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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 17  |  Issue : 1  |  Page : 40-41

Acute myelogenous leukemia revealed by acute appendicitis


Department of Pediatrics, University Hospital Center Mohammed VI, Oujda, Morocco

Date of Submission19-Nov-2019
Date of Acceptance30-Dec-2019
Date of Web Publication17-Mar-2020

Correspondence Address:
Sanae El Marzguioui
Department of Pédiatrics, University Hospital Center Mohammed VI, Oujda, Morocco. BP: 4806, Oujda University, Oujda 60049
Morocco
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_73_19

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  Abstract 


Acute myelogenous leukemia can rarely involve the digestive tract. We report a case of a girl of 9 years old, admitted for surgical abdomen and operated for acute appendicitis. Complete blood count showed pancytopenia. The pathology study showed appendicular localization of acute myelogenous leukemia.

Keywords: Acute myelogenous leukemia, appendicitis, blasts, pancytopenia, pathology


How to cite this article:
El Marzguioui S, Benameur S, Babakhouya A, Rkain M, Benajiba N. Acute myelogenous leukemia revealed by acute appendicitis. Apollo Med 2020;17:40-1

How to cite this URL:
El Marzguioui S, Benameur S, Babakhouya A, Rkain M, Benajiba N. Acute myelogenous leukemia revealed by acute appendicitis. Apollo Med [serial online] 2020 [cited 2020 Sep 22];17:40-1. Available from: http://www.apollomedicine.org/text.asp?2020/17/1/40/280915




  Introduction Top


Acute myeloid leukemia (AML) is characterized by a block in differentiation and an unregulated proliferation of myeloid progenitor cells.[1] It comprises about 20% of acute leukemias in children.[2] Extramedullary infiltration is often seen in AML. However, leukemic cell infiltration of the appendix is rare.[3] We report a case of AML revealed by acute appendicitis due to leukemic cell infiltration.


  Case Report Top


A 9-year-old girl, who consulted for abdominal pain and fever evolving for 2 weeks before her admission, was treated traditionally in the beginning, but evolution was marked by persistence of fever and worsening of abdominal pain what motivated her consultation. Medical history was unremarkable.

On admission, physical examination showed right lower quadrant tenderness at McBurney's point with muscle rigidness, she was pale and her general state was altered, and there was neither hepatosplenomegaly nor enlarged lymph nodes. An abdominal ultrasound examination showed a larger and distended appendix with thickened wall. The diagnosis of acute appendicitis was made, and open appendectomy was performed immediately. In surgery, his appendix was found phlegmonous and necrotic. The operative sequences were simple.

Complete blood count was as follows: hemoglobin – 7.4 g/dL, white blood cell – 19710/μl, neutrophils – 119/μl, and platelet 85,000/μl. C-reactive protein was 338 mg/dL. Blood urea, serum creatinine, blood electrolytes, calcium, alkaline phosphatase, and albumin were all within the normal limits. Lactate dehydrogenase was increased: 1350 U/L (normal values: 125–243 U/L). Peripheral blood smear showed 90% of blasts, Bone marrow aspirtation smear showed infiltration of bone marrow by monoblastic blasts at 95%, and myeloperoxidase staining was positive confirming the diagnosis of acute myelogenous leukemia type a5 according to the FAB classification.

The pathology study showed profuse blastic cell infiltration in the appendiceal wall throughout its thickness, and multiple zones of tumor necrosis and ulceration were also observed.

Immunohistochemistry confirmed that these atypical mononuclear cells had a myeloid origin with immunoreactivity to CD45 and bcl2. Those cells showed also focal positivity by myeloperoxidase staining [Figure 1].
Figure 1:(a) Cross-section of the appendix specimen(H and E, ×4).(b) Infiltration of the appendix by monomorphic leukemic cells (H and E, ×40). (c) These tumor cells are immunoreactive to myeloperoxidase protein (×40)

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The proliferation index is estimated at 80%. Hence, the diagnosis of appendicular localization of AML was made.

After the surgery, the patient developed operative wound infection, and she was given adequate antibiotic therapy.


  Discussion Top


Extramedullary disease may present with adenopathy and hepatosplenomegaly. Otherwise, chloroma or peripheral collections of leukemic blast cells may occur in the soft tissues, skin (leukemia cutis), gingivae, orbit, or elsewhere.[1]

Infiltration of leukemic cells in the appendix is rare in AML. Most of the symptomatic cases happened in the course of leukemia relapse or progression.[3] Limited cases have been reported in the literature.[3] It has been reported that appendiceal involvement by leukemic cells occurs in approximately three of 36 patients (8.3%).[4] Patients with acute abdomen, such as acute appendicitis, need early surgery.[5] Systemic chemotherapy is necessary in this setting for additional radiation.[4] However, this condition is associated with a poor prognosis in the long run.[3]


  Conclusion Top


We experienced a rare case of acute myelogenous leukemia revealed by acute appendicitis at initial presentation. Besides the commonly involved sites such as the skin, lymph node, soft tissue, and testis, infiltration of leukemic cells in the appendix is rare in AML.[3] Our case highlights the importance of sending all appendectomies to pathological study and verification of blood analyses.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Langmuir PB, Aplenc R, Lange BJ. Acute myeloid leukaemia in children. Best Prac Res Clin Haematol 2001;14:77-93.  Back to cited text no. 1
    
2.
Arya LS. Acute myeloid leukemia in children and adolescents: Current treatment strategies. Apollo Med 2008;5:168-77.  Back to cited text no. 2
    
3.
Shen K, Yang CL, Cui X, Liu T. Acute myeloid leukemia masquerading as acute appendicitis. Chin Med J (Engl) 2017;130:623-4.  Back to cited text no. 3
    
4.
Hsiao PJ, Kuo SM, Chen JH, Lin HF, Chu PL, Lin SH, et al. Acute myelogenous leukemia and acute leukemic appendicitis: A case report. World J Gastroenterol 2009;15:5624-5.  Back to cited text no. 4
    
5.
Toubai T, Kondo Y, Ogawa T, Imai A, Kobayashi N, Ogasawara M, et al. A case of leukemia of the appendix presenting as acute appendicitis. Acta Haematol 2003;109:199-201.  Back to cited text no. 5
    


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