Isolated kidney infiltration by suspected leukemic cells – complex differential diagnostics and an unusual case report

Czech version

Authors: P. Vičar ¹; B. Weinbergerová ²; M. Krejčí ²; D. Žáčková ²; N. Podstavková ²; P. Divácká ³; S. Hotárková ⁴; I. Svobodová ⁴; Z. Bednařík ⁴; K. Kamarádová ^5,6; M. Borský ²; I. Ježíšková ²; M. Doubek ²; M. Hermanová ⁴; Z. Král ²; J. Mayer ²
Authors‘ workplace: LF MU Brno ¹; Interní hematologická a onkologická klinika LF MU a FN Brno ²; Interní gastroenterologická klinika LF MU a FN Brno ³; I. ústav patologie LF MU a FN u sv. Anny v Brně ⁴; AeskuLab Patologie, Unilabs Company, Praha ⁵
Published in: Transfuze Hematol. dnes,28, 2022, No. 1, p. 38-45.
Category: Case Reports
doi: https://doi.org/10.48095/cctahd2022prolekare.cz5

Overview

This article describes a case of highly suspected isolated diffuse kidney infiltration by myeloid leukemic cells, without primary bone marrow involvement or any pathological imaging findings in a patient presenting with fever of unknown origin, acute kidney injury, microcytic anaemia, weight loss, anorexia, dry cough and mild splenomegaly. This complex diagnostic process thus required repeated biopsy of both bone marrow and kidney, which subsequently ruled out leukemic infiltration. The presenting symptoms and pathological laboratory findings responded promptly to corticosteroid treatment, and our patient was finally diagnosed with tubulointerstitial nephritis.

Keywords:

acute myeloid leukaemia – fever of unknown origin – tubulointerstitial nephritis – acute kidney injury – kidney leukemic infiltration – myelosarcoma

Sources

1. Arber DA, Orazi A, Hasserjian R, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016; 127 (20): 2391–2405.

2. Byrd JC, Edenfield WJ, Shields DJ, Dawson NA. Extramedullary myeloid cell tumors in acute nonlymphocytic leukemia: a clinical review. J Clin Oncol. 1995; 13 (7): 1800–1816.

3. Wang HQ, Li J. Clinicopathological features of myeloid sarcoma: Report of 39 cases and literature review. Pathol Res Pract. 2016; 212 (9): 817–824.

4. Pileri SA, Ascani S, Cox M-C, et al. Myeloid sarcoma: Clinico-pathologic, phenotypic and cytogenetic analysis of 92 adult patients. Leukemia. 2007; 21: 340–350.

5. Almond LM, Charalampakis M, Ford SJ, et al. Myeloid sarcoma: presentation, diagnosis, and treatment. Clin Lymphoma Myeloma Leuk. 2017; 17 (5): 263–267.

6. Paydas S, Zorludemir S, Ergin M. Granulocytic sarcoma: 32 cases and review of the literature. Leuk Lymphoma. 2006; 47: 2527–2541.

7. Meis JM, Butler JJ, Osborne BM, Manning JT. Granulocytic sarcoma in nonleukemic patients. Cancer. 1986; 58: 2697–2709.

8. Yamauchi K, Yasuda M. Comparison in treatments of nonleukemic granulocytic sarcoma: Report of two cases and a review of 72 cases in the literature. Cancer. 2002; 94: 1739–1746.

9. Agrawal V, Gupta A, Gupta R, Sharma MC, Das P. Nonleukemic granulocytic sarcoma of kidney with mixed phenotype blasts: a diag- nostic dilemma. Indian J Pathol Microbiol. 2011; 54 (3): 606–608.

10. Liu PI, Ishimaru T, McGregor DH, Okada H, Steer A. Autopsy study of granulocytic sarcoma (chloroma) in patients with myelogenous leukemia, Hiroshima-Nagasaki 1949–1969. Cancer. 1973; 31: 948–955.

11. Bagg MD, Wettlaufer JN, Willadsen DS, et al. Granulocytic sarcoma presenting as a diffuse renal mass before hematological manifestations of acute myelogenous leukemia. J Urol. 1994; 152 (20): 2092–2093.

12. Duda J, Zoger S. Presentation of M4 acute myeloid leukemia in anuric renal failure with hyperuricemia and enlarged kidneys. J Pediatr Hematol Oncol. 2002; 24: 55–58.

13. Tapper EB, Luptakova K, Joyce RM, Tzachanis D. A 78-year-old man with acute myeloid leukemia (AML) and acute renal failure. Am J Case Rep. 2014; 15: 364–367.

14. Aratani S, Aburakawa S, Ryotokuji T, et al. Primary tumor infiltration and severe acute kidney injury in patients with acute myeloblastic leukemia. J Nippon Med Sch. 2020; 87 (1): 43–48.

15. https: //ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcae_v5_quick_reference_5x7.pdf. Accessed 23 January 2021.

16. Křivanová A, Adam Z, Mayer J, et al. Teplota nejasné etiologie: příčiny a diagnostický postup. Vnitř Lék. 2007; 53 (2): 169–178.

17. Bisschop MM, Révész T, Bierings M, et al. Extramedullary infiltrates at diagnosis have no prognostic significance in children with acute myeloid leukaemia. Leukemia. 2001; 15 (1): 46–49.