Hepatic vein thrombosis (Budd-Chiari syndrome) in the microgranular variant of acute promyelocytic leukemia.

The microgranular form of acute promyelocytic leukemia (APL) was described in the late 1970s and adopted by the French, American, and British classification system in the early 1980s. Morphologically, this form shows distinct differences from the classic form of APL, but clinically it shares many of the same traits. Among these is the predilection for coagulopathies, including disseminated intravascular coagulation (DIC). This DIC has been associated with one previously reported case of fatal hepatic vein thrombosis (Budd-Chiari syndrome), in association with an untreated case of APL. The authors present a case of the microgranular variant of acute promyelocytic leukemia (FAB-M3V), with autopsy and electron microscopic evidence in support. It is important to recognize this variant form of APL and its association with hepatic vein thrombosis, because any successful attempt at therapy must be instituted early in the course of the disease.