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Hosokawa T, Sato Y, Tanami Y, Arakawa Y, Deie K, Iwama I, Kawashima H, Oguma E. Incidence and Diagnostic Performance of Ultrasound for Abdominal Organ Involvements (Liver, Spleen, Renal, Pancreas, and Gastrointestinal Tract) in Pediatric Patients With Hematological Malignancy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2025. [PMID: 40375648 DOI: 10.1002/jcu.24083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Revised: 04/04/2025] [Accepted: 04/22/2025] [Indexed: 05/18/2025]
Abstract
OBJECTIVES To demonstrate abdominal organ (liver, spleen, renal, pancreatic, and gastrointestinal tract) involvement incidence in pediatric patients with hematological malignancy and describe the diagnostic performance of ultrasound in detecting this involvement. METHODS Sixty-five pediatric patients with hematological malignancies who underwent ultrasound before other imaging examinations, such as computed tomography or fluorodeoxyglucose positron emission tomography, were reviewed. To assess the diagnostic performance of ultrasound for abdominal organ involvement, results were compared with other imaging findings. RESULTS Thirty-four patients (52.3%) exhibited abdominal organ involvement (liver, 40.0% [26/65]; spleen, 38.5% [25/65]; kidney, 12.3% [8/65]; pancreas, 6.2% [4/65]; and gastrointestinal tract, 7.7% [5/65]). Sonography could detect 22 of 26, 23 of 25, five of eight, three of four, and four of five cases of liver, spleen, renal, and pancreas involvement, respectively. Diagnostic accuracy, sensitivity, and specificity for sonography were 93.8%, 88.5%, and 0% (liver), 96.9%, 92.0%, and 0% (spleen), 95.4%, 62.5%, and 0% (kidney), 98.5%, 75%, and 0% (pancreas), and 98.5%, 80%, and 0% (gastrointestinal tract), respectively. CONCLUSIONS Abdominal organ involvement incidence in hematological malignancies was 52.3%. Ultrasound provided reliable diagnostic performance for the initial evaluation of these involvements, and physicians could rapidly plan adequate further examinations based on these results.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yuki Arakawa
- Department of Hematology and Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Kyoichi Deie
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Itaru Iwama
- Department of Hepatology and Gastroenterology, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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Alkhouli L, Zein NA. Acute lymphoblastic leukemia with pancreatic infiltration: Atypical presentation of a common disease in a 3-month-old infant: A case report. Pediatr Blood Cancer 2023; 70:e30306. [PMID: 36965193 DOI: 10.1002/pbc.30306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 03/27/2023]
Affiliation(s)
- Laila Alkhouli
- Pediatric Residency Program, Department of Paediatrics, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Naser Al Zein
- Division of Hematology/Oncology, Department of Paediatrics, Sheikh Khalifa Medical City, Abu Dhabi, UAE
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Yang WX, An K, Liu GF, Zhou HY, Gao JC. Acute pancreatitis as initial presentation of acute myeloid leukemia-M2 subtype: A case report. World J Clin Cases 2023; 11:1385-1392. [PMID: 36926134 PMCID: PMC10013121 DOI: 10.12998/wjcc.v11.i6.1385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/30/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Direct infiltration of the pancreas by acute myeloid leukemia (AML) with acute pancreatitis (AP) as an initial symptom is extremely rare. Only once in the literature, the leukemia cells in AML have been implicated as the cause of AP. Pancreatitis caused by a rare predisposing factor is often misdiagnosed as idiopathic pancreatitis or pancreatitis of other common causes. Severe AP (SAP) progresses rapidly with a high fatality rate. Therefore, it is important to identify the predisposing factors in the early stage of SAP, evaluate the condition, determine prognosis, formulate treatment plans, and prevent a recurrence. Here, we describe a case of SAP due to AML.
CASE SUMMARY A 61-year-old man presented to the hospital with fever and persistent abdominal pain. Blood analysis presented significantly elevated serum amylase and severe thrombocytopenia. Computed tomography examination of the abdomen revealed peripancreatic inflammatory effusion. The patient had no common etiologies and risk factors for AP, but the concurrent severe thrombocytopenia could not be explained by pancreatitis. Finally, the bone marrow aspirate and biopsy inspection revealed the underlying reason for pancreatitis, AML (M2 type based on the French-American-British classifications system).
