Journal of Shandong University (Health Sciences) ›› 2023, Vol. 61 ›› Issue (7): 109-117.doi: 10.6040/j.issn.1671-7554.0.2023.0029

• 临床医学 • Previous Articles    

Acute pancreatitis as initial manifestation in a patient with acute myeloid leukemia: a case report and literature review

YANG Wenxin1,2, LIU Yingjiao1, GAO Ya1,3, YANG Anyi1,4, ZHOU Hengyu1,3, GAO Juncha1   

  1. 1. Department of Gastroenterology, Hebei General Hospital, Shijiazhuang 050051, Hebei, China;
    2. Graduate School of Hebei Medical University, Shijiazhuang 050011, Hebei, China;
    3. Graduate School of North China University of Science and Technology, Tangshan 063210, Hebei, China;
    4. Graduate School of Hebei North China University, Zhangjiakou 075132, Hebei, China
  • Published:2023-07-04

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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

CLC Number: 

  • R657.5
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