Chinese clinical oncology · 2025
Rare cases of atraumatic splenic rupture managed conservatively in patients with myeloid neoplasms: a report of two cases and literature review.
СтатьяКлинический случайОбзорНазвание и аннотация: Перевод в очереди
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Chen Meng, Jiang Moqin, Zhang Weifeng, Zhao Lei, Zhang Ying
Аннотация
BACKGROUND: Atraumatic splenic rupture (ASR) is rare and typically attributed to underlying pathological conditions, with neoplastic diseases being the main etiologies. Traditionally, surgical intervention has been the standard approach for managing ASR in the majority of patients. However, reports on the outcomes of conservative management, especially for ASR related to myeloid neoplasms, are scarce.
CASE DESCRIPTION: Here, we present two case reports involving ASR associated with myeloid neoplasms. The first patient, suffering from chronic myelomonocytic leukemia (CMML) harboring CBL and ASXL1 mutations, developed ASR shortly after receiving treatment with the hypomethylating agent 5-azacytidine. The second patient, in the blast phase of myeloproliferative neoplasms (MPN), experienced ASR during the progression of their disease. In the initial case, despite experiencing intense abdominal pain and hypovolemic shock, the patient responded favorably to prompt fluid resuscitation and blood transfusion upon, thanks to a timely diagnosis. A non-operative management approach successfully averted the need for splenectomy or arterial embolism, leading to a favorable outcome. In the second case, the patient presented with progressive abdominal pain but remained hemodynamic stability throughout the ASR episode. We opted for a cautious approach, prioritizing resuscitation, close monitoring, and a watchful waiting strategy. Regrettably, the patient's condition deteriorated, marked by increasing splenomegaly, unchecked leukocytosis, and recurrent parenchymal hemorrhages.
CONCLUSIONS: Here, we report two cases of ASR in myeloid neoplasms, demonstrating that patients may achieve acceptable outcomes with conservative management.
CASE DESCRIPTION: Here, we present two case reports involving ASR associated with myeloid neoplasms. The first patient, suffering from chronic myelomonocytic leukemia (CMML) harboring CBL and ASXL1 mutations, developed ASR shortly after receiving treatment with the hypomethylating agent 5-azacytidine. The second patient, in the blast phase of myeloproliferative neoplasms (MPN), experienced ASR during the progression of their disease. In the initial case, despite experiencing intense abdominal pain and hypovolemic shock, the patient responded favorably to prompt fluid resuscitation and blood transfusion upon, thanks to a timely diagnosis. A non-operative management approach successfully averted the need for splenectomy or arterial embolism, leading to a favorable outcome. In the second case, the patient presented with progressive abdominal pain but remained hemodynamic stability throughout the ASR episode. We opted for a cautious approach, prioritizing resuscitation, close monitoring, and a watchful waiting strategy. Regrettably, the patient's condition deteriorated, marked by increasing splenomegaly, unchecked leukocytosis, and recurrent parenchymal hemorrhages.
CONCLUSIONS: Here, we report two cases of ASR in myeloid neoplasms, demonstrating that patients may achieve acceptable outcomes with conservative management.