J Korean Med Sci.  2006 Jun;21(3):550-554. 10.3346/jkms.2006.21.3.550.

Isolated Biliary Granulocytic Sarcoma Followed by Acute Myelogeneous Leukemia with Multilineage Dysplasia: A Case Report and Literature Review

• Sung CO
• Ko YH
• Park CK
• Jang KT
• Heo JS

• KMID: 1778443
• DOI: http://doi.org/10.3346/jkms.2006.21.3.550

Abstract

Granulocytic sarcoma is a rare extramedullary tumor composed of myeloid progenitor cells. Primary involvement of the biliary tract without evidence of leukemia is exceedingly rare. Here, we report an isolated biliary granulocytic sarcoma in a 30-yr-old man who presented with jaundice, fever, and chill without any evidence of leukemia. However, five months after the diagnosis, he developed acute myelogenous leukemia with multilineage dysplasia and chromosomal abnormality. A rare possibility of biliary granulocytic sarcoma should be considered as a differential diagnosis in patients with obstructive jaundice. A histologic evaluation by aggressive diagnostic intervention is important and may improve prognosis.

Keyword

Sarcoma, Granulocytic; Leukemia; Jaundice, Obstructive; Bile Ducts

MeSH Terms

Tomography, X-Ray Computed
Sarcoma, Granulocytic/*complications/*pathology
Prognosis
Male
Leukemia, Myelocytic, Acute/*diagnosis/*pathology
Karyotyping
Humans
Cell Lineage
Bile Ducts/metabolism/pathology
Bile Duct Neoplasms/*complications/*pathology
Adult

Figure

• 

  Fig. 1 Endoscopic retrograde cholangiopancreatography (ERCP) reveals the common bile duct stricture.

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  Fig. 2 Computed tomogram discloses a low density rim around the ENBD tube, but no definitive abnormal enhancing lesion or mass is recognized.

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  Fig. 3 Microscopic finding of bile duct shows a monomorphous and discohesive cellular infiltration along the bile duct wall (A) having medium to large nuclei with one or more distinct but not prominent nucleoli and a dispersed chromatin (H&E, ×40) (B). Tumor cells are positive for myeloperoxidase (PAP, ×400) (C).

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  Fig. 4 Bone marrow findings. Monomorphic myeloblasts in trephine biopsy (H&E, ×400) (A). Myeloblasts with cytoplasmic blebs and dyshematopoietic erythroid cell (inset) (Wright stain, ×1,000) (B).

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