LIVER INVOLVEMENT IN ACUTE MYELOID LEUKEMIA: A CASE REPORT |
| title_fullStr | LIVER INVOLVEMENT IN ACUTE MYELOID LEUKEMIA: A CASE REPORT |
| title_full_unstemmed | LIVER INVOLVEMENT IN ACUTE MYELOID LEUKEMIA: A CASE REPORT |
| title_short | LIVER INVOLVEMENT IN ACUTE MYELOID LEUKEMIA: A CASE REPORT |
| title_sort | liver involvement in acute myeloid leukemia a case report |
| url | http://www.sciencedirect.com/science/article/pii/S2531137924028761 |
| work_keys_str_mv | AT nidaakgul liverinvolvementinacutemyeloidleukemiaacasereport AT alidogan liverinvolvementinacutemyeloidleukemiaacasereport AT cihanural liverinvolvementinacutemyeloidleukemiaacasereport AT ramazanipek liverinvolvementinacutemyeloidleukemiaacasereport |