Imaging Findings of Leukemic Involvement of the Pancreaticobiliary System in Adults
Eugene K. Choi1,2,
Jae Ho Byun1,
Soon Jin Lee3,
Seung Eun Jung4,
Mi-Suk Park5,
Seong Ho Park1 and
Moon-Gyu Lee1
1 Department of Radiology and Research Institute of Radiology, University of
Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2dong,
Songpa-gu, Seoul 138-736, Korea.
2 Weill Medical College of Cornell University, New York, NY.
3 Department of Radiology and Center for Imaging Science, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
4 Department of Radiology, St. Mary's Hospital, College of Medicine, The
Catholic University of Korea, Seoul, Korea.
5 Department of Radiology, Severance Hospital, Yonsei University College of
Medicine, Seoul, Korea.
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Fig. 1A —32-year-old woman with history of acute lymphoblastic
leukemia who presented with jaundice and abdominal pain with total bilirubin
of 3.5 mg/dL. Contrast-enhanced axial CT scan shows dilatation of intrahepatic
biliary ducts (arrow).
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Fig. 1B —32-year-old woman with history of acute lymphoblastic
leukemia who presented with jaundice and abdominal pain with total bilirubin
of 3.5 mg/dL. Contrast-enhanced axial CT scan shows low attenuating, diffuse
lesion with poorly defined borders in pancreatic body (white arrow)
and nodular lesion in tail (black arrow) of pancreas. There is
evidence of extrahepatic biliary duct (black arrowhead) and
pancreatic duct (white arrowhead) dilatation.
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Fig. 1C —32-year-old woman with history of acute lymphoblastic
leukemia who presented with jaundice and abdominal pain with total bilirubin
of 3.5 mg/dL. Contrast-enhanced axial CT scan shows dilatation of pancreatic
duct (white arrowhead) upstream in relation to diffuse mass
(white arrow) infiltrating body of pancreas and encasing celiac axis.
Accompanying dilatation of extrahepatic biliary duct (black
arrowhead) is also noted.
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Fig. 1D —32-year-old woman with history of acute lymphoblastic
leukemia who presented with jaundice and abdominal pain with total bilirubin
of 3.5 mg/dL. Contrast-enhanced axial CT scan shows large infiltrative mass
(white arrow) replacing pancreatic head and body. Dilatation of
extrahepatic biliary duct is noted (black arrowhead).
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Fig. 2A —30-year-old woman with no history of leukemia who presented
with abdominal mass. Contrast-enhanced axial CT scan at level of celiac axis
shows two ill-circumscribed nodules in tail of pancreas
(arrowheads).
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Fig. 2B —30-year-old woman with no history of leukemia who presented
with abdominal mass. Contrast-enhanced axial CT scan at level of root of
superior mesenteric artery shows large retroperitoneal mass (arrow)
that has infiltrated left kidney. Needle biopsy of mass confirmed diagnosis of
granulocytic sarcoma. Well-margined, nodular lesion (arrowhead) is
present in tail of pancreas. Mass shows low contrast enhancement with respect
to normal pancreas parenchyma.
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Fig. 2C —30-year-old woman with no history of leukemia who presented
with abdominal mass. Contrast-enhanced axial CT scan obtained 2 months after
chemotherapy at level of A shows absence of any nodular lesions
throughout length of pancreas.
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Fig. 2D —30-year-old woman with no history of leukemia who presented
with abdominal mass. Contrast-enhanced axial CT scan obtained 2 months after
chemotherapy at the level of B shows marked resolution of
retroperitoneal and pancreatic masses. Despite absence of direct pathologic
proof, pancreatic lesions most likely represented granulocytic sarcoma of
pancreas that resolved with therapy.
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Fig. 3A —44-year-old man with no history of leukemia who presented
with jaundice and fever with total bilirubin of 9.5 mg/dL. Contrast-enhanced
axial CT scan shows dilatation of intrahepatic biliary ducts
(arrow).
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Fig. 3B —44-year-old man with no history of leukemia who presented
with jaundice and fever with total bilirubin of 9.5 mg/dL. Contrast-enhanced
axial CT scan shows mild ductal wall thickening of hilum of intrahepatic bile
ducts (arrow).
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Fig. 3C —44-year-old man with no history of leukemia who presented
with jaundice and fever with total bilirubin of 9.5 mg/dL. Contrast-enhanced
axial CT scan shows extrahepatic biliary ductal wall thickening with complete
obliteration of lumen and mild periductal infiltration (arrow).
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Fig. 3D —44-year-old man with no history of leukemia who presented
with jaundice and fever with total bilirubin of 9.5 mg/dL. MR
cholangiopancreatography shows presence of luminal narrowing and obstruction
from confluence (arrow) of intrahepatic bile duct to proximal
extrahepatic bile duct and central portion of right posterior intrahepatic
bile duct (arrowhead). Drainage of right posterior bile duct into the
common duct represents anatomic variant.
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Fig. 3E —44-year-old man with no history of leukemia who presented
with jaundice and fever with total bilirubin of 9.5 mg/dL. Photograph of gross
pathologic specimen shows ill-defined, diffusely fibrotic, and thickened
extrahepatic bile duct (arrows). Intrahepatic bile duct wall is
mildly thickened due to inflammatory and fibrotic change.
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Fig. 3F —44-year-old man with no history of leukemia who presented
with jaundice and fever with total bilirubin of 9.5 mg/dL. Photomicrograph of
specimen shows infiltration of biliary ductal epithelial and subepithelial
space with immature and mature myeloid cells confirmed by immunohistochemistry
staining. (H and E, x100)
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Copyright © 2007 by the American Roentgen Ray Society.