CONCLUSION Direct infiltration of the pancrease by acute leukemia, particularly AML cells, is an infrequent cause of AP. Therefore, although AP is a rare extramedullary infiltration characteristic for AML patients, it should be considered when determining the etiology of AP.
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Affiliation(s)
- Wen-Xin Yang
- Department of Gastroenterology, Hebei General Hospital, Shijiazhuang 050057, Hebei Province, China
- Graduate School, Hebei Medical University, Shijiazhuang 050013, Hebei Province, China
| | - Kang An
- Department of Gastroenterology, Hebei General Hospital, Shijiazhuang 050057, Hebei Province, China
| | - Gai-Fang Liu
- Department of Gastroenterology, Hebei General Hospital, Shijiazhuang 050057, Hebei Province, China
| | - Heng-Yu Zhou
- Department of Gastroenterology, Hebei General Hospital, Shijiazhuang 050057, Hebei Province, China
- Graduate School, North China University of Science and Technology, Tangshan 063509, Hebei Province, China
| | - Jun-Cha Gao
- Department of Gastroenterology, Hebei General Hospital, Shijiazhuang 050057, Hebei Province, China
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Kumari N, Bakliwal A, Singh M, Dhingra G, Gupta A, Nath UK. B-lymphoblastic lymphoma presenting as acute pancreatitis: a rare mimicker. Hematol Transfus Cell Ther 2023; 45:102-105. [PMID: 34303652 PMCID: PMC9938471 DOI: 10.1016/j.htct.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/31/2021] [Accepted: 02/18/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
| | | | - Monika Singh
- All India Institute of Medical Science Rishikesh (AIIMS), Rishikesh, India.
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Acute Lymphocytic Leukemia With the Initial Presentation as a Pancreatic Mass. Pancreas 2020; 49:e58-e59. [PMID: 32590626 DOI: 10.1097/mpa.0000000000001586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Wang Y, Zhang X, Dong L, Tang K, Fang H, Tang Z, Zhang B. Acute lymphoblastic leukemia with pancreas involvement in an adult patient mimicking pancreatic tumor: A case report. Medicine (Baltimore) 2019; 98:e15685. [PMID: 31169671 PMCID: PMC6571396 DOI: 10.1097/md.0000000000015685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
RATIONALE Acute lymphoblastic leukemia (ALL) is a malignant disease originating from abnormal proliferation of B or T lymphocytes in bone marrow (BM). Invasion of the pancreas is extremely rare in adults. PATIENT CONCERNS In this article, we report a case presenting that ALL invades the pancreas, as well as liver, kidney, and duodenum detected by magnetic resonance image. The patient was misdiagnosed as pancreatic tumor at initial since hemogram was unremarkable. DIAGNOSES The diagnosis of ALL was established based on the endoscopic ultrasonography-guided fine-needle aspiration and bone marrow examination, showing BCR/ABL gene positive. INTERVENTIONS The patient was actively treated with chemotherapy. Hematological remission was obtained and the lesions in the pancreas disappeared. OUTCOMES The patient finally died of complication from fungal pneumonia and central nervous system involvement 12 months after diagnosis. LESSONS Under the context of infection, persistent or intermittent fever and complete blood count are not significant prognoses of pancreatic involvement for adult with ALL. We hope that this case will help hepatobiliary and pancreatic surgeon to be aware of this kind of disease as pancreatic carcinoma and pancreas involvement by ALL have totally different treatment strategy.
