|
1
|
Devarapalli UV, Sarma MS, Mathiyazhagan G. Gut and liver involvement in pediatric hematolymphoid malignancies. World J Gastrointest Oncol 2022; 14:587-606. [PMID: 35321282 PMCID: PMC8919016 DOI: 10.4251/wjgo.v14.i3.587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/22/2021] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
Hematolymphoid malignancies are common neoplasms in childhood. The involvement of the gastrointestinal (GI) tract, liver, biliary system, pancreas, and peritoneum are closely interlinked and commonly encountered. In leukemias, lymphomas, and Langerhans cell histiocytosis (LCH), the manifestations result from infiltration, compression, overwhelmed immune system, and chemotherapy-induced drug toxicities. In acute leukemias, major manifestations are infiltrative hepatitis, drug induced gastritis, neutropenic typhlitis and chemotherapy related pancreatitis. Chronic leukemias are rare. Additional presentation in lymphomas is cholestasis due to infiltration or biliary obstruction by lymph nodal masses. Presence of ascites needs a thorough workup for the underlying pathophysiology that may modify the therapy and affect the outcome. Uncommon hematolymphoid malignancies are primary hepatic, hepatosplenic, and GI lymphomas which have strict definitions. In advanced diseases with extensive spread, it may be impossible to distinguish these diseases from the primary site of origin. LCH produces biliary strictures that mimic as sclerosing cholangitis. Liver infiltration is associated with poor liver recovery even after chemotherapy. The heterogeneity of gut and liver manifestations in hematolymphoid malignancies has a clinical impact on their management. Though chemotherapy is the mainstay of therapy in all hematolymphoid malignancies, debulking surgery and radiotherapy have an adjuvant role in specific clinical scenarios. Rare situations presenting as liver failure or end-stage liver disease require liver transplantation. At their initial presentation to a primary care physician, given the ambiguity in clinical manifestations and the prognostic difference with time-bound management, it is vital to recognize them early for optimal outcomes. Pooled data from robust registries across the world is required for better understanding of these complications.
Collapse
Affiliation(s)
- Umeshreddy V Devarapalli
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Moinak S Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Gopinathan Mathiyazhagan
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| |
Collapse
|
|
5
|
Abu-Zeinah GF, Weisman P, Ganesh K, Katz SS, Dogan A, Abou-Alfa GK, Stein EM, Jarnagin W, Mauro MJ, Harding JJ. Acute myeloid leukemia masquerading as hepatocellular carcinoma. J Gastrointest Oncol 2016; 7:E31-5. [PMID: 27284485 DOI: 10.21037/jgo.2015.12.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is often diagnosed on the basis of high quality imaging without a biopsy in the cirrhotic liver. This is a case of a 64-year-old Caucasian man with no history of liver disease or cirrhosis that presented with fatigue, weight loss, and abdominal distension and was found to have a large, isolated liver mass with arterial enhancement and portal venous washout on triple-phase computed tomography (CT) suspicious for HCC. The patient was initially referred for a surgical evaluation. Meanwhile, he developed fevers, pancytopenia, and worsening back pain, and a subsequent spinal MRI revealed a heterogeneous bone marrow signal suspicious for metastatic disease. A bone marrow biopsy that followed was diffusely necrotic. A core biopsy of the patient's liver mass was then performed and was diagnostic of acute monocytic-monoblastic leukemia. Findings from peripheral flow cytometry and a repeat bone marrow biopsy were also consistent with this diagnosis, and induction chemotherapy with cytarabine and idarubicin was initiated. This case describes a rare presentation of myeloid sarcoma (MS) as an isolated, hypervascular liver mass that mimics HCC in its radiographic appearance. Due to the broad differential for a liver mass, a confirmatory biopsy should routinely be considered prior to surgical intervention.
Collapse
Affiliation(s)
- Ghaith F Abu-Zeinah
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Paul Weisman
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Karuna Ganesh
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Seth S Katz
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Ahmet Dogan
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Ghassan K Abou-Alfa
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Eytan M Stein
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - William Jarnagin
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Michael J Mauro
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - James J Harding
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|