Rare cases of atraumatic splenic rupture managed conservatively in patients with myeloid neoplasms: a report of two cases and literature review.

IF 2.1 4区 医学 Q3 ONCOLOGY
Meng Chen, Moqin Jiang, Weifeng Zhang, Lei Zhao, Ying Zhang
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Abstract

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.

髓系肿瘤患者保守治疗非外伤性脾破裂的罕见病例:附2例报告并文献复习。
背景:非外伤性脾破裂(ASR)是罕见的,通常归因于潜在的病理条件,肿瘤疾病是主要的病因。传统上,手术是大多数ASR患者治疗的标准方法。然而,关于保守治疗的结果,特别是与髓系肿瘤相关的ASR的报道很少。病例描述:在这里,我们报告两例涉及ASR与髓系肿瘤相关的病例报告。第一位患者患有慢性髓细胞白血病(CMML),携带CBL和ASXL1突变,在接受低甲基化药物5-氮杂胞苷治疗后不久发生ASR。第二例患者,在骨髓增生性肿瘤(MPN)的母细胞期,在其疾病进展过程中经历了ASR。在最初的病例中,尽管经历了剧烈的腹痛和低血容量性休克,但由于及时的诊断,患者对及时的液体复苏和输血反应良好。非手术治疗方法成功避免了脾切除术或动脉栓塞的需要,导致了良好的结果。在第二个病例中,患者表现为进行性腹痛,但在整个ASR发作期间血流动力学保持稳定。我们选择了谨慎的方法,优先进行复苏,密切监测,并采取观察等待的策略。遗憾的是,病人的病情恶化,表现为脾肿大,白细胞增多,反复出现实质出血。结论:在这里,我们报告了两例髓系肿瘤的ASR,表明患者可以通过保守治疗获得可接受的结果。
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来源期刊
CiteScore
3.90
自引率
0.00%
发文量
0
期刊介绍: The Chinese Clinical Oncology (Print ISSN 2304-3865; Online ISSN 2304-3873; Chin Clin Oncol; CCO) publishes articles that describe new findings in the field of oncology, and provides current and practical information on diagnosis, prevention and clinical investigations of cancer. Specific areas of interest include, but are not limited to: multimodality therapy, biomarkers, imaging, tumor biology, pathology, chemoprevention, and technical advances related to cancer. The aim of the Journal is to provide a forum for the dissemination of original research articles as well as review articles in all areas related to cancer. It is an international, peer-reviewed journal with a focus on cutting-edge findings in this rapidly changing field. To that end, Chin Clin Oncol is dedicated to translating the latest research developments into best multimodality practice. The journal features a distinguished editorial board, which brings together a team of highly experienced specialists in cancer treatment and research. The diverse experience of the board members allows our editorial panel to lend their expertise to a broad spectrum of cancer subjects.
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