Synchronous Granulocytic Sarcoma of the Gallbladder and Stomach as the Initial Presentation of Chronic Myeloid Leukemia: A Case Report and Review of the Literature

Kaiyu Sun, Jing Cheng, Yan Li, Jinning Ye, Hui Wu, Jianjun Peng and Jianbo Xu

Division of Gastrointestinal Surgery, The First Affiliated Hospital, China
Department of Laboratory Medicine, The First Affiliated Hospital, China
Department of Pathology, The First Affiliated Hospital, China

^*Correspondance to: Jianbo Xu 

 PDF  Full Text DOI: 10.25107/2474-1647.2199

Abstract

Granulocytic Sarcoma (GS) is a rare extramedullary tumor composed of myeloid progenitor cells. GS usually arises with a diagnosis of acute myeloid leukemia, although it also infrequently occurs during the accelerated or blast crisis phases of Chronic Myeloid Leukemia (CML). Involvement of gastro intestine or gallbladder is rare. We report the first case of synchronous GS of gallbladder and stomach as the initial presentation of CML in the blast crisis in a patient who presented with acute upper abdominal discomfort and hematemesis. Emergency gastroscopy and exploratory laparotomy revealed two gastric masses and one lesion on the surface of gallbladder, which were suspected of mesenchymoma. Combining with the result of complete blood count, the patient was initially diagnosed with CML with other neoplasm. However, the results of pathological examination, immune histochemistry and in situ hybridization test of specimens did not support a diagnosis of mesenchymoma. Finally, with Bone Marrow (BM) aspiration, flow cytometry of the BM aspirate, and fluorescence in situ hybridization test for bcr-abl oncogene, we made the diagnosis of CML with GS. It is very difficult to differentiate between CML with GS or CML with other malignancies. A careful work-up using immune histochemistry and cytogenetic/molecular testing is critical to reach a correct diagnosis.

Keywords

Granulocytic sarcoma; Chronic myeloid leukemia; Stomach; Gallbladder

Cite the article

Sun K, Cheng J, Li Y, Ye J, Wu H, Peng J, et al. Synchronous Granulocytic Sarcoma of the Gallbladder and Stomach as the Initial Presentation of Chronic Myeloid Leukemia: A Case Report and Review of the Literature. Clin Surg. 2018; 3: 2199.