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Affiliation(s)
| | - Xuzhao Zhang
- Department of Hematology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Cunningham I, Worthley D. Leukemia in gastrointestinal organs as cause of treatment failure: 378 cases analyzed. Am J Hematol 2018; 93:1327-1336. [PMID: 30105897 DOI: 10.1002/ajh.25250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/31/2018] [Accepted: 08/06/2018] [Indexed: 12/19/2022]
Abstract
Leukemia growing as tumors in gastrointestinal organs is an under-investigated cause of treatment failure and death. These present with symptoms often mistaken for common toxicities but may grow large before symptoms. To synthesize experience available only in case reports, 378 were analyzed. Invasive and metastatic behavior typical of solid GI tumors was revealed even when marrow was uninvolved. Within 3 months of diagnosis, 33% had died, 47% within 1 year. Survivals of 4 to 18 years after involvement suggest cure is possible. Evidence is presented that combined local and systemic therapy has successfully treated GI leukemic tumors when identified early.
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Affiliation(s)
- Isabel Cunningham
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Daniel Worthley
- Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
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Wang GX, Liao JL, Zhang D, Wen L. Relapse of acute lymphoblastic leukemia in the pancreas after bone marrow transplant. World J Pediatr 2015; 11:389-91. [PMID: 24974210 DOI: 10.1007/s12519-014-0489-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Relapse of acute lymphoblastic leukemia (ALL) in the pancreas is rare. We report a case of a 12-year-old boy who experienced a relapse of ALL in the pancreas after a bone marrow transplant. METHODS Clinical data, including course of illness, laboratory results, and imaging studies are included. The patient presented with acute pancreatitis, suspected to be secondary to gallstones, with ampullary obstruction. Ultrasound and magnetic resonance imaging demonstrated a distended gallbladder and intra- and extra-hepatic biliary dilatation with a cutoff at the pancreatic head, but with no evidence of gallstones. RESULTS Ultrasound-guided biopsy of the pancreas revealed ALL in the pancreas. Systematic chemotherapy was recommended, but was declined by the parents. The patient died one week later. CONCLUSION Relapse of ALL in the pancreas is rare, but when a history of ALL is present, it should be considered in patients with pancreatic enlargement, obstructive jaundice, and pancreatitis.
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Affiliation(s)
- Guang-Xian Wang
- , Chongqing, China.,Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Jun-Lin Liao
- , Chongqing, China.,Department of Surgery, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, 1422 JCP Iowa City, IA, 52242, Washington D.C., USA
| | - Dong Zhang
- , Chongqing, China.,Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Li Wen
- , Chongqing, China. .,Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China.
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Pamuk GE, Tapan U, Aksoy S, Umit H. An adult patient with common B-cell acute lymphoblastic leukaemia who presented with pancreatic involvement, description of the second adult case and review of paediatric cases. BMJ Case Rep 2014; 2014:bcr-2013-200817. [PMID: 24855096 DOI: 10.1136/bcr-2013-200817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pancreatic involvement in acute lymphoblastic leukaemia (ALL) may go unrecognised. There are only a few paediatric cases; nevertheless, presentation with pancreatic involvement in an adult patient with ALL has been reported rarely. Our 52-year-old male patient came to us with abdominal pain, nausea and vomiting; he had pancreatic enlargement on CT. He was diagnosed with common B-cell ALL with pancreatic involvement. The patient obtained haematological remission and the pancreatic enlargement regressed after chemotherapy, but later he had central nervous system and liver relapses. He died 6 months after diagnosis because of progressive pneumonia and chemotherapy-resistant ALL with multiple extramedullary relapses.
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Affiliation(s)
- Gulsum Emel Pamuk
- Department of Hematology, Trakya University Medicine Faculty, Edirne, Turkey
| | - Umit Tapan
- Department of Internal Medicine, Steward Carney Hospital, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Sema Aksoy
- Department of Radiodiagnostics, Bakirkoy Dr.Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Hasan Umit
- Department of Gastroenterology, Trakya University Medical Faculty, Edirne, Turkey
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Kidney and pancreatic extramedullary relapse in adult acute lymphoblastic leukemia: a case report and review of the literature. Case Rep Hematol 2013; 2013:637264. [PMID: 23984125 PMCID: PMC3747418 DOI: 10.1155/2013/637264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 06/30/2013] [Indexed: 11/18/2022] Open
Abstract
Extramedullary relapse of acute lymphoblastic leukemia (ALL) is rare and has been primarily reported in pediatric patients or hematopoietic stem cell transplant recipients. We report a case of a 62-year-old woman who presented with relapsed ALL involving her kidneys, pancreas, and bone marrow 2 years after completing chemotherapy with a standard ALL protocol. Unfortunately, her extramedullary disease progressed despite treatment. To the best of our knowledge, this is the first reported case of extramedullary relapse of B-cell ALL to the kidneys and pancreas occurring in an adult patient who had not previously undergone a hematopoietic stem cell transplant. A literature review of kidney and pancreatic extramedullary relapse in ALL is also included.
