Acute myeloid leukemia presenting as a critical upper airway obstruction
Location
D.P. Culp Center Ballroom
Start Date
4-5-2024 9:00 AM
End Date
4-5-2024 11:30 AM
Poster Number
54
Name of Project's Faculty Sponsor
Sakshi Singal
Faculty Sponsor's Department
Internal Medicine
Competition Type
Competitive
Type
Poster Presentation
Presentation Category
Health
Abstract or Artist's Statement
Acute myeloid leukemia (AML) is a clonal hematologic malignancy that frequently presents with fatigue, fever, bruising, and bleeding (reflecting the extent of bone marrow failure). Infrequently, AML can present as an extramedullary mass known as myeloid sarcoma (MS). Our patient is a 51-year-old male who presented to the emergency department with a complain of rapid neck swelling, a choking sensation, inability to swallow, and a muffled voice. CT imaging of the neck showed a four-centimeter mass at the base of the tongue and epiglottis. Labs were significant for new-onset leukocytosis, anemia, and thrombocytopenia. The peripheral blood smear demonstrated rare circulating blasts. Given the concern for acute upper airway compromise, the patient underwent an emergent tracheostomy procedure with direct laryngoscopy exam. Findings were notable for a large mass involving the base of the tongue, vallecula, and epiglottis. The pathology of the mass was consistent with acute myeloid leukemia involving the submucosa. Bone marrow biopsy showed hypercellular marrow with abnormal mononuclear cells, six percent blasts and forty percent promonocytes consistent with diagnosis of AML with monocytic differentiation. Cerebrospinal fluid cytology was also positive for leukemia. MRI brain did not show leptomeningeal involvement. The patient received induction chemotherapy with cytarabine and daunorubicin along with intrathecal methotrexate. Day 28 Bone marrow showed complete remission. CT neck after induction treatment showed complete resolution of neck mass and allowed for removal of tracheostomy tube. The patient received 4 cycles of consolidation treatment with high dose cytarabine, with plans for bone marrow transplant. The most common locations of MS involve the gastrointestinal tract, bones, and skin; although, laryngeal involvement has been reported. Most of these cases required emergent tracheostomy for critical airway compromise. Patients without bone marrow involvement have a better prognosis than those with systemic AML and a lower rate of relapse. This case demonstrates how AML can infrequently present with myeloid sarcoma of larynx and early recognition is critical for a timely intervention such as an emergent tracheostomy.
Acute myeloid leukemia presenting as a critical upper airway obstruction
D.P. Culp Center Ballroom
Acute myeloid leukemia (AML) is a clonal hematologic malignancy that frequently presents with fatigue, fever, bruising, and bleeding (reflecting the extent of bone marrow failure). Infrequently, AML can present as an extramedullary mass known as myeloid sarcoma (MS). Our patient is a 51-year-old male who presented to the emergency department with a complain of rapid neck swelling, a choking sensation, inability to swallow, and a muffled voice. CT imaging of the neck showed a four-centimeter mass at the base of the tongue and epiglottis. Labs were significant for new-onset leukocytosis, anemia, and thrombocytopenia. The peripheral blood smear demonstrated rare circulating blasts. Given the concern for acute upper airway compromise, the patient underwent an emergent tracheostomy procedure with direct laryngoscopy exam. Findings were notable for a large mass involving the base of the tongue, vallecula, and epiglottis. The pathology of the mass was consistent with acute myeloid leukemia involving the submucosa. Bone marrow biopsy showed hypercellular marrow with abnormal mononuclear cells, six percent blasts and forty percent promonocytes consistent with diagnosis of AML with monocytic differentiation. Cerebrospinal fluid cytology was also positive for leukemia. MRI brain did not show leptomeningeal involvement. The patient received induction chemotherapy with cytarabine and daunorubicin along with intrathecal methotrexate. Day 28 Bone marrow showed complete remission. CT neck after induction treatment showed complete resolution of neck mass and allowed for removal of tracheostomy tube. The patient received 4 cycles of consolidation treatment with high dose cytarabine, with plans for bone marrow transplant. The most common locations of MS involve the gastrointestinal tract, bones, and skin; although, laryngeal involvement has been reported. Most of these cases required emergent tracheostomy for critical airway compromise. Patients without bone marrow involvement have a better prognosis than those with systemic AML and a lower rate of relapse. This case demonstrates how AML can infrequently present with myeloid sarcoma of larynx and early recognition is critical for a timely intervention such as an emergent tracheostomy.