Holzwanger Erik A, Alam Zainab, Hsu Emily, Hsu Andrew, Mangano Mark, Kathman Deirdre L
Department of Internal Medicine, UMass Memorial Medical Center, Worcester, MA, USA.
Department of Pathology, Milford Regional Medical Center, Milford, MA, USA.
Am J Case Rep. 2018 Oct 24;19:1262-1266. doi: 10.12659/AJCR.911390.
BACKGROUND Granulocytic sarcoma, or 'chloroma,' due to extramedullary acute myeloid leukemia (AML) or due to acute myelomonocytic leukemia (AML M5), is rare and is associated with a poor prognosis. This report is of a case of granulocytic sarcoma of the gallbladder and describes the approach to diagnosis and treatment. CASE REPORT A 74-year-old Hispanic woman from Ecuador presented to the emergency department with a five-day history of fever, jaundice, and right upper quadrant abdominal pain. The right upper quadrant ultrasound showed a thickened gallbladder wall with cholelithiasis, a positive sonographic Murphy sign, and marked dilatation of the common bile duct, which was up to 17 mm in diameter. Endoscopic retrograde cholangiopancreatography (ERCP) showed purulence and a stone in the common bile duct, which was removed. She underwent laparoscopic cholecystectomy which identified gangrenous cholecystitis. Despite cholecystectomy and treatment with broad-spectrum antibiotics, she remained febrile with a leukocytosis of up to 80,000 cells/µL. Histopathology of the gallbladder showed infiltrating myeloblasts within the mucosa, submucosa, and muscularis consistent with a granulocytic sarcoma associated with gangrenous cholecystitis due to cholelithiasis. Immunohistochemistry, using a panel of antibodies to CD33, CD68, HLA-DR, and lysozyme, supported the diagnosis of granulocytic sarcoma or extramedullary acute myelomonocytic leukemia (AML M5). CONCLUSIONS A rare case of an extramedullary hematologic malignancy, granulocytic sarcoma of the gallbladder is presented, which highlights the importance of timely diagnosis and treatment, due to the high mortality rate associated with granulocytic sarcoma, or extramedullary AML.
由髓外急性髓系白血病（AML）或急性粒单核细胞白血病（AML M5）引起的粒细胞肉瘤，即“绿色瘤”，较为罕见，且预后较差。本报告介绍了一例胆囊粒细胞肉瘤病例，并描述了其诊断和治疗方法。病例报告：一名来自厄瓜多尔的74岁西班牙裔女性因发热、黄疸和右上腹腹痛5天就诊于急诊科。右上腹超声显示胆囊壁增厚伴胆结石，超声墨菲氏征阳性，胆总管明显扩张，直径达17毫米。内镜逆行胰胆管造影（ERCP）显示胆总管有脓性分泌物和结石，结石被取出。她接受了腹腔镜胆囊切除术，术中发现坏疽性胆囊炎。尽管进行了胆囊切除术并使用了广谱抗生素治疗，但她仍发热，白细胞计数高达80,000个/微升。胆囊组织病理学检查显示黏膜、黏膜下层和肌层有幼稚粒细胞浸润，符合因胆结石导致坏疽性胆囊炎相关的粒细胞肉瘤。免疫组织化学使用一组针对CD33、CD68、HLA-DR和溶菌酶的抗体，支持粒细胞肉瘤或髓外急性粒单核细胞白血病（AML M5）的诊断。结论：本文报告了一例罕见的髓外血液系统恶性肿瘤——胆囊粒细胞肉瘤，由于粒细胞肉瘤或髓外AML相关的高死亡率，强调了及时诊断和治疗的重要性。
