Acute Liver Failure Because of Chronic Lymphocytic Leukemia: Case Report and Review of the Literature

Esfahani, Khashayar; Gold, Philip J.; Wakil, Salma M.; Michel, René P.; Solymoss, Susan

doi:10.3747/co.v18i1.756

Cited by 16 publications

(7 citation statements)

References 23 publications

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“…Secondary (5): B-cell lymphoma (4 cases), CHL (1 case). 13 Rao et al [ 13 ] 2011 Gallbladder 1 CLL 14 Esfahani et al [ 14 ] 2011 Liver 1 CLL 15 Ozawa et al [ 8 ] 2012 Gallbladder 1 B-LL 16 Psarras et al [ 5 ] 2014 Gallbladder 1 B-LL (primary) 17 Azin et al [ 19 ] 2014 Gallbladder 1 AML 18 Mitropoulos et al [ 20 ] 2015 Gallbladder 1 T-LL (primary) 19 Sayyed et al [ 9 ] 2018 Liver 1 ALL 20 Jafroodifar et al [ 15 ] 2021 Gallbladder 1 CLL 21 Present case report, Rahim et al 2022 Gallbladder 1 B-LL ALL acute lymphoblastic leukemia/lymphoma, B-LL B-lymphoblastic leukemia/lymphoma, T-LL T-lymphoblastic leukemia/lymphoma, CLL chronic lymphocytic leukemia, AML acute myeloid leukemia, FL follicular lymphoma, DLBCL diffuse large B-cell lymphoma, CHL classic Hodgkin lymphoma, MCL Mantle cell lymphoma …”

Section: Discussionmentioning

confidence: 99%

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Secondary involvement of gallbladder by acute lymphoblastic leukemia presenting clinically as cholecystitis in a young patient: a case report

et al. 2023

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Background Primary lymphoma of the liver, gallbladder, and extrahepatic bile ducts or secondary involvement of these organs by leukemia is exceedingly rare. Patients with primary lymphoma or leukemic involvement of the biliary tract and liver often present with symptoms and signs of biliary tract obstruction or inflammation. Case presentation We present a case of a 24-year-old male with biliary tract symptoms who underwent laparoscopic cholecystectomy. His precholecystectomy complete blood count performed on the same morning showed 72% lymphocytes while peripheral blood smears showed approximately 15% blasts. Surgeon went ahead with the procedure. Imaging done prior to surgery showed thickened gallbladder, while the liver, biliary tract, and pancreas did not show any thickening or mass lesion. However, the liver was enlarged. Grossly, the gallbladder wall did not show any stones or discrete mass involving the wall. Instead, there was subtle thickening of the gallbladder wall due to diffuse infiltration by the leukemic infiltrate. This lymphoid population reacted with PAX-5 and TdT immunohistochemical antibodies in a diffuse manner confirming precursor B-cell origin. This patient was found to have B-lymphoblastic leukemia involving his bone marrow on further clinical and diagnostic workup. Patient responded well to chemotherapy and is currently on maintenance treatment. He is well 1.5 years after his diagnosis. Conclusion This case highlights a unique and rare scenario where a previously undiagnosed and unsuspected hematologic malignancy initially presented with clinical features of a chronic inflammatory condition involving an abdominal organ owing to secondary involvement by the malignant infiltrate.

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Section: Discussionmentioning

confidence: 99%

“…Histological examination revealed extensive infiltration by AML [ 19 ]. Liver involvement by CLL leading to liver failure has also been reported [ 10 , 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Secondary involvement of gallbladder by acute lymphoblastic leukemia presenting clinically as cholecystitis in a young patient: a case report

et al. 2023

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“…Although exceedingly rare, hematologic malignancies can cause acute liver failure by massive infiltration of leukemic cells leading to hepatic necrosis. Case reports have described this phenomenon in the setting of ALL, CLL, and adult T‐cell leukemia . In these reported cases, liver transplantation was not pursued because the diagnosis of hematologic malignancy was firmly established up front.…”

