A case of pathologic splenic rupture as the initial manifestation of acute myeloid leukemia M2

Abstract

A pathologic splenic rupture refers to a rupture without trauma. A splenic rupture as the initial manifestation of acute myeloid leukemia is extremely rare. In this study, we described a rare case of acute myeloid leukemia presenting principally as an acute abdomen due to a pathologic splenic rupture in a 35-year old male patient. We can assert that a pathologic splenic rupture in hematologic diseases is a potentially life-threatening complication, which necessitates immediate operative intervention. Any such patient complaining about left upper abdominal tenderness should be closely observed, and further diagnostic investigations (ultrasonograph of the abdomen, abdominal CT scan) should be initiated in order to rule out a splenic rupture. The oncologist should be aware of this rare initial presentation of acute myeloid leukemia (AML) M2, as the condition generally necessitates a prompt splenectomy.

Keywords: Acute myeloid leukemia M2; pathologic; splenic rupture.

Fig. 1

Computed tomography (CT) image of the upper abdomen demonstrates multiple splenic lacerations evidenced by the irregular, nonhomogeneous, low density of splenic body (red arrows).

Fig. 2

(A) The spleen shows blood clots attached to the ruptured capsule (H-E stain, ×20). (B) The spleen evidences diffuse invasion by immature myeloid cells (H-E stain, ×200). (C) The infiltrates are composed principally of myeloperoxidase-positive immature myeloid cells (Myeloperoxidase stain, ×400).

Fig. 3

(A) This section shows hypercellular marrow with a cellularity of 70-80% and a diffuse infiltration of leukemic blasts (H-E stain, ×400). (B) Leukemic blasts tested positive for myeloperoxidase (Myeloperoxidase stain, ×1,000). (C) Leukemic blasts tested positive for PAS (PAS stain, ×1,000).