以急性胰腺炎为首发表现的急性髓系白血病1例并文献复习

doi:10.6040/j.issn.1671-7554.0.2023.0029

摘要/Abstract

摘要： 目的报告1例急性髓系白血病患者发生髓外浸润致急性胰腺炎的诊断及治疗过程并文献复习,以提高临床医生对急性胰腺炎罕见病因及表现的认识。方法 2021年9月20日河北省人民医院消化内科收治以急性胰腺炎为首发表现的急性髓系白血病的患者1例,男,61岁。采用腹部CT、外周血及骨髓的组织病理学分析、免疫组化检查等方法进行确诊,并对该病例的影像学表现、临床表现、诊断及治疗情况等进行总结与分析。检索美国国立医学图书馆(PubMed)数据库、万方数据库、中国知网、维普数据库自建库到2022年12月报道的关于白血病发生直接髓外浸润累及胰腺的文献,结合文献对该病的诊疗情况进行总结分析。结果共检索国内外文献25篇,涉及25例白血病并发胰腺浸润的患者,其中儿童8例,男5例,女3例,10周~12岁,中位年龄4.5岁;成人17例,男9例,女8例,19~78岁,中位年龄42岁。25例均确诊白血病,其中18例为急性淋巴细胞白血病,5例为急性髓系白血病,2例为慢性淋巴细胞白血病。11例患者均以急性胰腺炎为主要表现,3例胰腺炎合并梗阻性黄疸,4例以梗阻性黄疸为主要表现,7例无特异性胰腺浸润表现。行胰腺部位活检取得白血病细胞浸润证据9例,多数通过超声内镜引导下细针穿刺活检的方式证实;其他依化疗效果、影像学表现等进行综合评估。接受化疗者胰腺部位病变均见减轻。结论临床医师需提高对白血病罕见髓外浸润部位及急性胰腺炎罕见致病病因的认识。当患者有腹痛、胰腺肿胀、低密度病变合并有血小板异常减低等血液病表现时,需考虑隐匿起病的白血病所致胰腺炎,建议早期行骨髓活检等,确诊后及时启动针对白血病的治疗。

关键词: 急性白血病, 急性胰腺炎, 髓外浸润, 鉴别诊断

Abstract: Objective To report the diagnosis and treatment of acute pancreatitis caused by extramedullary infiltration in a patient with acute myeloid leukemia, so as to improve clinicians understanding of the disease. Methods A 61-year-old patient with acute pancreatitis as the initial manifestation caused by acute myeloid leukemia was admitted to Hebei General Hospital on Sep. 20, 2021. Abdominal CT, histopathological analysis and immunohistochemical examination of the peripheral blood and bone marrow were used to confirm the diagnosis. The imaging and clinical manifestations, as well as the diagnosis and treatment of the case were summarized and analyzed. Relevant literatures were retrieved in PubMed, Wanfang Data, CNKI and Chinese Scientific Journal Database developed by VIP from inception to Dec. 2022. The diagnosis and treatment of the disease were summarized and analyzed. Results A total of 25 literatures were collected, including 8 children(5 boys and 3 girls, aged from 10 weeks to 12 years, median 4.5 years)and 17 adults(9 males and 8 females, aged from 19 to 78 years, median 42 years). All 25 cases were confirmed leukemia, including acute lymphoblastic leukemia in 18 cases, acute myeloid leukemia in 5 cases and chronic lymphoblastic leukemia in 2 cases. The main manifestation was acute pancreatitis in 11 cases, complicated with obstructive jaundice in 3 cases, obstructive jaundice in 4 cases, and 7 cases had no specific manifestations of pancreatic invasion. Leukemia cell infiltration was confirmed by pancreatic biopsy in 9 cases, most of which were confirmed by endoscopic ultrasound-guided fine needle aspiration biopsy, and the rest were evaluated comprehensively based on the effects of chemotherapy and imaging findings. The pancreatic lesions were reduced in all patients receiving chemotherapy. Conclusion Clinicians need to improve understanding of the rare sites of extramedullary infiltration of leukemia and the rare etiology of acute pancreatitis. When patients present with hematologic manifestations such as abdominal pain, pancreatic swelling, low-density lesions with decreased platelet abnormalities, it is necessary to consider pancreatitis caused by leukemia. It is recommended to conduct bone marrow biopsy at an early stage, and to start the treatment for leukemia in time after diagnosis.

Key words: Acute leukemia, Acute pancreatitis, Extramedullary infiltration, Differential diagnosis

中图分类号:

R657.5

杨文欣,刘英姣,高雅,杨安逸,周恒宇,高俊茶. 以急性胰腺炎为首发表现的急性髓系白血病1例并文献复习[J]. 山东大学学报 (医学版), 2023, 61(7): 109-117.

YANG Wenxin, LIU Yingjiao, GAO Ya, YANG Anyi, ZHOU Hengyu, GAO Juncha. Acute pancreatitis as initial manifestation in a patient with acute myeloid leukemia: a case report and literature review[J]. Journal of Shandong University (Health Sciences), 2023, 61(7): 109-117.

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