Chronic lymphoid leukemia metastasis to the gallbladder as a focal mass: A case report

Abstract

Chronic lymphocytic leukemia (CLL) is the second most common hematologic malignancy, and it is characterized by lymphocytic leukocytosis and secondary hematologic deficiencies. While it most commonly presents as a systemic disease, extramedullary involvement may rarely occur. The literature surrounding CLL metastatic disease to the gallbladder is particularly sparse. Interestingly, we describe a case of a 67-year-old female who presented with painless jaundice and was found to have a rapidly growing gallbladder wall mass which was determined to be CLL metastatic disease after extensive surgical resection. It is important for radiologists to recognize the possibility of CLL metastatic disease to the gallbladder when evaluating potential cases of cholecystitis due to the overlapping spectrum of imaging findings. Cognizant radiologists can potentially save patients from surgical intervention as CLL is classically treated with chemotherapy.

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

“…Over the years, several case reports have documented primary or secondary involvement of liver, gallbladder, and biliary tract by acute and chronic lymphoid [ 5 – 15 ] or acute and chronic myeloid [ 16 – 19 ] leukemia. These are listed in Table 1 .…”

“…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 …”

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

“…Positivity for IHC stains CD79a, CD10, CD 4, and TdT is also seen in B lymphoblasts in cases of B-ALL. However, cyclin D1 is negative [ 9 , 15 ]. T-cell lineage is indicated by positivity for CD1a, CD3, CD4, CD5, CD68, and CD43 [ 7 ].…”