Section: Discussionmentioning

confidence: 99%

“…Acute leukemia is an exceedingly rare cause of acute liver failure, although some degree of secondary hepatic involvement is common . There are a few isolated case reports of AML, CLL, and adult T‐cell leukemia leading to acute liver failure . More commonly described is acute liver failure from B‐cell ALL and T‐cell ALL .…”

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confidence: 99%

Liver transplantation in an adolescent with acute liver failure from acute lymphoblastic leukemia

Reddi

Barbas

Castleberry

et al. 2014

Pediatric Transplantation

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The most common identifiable causes of acute liver failure in pediatric patients are infection, drug toxicity, metabolic disease, and autoimmune processes. In many cases, the etiology of acute liver failure cannot be determined. Acute leukemia is an extremely rare cause of acute liver failure, and liver transplantation has traditionally been contraindicated in this setting. We report a case of acute liver failure in a previously healthy 15-yr-old male from pre-B-cell acute lymphoblastic leukemia. He underwent liver transplantation before the diagnosis was established, and has subsequently received chemotherapy for pre-B-cell acute lymphoblastic leukemia. He is currently alive 31 months post-transplantation. The published literature describing acute lymphoblastic leukemia as a cause of acute liver failure is reviewed.

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“…Marked hepatic infiltration leads to a variety of functional derangements of the organ. In rare instances, hepatic involvement in CLL results in severe hepatocyte injury and acute liver failure (Shehab et al 1997;Costa et al 1998;Hasuike et al 2004;Esfahani et al 2011). In one patient, this complication occurred in the setting of chronic hepatitis B, but autopsy revealed nodular and massive invasion of the liver by neoplastic lymphocytes associated with hepatocyte necrosis (Hasuike et al 2004).…”

Section: Hepatic Failure In Cllmentioning

confidence: 99%

B-Cell Non-Hodgkin’s Lymphomas with a Small Cell to Intermediate Cell Phenotype

Zimmermann¹

2016

Tumors and Tumor-Like Lesions of the Hepatobiliary Tract

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B-cell non-Hodgkin's lymphomas (B-cell NHLs) showing a proliferation of small-to medium-sized neoplastic cells have a strong tendency to infiltrate the liver. In particular, small lymphoma cells are capable to circulate and recirculate in the body and to leave the microcirculation in several organs. The most common B-cell NHL is chronic lymphocytic leukemia of the B-cell type. In this slowly progressing neoplasia, the liver is almost always involved. Accumulation of neoplastic cells causes hepatomegaly, a typical and frequent finding, with liver weights slowly increasing over time to sometimes reaching several kilograms. The exterior aspect of the liver may become grayish white, and the cut surface shows numerous small whitish nodules. The histologic substrate is markedly enlarged portal tracts which are densely infiltrated by small neoplastic lymphocytes. In long-standing disease, larger nodular lesions can develop, mimicking metastatic disease. A similar type of liver involvement is seen in the rare B-cell prolymphocytic leukemia. Focal and nodular hepatic infiltration is also observed in follicular NHL, mantle cell lymphoma, and extranodal marginal zone B-cell NHL of mucosa-associated lymphoid tissue/MALT. Chronic B-Cell Lymphocytic Leukemia (Small B-Cell Lymphocytic Lymphoma; B-CLL/SLL) ICD-O code 9823/3 play a role for the survival of follicular neoplastic B cells (Amé-Thomas et al. 2012).

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Acute Liver Failure Because of Chronic Lymphocytic Leukemia: Case Report and Review of the Literature

Cited by 16 publications

References 23 publications

Secondary involvement of gallbladder by acute lymphoblastic leukemia presenting clinically as cholecystitis in a young patient: a case report

Secondary involvement of gallbladder by acute lymphoblastic leukemia presenting clinically as cholecystitis in a young patient: a case report

Liver transplantation in an adolescent with acute liver failure from acute lymphoblastic leukemia

B-Cell Non-Hodgkin’s Lymphomas with a Small Cell to Intermediate Cell Phenotype

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