Leukaemic infiltration of gall bladder – unusual presentation of occult chronic lymphocytic leukaemia

Rao, V; Watkins, R M; Kaleem, AZ; Jp, Cooke; Wedgwood, K. R.

doi:10.1093/jscr/2011.1.7

Cited by 5 publications

(4 citation statements)

References 9 publications

(9 reference statements)

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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%

“…Most cases of leukemic infiltration of gallbladder present with clinicopathological features closely resembling acute and/or chronic cholecystitis [ 6 , 11 – 13 , 16 , 17 ]. Azin et al reported a patient with known AML who received chemotherapy and achieved a morphological free state.…”

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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“…Ratterman et al, in the systematic analysis of cases reported between 1975 and 2012, states that the central nervous system (CNS) and skin were the most commonly identified sites of spread, with some evidence that prognosis could be related to the location of involvement [6]. Less commonly, the involvement of the prostate, gallbladder, pituitary, thyroid, orbit, nasal mucosa has been reported [5,7]. Rarely, endocardial deposits can be seen with intracavitary growth and even rarer tumor infiltration of heart valves [8].…”

Section: Discussionmentioning

confidence: 99%

Chronic Lymphocytic Leukemia of the Aortic Valve: A Case Report

Posch¹,

Prince²,

Thompson³

et al. 2021

Cureus

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Chronic lymphocytic leukemia (CLL) is characterized by the chronic accumulation of mature B-cell lymphocytes in the bone marrow. CLL accounts for approximately one-quarter of new leukemia cases each year and is the most common leukemia in Western countries. Most notably, this leukemia involves the lymph nodes, spleen, and liver, whereas non-lymphoid tissue is seldom associated with CLL infiltration. A large percentage of patients are asymptomatic at presentation; however, for those who are symptomatic, lymphadenopathy is the most common presenting complaint. This is the case of a 75-year-old Caucasian male with CLL on ibrutinib who presented with chest pressure and worsening shortness of breath. The patient underwent cardiac catheterization, which revealed demonstrable aortic stenosis. His aortic valve was subsequently replaced, and tissue was sent for histochemical analysis. Stains were positive for CD20, BCL2, CD5, and CD23, compatible with the CLL of the valve. To be able to investigate those with a known leukemic disease in patients with valvular disease would be beneficial to clinicians as CLL can present in atypical locations.

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“…T-cell neoplasms reported as part of composite lymphoma (or possible transformation) with CLL/SLL have been of cytotoxic CD8 + T cell immunophenotype and we are unaware of any reports of cases similar to the case we report. Incidental CLL/SLL found in lymph nodes evaluated for other reasons is not an uncommon event [47–50]; however, the incidental finding of T-PLL is rare [4]. The presence of CLL/SLL in the dissected lymph node, though in a rare follicular pattern [51], in conjunction with a CLL/SLL clone in the peripheral blood, led to inadvertent failure to diagnose the concurrent T-PLL in the same lymph node.…”

Section: Discussionmentioning

confidence: 99%

Composite Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma and T-Prolymphocytic Leukemia Presenting with Lymphocytosis, Skin Lesions, and Generalized Lymphadenopathy

Sakhdari

Tang

Ginsberg

et al. 2019

Case Reports in Pathology

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Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in Western countries with an incidence of 3-5 cases per 100,000 persons. Most patients follow an indolent clinical course with eventual progression and need for therapy. In contrast, T-prolymphocytic leukemia (T-PLL) is a rare type of T-cell leukemia with most patients having an aggressive clinical course and a dismal prognosis. Therapies are limited for T-PLL patients and there is a high relapse rate. Morphologically, the cells of CLL and T-PLL can show overlapping features. Here, we report the case of a 61-year-old man who presented with a clinically indolent CLL and T-PLL, initially diagnosed solely and followed as CLL, despite the presence of an associated but unrecognized aberrant T-cell population in blood. After 2 years, the T-PLL component became more apparent with cutaneous and hematologic manifestations and the diagnosis was confirmed by immunophenotypic and cytogenetic analysis. Fluorescence in situ hybridization demonstrated an ATM deletion in both CLL and T-PLL components. Retrospective testing demonstrated that composite CLL and T-PLL were both present in skin and lymph nodes as well as in blood and bone marrow since initial presentation. This case is also unique because it highlights that a subset of T-PLL patients can present with clinically indolent disease. The concomitant detection of ATM mutation in CLL and T-PLL components raises the possibility of a common pathogenic mechanism.

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Leukaemic infiltration of gall bladder – unusual presentation of occult chronic lymphocytic leukaemia

Cited by 5 publications

References 9 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

Chronic Lymphocytic Leukemia of the Aortic Valve: A Case Report

Composite Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma and T-Prolymphocytic Leukemia Presenting with Lymphocytosis, Skin Lesions, and Generalized Lymphadenopathy

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