Ittero ostruttivo come sintomo d'esordio in soggetto con leucemia monocitica acuta

A 24-year-old man presented with abdominal pain, fever and jaundice. Ultrasound examination of the abdomen showed a lithiasis of the gallbladder and a dilatation of the common bile duct without stones inside. A MR cholangiography showed a stenosis in the distal tract of the common bile duct which was dilated. The same picture was demonstrated by an endoscopic retrograde cholangiopancreatography (ERCP). The patient underwent an explorative laparotomy. No stones were found in the gallbladder, but in its infundibular region a hard nodule was present and located in the thickness of the wall. Another hard lesion was palpable in the middle tract of the common bile duct. Some enlarged mesenteric and hepatic hilar lymph nodes were present. An intraoperative cholangiography was performed: the common bile duct was dilated and parietal stenosis of the middle tract was present, but the contrast medium flow into the duodenum was maintained. Choledocoscopy confirmed a stenosis but no mucosal lesion was seen. Cholecystectomy and hilar lymph node biopsy was performed and a histological examination showed monocytic leukemia. A choledoco-duodenostomy with a T-tube was performed. The postoperative period was uncomplicated and the patient underwent a chemotherapy. He is alive and disease-free 7 years after the operation