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Ramanathan S, Prakash M, Khandelwal N. Concurrent pancreatic and renal leukemic cell infiltration. Indian J Hematol Blood Transfus 2013; 30:57-9. [PMID: 25332536 DOI: 10.1007/s12288-013-0246-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 02/18/2013] [Indexed: 11/29/2022] Open
Abstract
Pancreatic involvement in acute lymphoblastic leukemia (ALL) is uncommon more so in adults. It can present as obstructive jaundice, pancreatitis or can be asymptomatic. We report here the clinical and imaging features in a 28 years old man with B cell ALL with simultaneous involvement of pancreas and bilateral kidneys. Computed tomography of abdomen showed diffuse infiltration of pancreas by multiple tiny hypodense lesions and multiple hypodense lesions in both kidneys. Although leukemic involvement of pancreas is unusual and our patient was asymptomatic, one should consider the possibility of pancreatic infiltration in a leukemic patient presenting with pancreatic enlargement, cholestatic jaundice or pancreatitis.
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Asymptomatic leukemic-cell infiltration of the pancreas: US findings. Pediatr Radiol 2011; 41:779-80. [PMID: 21076824 DOI: 10.1007/s00247-010-1891-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 09/28/2010] [Accepted: 10/20/2010] [Indexed: 10/18/2022]
Abstract
Pancreatic infiltration of leukemic cells is a very rare manifestation at the onset of acute lymphoblastic leukemia (ALL) in childhood. Pancreatic enlargement in this situation is unusual and pancreatic involvement is often associated with biliary obstruction, cholestasis and pancreatitis. We report a 3-month-old girl who presented with asymptomatic leukemic infiltration of the pancreas, demonstrated by US with heterogeneous pancreatic enlargement associated with multiple hypoechogenic lesions, without cholestasis. Although these manifestations are rare, ALL should be considered a cause of pancreatic enlargement.
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Qiu L, Luo Y, Peng YL. Value of ultrasound examination in differential diagnosis of pancreatic lymphoma and pancreatic cancer. World J Gastroenterol 2008; 14:6738-42. [PMID: 19034981 PMCID: PMC2773320 DOI: 10.3748/wjg.14.6738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the value of clinical manifestations and ultrasound examination in the differential diagnosis of pancreatic lymphoma and pancreatic cancer.
METHODS: The clinical and ultrasonic characteristics of 12 cases of pancreatic lymphoma and 30 cases of pancreatic cancer were retrospectively analyzed.
RESULTS: Statistically significant differences were found in the course of disease, back pain, jaundice, carcino-embryonic antigen (CEA) and CA19-9 increase, palpable abdominal lump, superficial lymph node enlargement, fever and night sweats, lesion size, bile duct expansion, pancreatic duct expansion, vascular involvement, retroperitoneal (below the renal vein level) lymph node enlargement, and intrahepatic metastasis between pancreatic lymphoma and pancreatic cancer. There were no significant differences in age of onset, gender ratio, weight loss, nausea and vomiting, lesion position, the echo of the lesion, and the blood flow of the lesion.
CONCLUSION: Pancreatic lymphoma should be considered for patients with long lasting symptoms, superficial lymph node enlargement, palpable abdominal lump, fever and night sweats, relatively large lesions, and retroperitoneal (below the level of the renal vein) lymph node enlargement. A diagnosis of pancreatic cancer should be considered more likely in the patients with relatively short disease course, jaundice, back pain, CEA and CA19-9 increase, relatively small lesions, bile duct expansion, obvious pancreatic duct expansion, peripheral vascular wrapping and involvement, or intrahepatic metastases.
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