VCOM Louisiana Research Day Program Book 2024

Case Studies

Austin Bordelon, OMS-IV; James Bordelon, Jr., MD, FACS Avoyelles Hospital 57 HIDDEN IN THE WALL: CHRONIC LYMPHOCYTIC LEUKEMIA DISGUISED AS CHRONIC CHOLECYSTITIS

Background: Infiltration of the gallbladder by lymphoma is a rare discovery. As cases continue to be published, it should be considered in the differential diagnosis for right upper quadrant abdominal pain. We describe the case of a 70-year-old patient who presented with a chronic cholecystitis-like presentation and lymphocytosis that upon further pathologic and diagnostic work-up confirmed chronic lymphocytic leukemia (CLL) as the primary diagnosis. The cholecystectomy specimen contained perimuscular and serosal invasion of the tumor, which may account for their intermittent and dull right upper quadrant abdominal pain. The patient also presented with post-operative right upper quadrant pain for one month, which could be attributed to her significant periportal lymphadenopathy causing portal vein compression. The initial plan was modified from watchful waiting to initiate ibrutinib. Consideration of CLL with this presentation may evolve the differential diagnosis for right upper quadrant abdominal pain as well as promote studies to determine whether surgical intervention is indicated prior to medical treatment. Conclusions: A literature review discovered only three cases of CLL infiltrating the gallbladder. Chim et al described a case of Rai

stage IV CLL involving the gallbladder three years after the patient’s original CLL diagnosis. Our patient was not diagnosed with CLL prior to their cholecystectomy. Dasanu et al described a case of CLL with perineural invasion that created a similar cholecystitis presentation. However, our patient was afebrile and lymphocytic infiltration was perimuscular and serosal. The patient reported by Rao et al was discovered post-cholecystectomy for gallstone pancreatitis. Unlike our patient, their patient did not have any reported lymphadenopathy. The majority of CLL cases occur as a result of chromosomal alterations. Deletion of chromosome 13q14 is the most common alteration, representing 50 60% of cases, including the patient in this case. This case illustrates the potential for chronic lymphocytic leukemia to arise in the gallbladder and mimic a cholecystitis-like presentation. Consideration of chronic lymphocytic leukemia with this presentation may evolve the differential diagnosis for right upper quadrant pain as well as promote studies for medical treatment and surgical indication.

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