Asymptomatic hepatosplenomegaly in chronic myeloid leukemia.

A 39-year-old male diagnosed as chronic myeloid leukemia, had no abdominal symptoms. However, his physical examination revealed apparent abdominal fullness. His liver and spleen were palpable. His abdominal CT revealed that a narrow space to pass intestinal digestive contents. Asymptomatic hepatosplenomegaly is somewhat typical in these chronic type hematological diseases.

A 39-year-old male was referred to our outpatient clinic because of leukocytosis, with a white blood cells count of 284 840/μl (eosinophil 9.2% and basophil 16.2%). His chief complaint was a fever. Although he had no complaint of abdominal symptoms, physical examination revealed apparent abdominal fullness. His liver and spleen were palpable 7 and 20 cm below the subcostal margin, respectively. His abdominal X-ray indicated compressed intestines from the bilateral sides caused by hepatosplenomegaly; the patient did not have any gastro-intestinal stasis or obstruction manifestation (Fig. 1). Abdominal CT revealed that a narrow space allowed the gastro-intestinal system to pass its digestive contents (Fig. 2). The flow of contents in stomach had not been disturbed (Fig. 2, filled broad arrow). He was diagnosed as chronic myeloid leukemia by the detection of breakpoint cluster region-Abelson mRNA. Treatment using a tyrosine kinase inhibitor, dasatinib, ameliorated the patient’s hepatosplenomegaly in a couple of weeks. Asymptomatic hepatosplenomegaly is somewhat typical in these chronic type hematological diseases [1], despite its giant organomegaly.

Figure 1:

The patient’s abdominal X-ray indicated compressed intestines from the bilateral sides caused by hepatosplenomegaly. No findings of gastrointestinal obstruction were observed.

Figure 2:

The patient’s abdominal CT revealed a narrow space to pass intestinal digestive contents. The filled broad arrows indicate the pathway of upper gastro-intestinal flow (left picture, coronal view). The right picture shows a space between liver and spleen in sagittal view.

GRANT SUPPORT

None.

CONFLICT OF INTEREST

No conflicts of interest exist.

FUNDING

We do not have any funding source to disclose concerning to this report.

INFORMED CONSENT

An informed consent was obtained from the patient for the publication of their information and imaging.

AUTHORS’ CONTRIBUTIONS

O.I. drafted and wrote the manuscript. O.I. managed the patient’s case. M.U. contributed to the literature search. M.U. made substantial contributions to the concept and design of this report. M.U. qualified and suggested important intellectual content. All authors approved the final version of the manuscript.