Presentation of Gallbladder Chloroma in B-Mode Imaging and Contrast-Enhanced Ultrasound (CEUS) in a Patient with Acute Myelomonocytic Leukemia (AML M5)

Introduction

Chloromas (myeloid sarcoma) are solid tumors consisting of primitive myeloid precursors and have been described in acute myeloid leukemia (AML) and myeloproliferative disorders (Aznab, Mozaffar; Kamalian, Naser; Beiki, Omid et al., Int J Hematol Oncol Stem Cell Res 2015; 9 (1), S. 50–54). In AML, they are observed in 3-8% of all cases, while the frequency varies (J. C.; Edenfield, W. J.; Shields, D. J. et al., Extramedullary myeloid cell tumors in acute nonlymphocytic leukemia: a clinical review. In: J Clin Oncol 1995, 13 (7), S. 1800–1816). Chloromas can be observed at diagnosis, precede the diagnosis, occur during the course of the disease or manifest as a relapse of the AML (Aznab, Mozaffar; Kamalian, Naser; Beiki, Omid et al., Int J Hematol Oncol Stem Cell Res 2015; 9 (1), S. 50–54). They can affect every organ system, with infiltration of bone, skin, soft tissues and lymph nodes being observed most frequently (Aznab, Mozaffar; Kamalian, Naser; Beiki, Omid et al., Int J Hematol Oncol Stem Cell Res 2015; 9 (1), S. 50–54), J. C.; Edenfield, W. J.; Shields, D. J. et al., Extramedullary myeloid cell tumors in acute nonlymphocytic leukemia: a clinical review. In: J Clin Oncol 1995, 13 (7), S. 1800–1816). Single case reports describe chloromas of the gallbladder and the bile ducts (Azin, Arash; Racz, Jennifer M.; Carolina Jimenez, M. et al. Int J Surg Case Rep 2014;5 (6), S. 302–305). In summary, we present the first description of contrast-enhanced ultrasound (CEUS) patterns of a histologically confirmed gallbladder chloroma.