Incidental Colonic Masses and Cytomegalovirus (CMV) Infection in a Treatment- Naïve Chronic Lymphocytic Leukemia Patient without GI symptoms. (28th October 2021)

• Record Type: Journal Article
• Authors: Elzamly, S; Taha, H; Shitawi, M; Ghosh, A; Everett, J
• Is Part Of: American journal of clinical pathology. Volume 156(2021)Supplement 1
• Page Start: S61
• Page End: S62
• Publication Date: 2021-10-28
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqab191.127
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Introduction/Objective: Gastrointestinal (GI) involvement by leukemia ranges from 5.7 to 13 % with very few published reports describing infiltration of the GI tract by chronic lymphocytic leukemia (CLL). GI bleeding, abdominal pain, and obstruction have been described as presenting symptoms of GI involvement. Yet, discrete lesions are rare. Infection is a common complication in patients with CLL. In untreated patients, these infections are typically by encapsulated bacteria involving the respiratory tract and associated with hypogammaglobulinemia. Viral infections often happen after therapy. This report presents a patient with a history of treatment- naïve CLL and HSV who presented for colostomy reversal and was incidentally found to have two partially obstructing colonic masses, as well as cytomegalovirus (CMV) infection. Methods/Case Report: This is a 78-years-old female with treatment-naïve CLL and past medical history of hypertension, atrial fibrillation, diverting colostomy secondary to chronic perineal HSV-2 ulcer and recent perirectal abscess. She presented for colostomy reversal in the absence of any reported GI symptoms at that time. Labs showed leukocytosis; WBCs count of 25 K/MM3, anemia and neutropenia. Endoscopic studies incidentally discovered two partially obstructing masses in the ascending and transverse colon that were biopsied. A right hemicolectomy and colostomy closure were followed, and the patient was discharged on valganciclovir. Results (if a Case Study enter NA): Histopathological examination demonstrated mucosal ulceration with viral cytopathic changes and positive CMV IHC stain. In addition, a dense atypical, small sized lymphoid cell infiltrate with no sheets of large cells or confluent necrosis were identified. Flowcytometry and IHC stains showed aberrant CD5+ B cells with CD23 co-expression consistent with the patient's history of CLL. Conclusion: The case describes the unique presentation of a patient with treatment- naïve CLL without any GI symptoms, yet was incidentally found to have colonic involvement by CLL forming discrete colonic masses as well as CMV and HSV infections. Since she is untreated, her infections (HSV and CMV) are likely secondary to being immunocompromised by CLL and neutropenia. In conclusion, although rare, GI involvement by CLL should be considered in treatment naïve CLL patient's and concomitant infections should be evaluated.