Extramedullary Gastric Relapse of Acute Myeloid Leukemia After Allogenic Hematopoietic Stem Cell Transplantation.

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CASE REPORT A 63-year-old man presented with abdominal discomfort and dyspepsia for 2 weeks. Four years prior, he had a diagnosis of acute myeloid leukemia (AML) with maturation and received induction chemotherapy. He had undergone allogenic hematopoietic stem cell transplantation (allo-HSCT) from a human leukocyte antigen-matched unrelated donor and maintained a complete hematologic remission. Esophagogastroduodenoscopy revealed mucosal edema with erythema and subepithelial hemorrhage, which resembled a snakeskin pattern in the fundus of the stomach (Figure 1). An endoscopic biopsy specimen taken from this lesion showed infiltration of leukemic cells that were positive for myeloperoxidase. The laboratory findings demonstrated a leukocyte count of 3,400/μL, a hemoglobin level of 11.3 g/dL, and a platelet count of 65,000/μL. Bone marrow biopsy showed approximately 10% myeloblasts, which were positive for CD34. He was diagnosed with relapsed AML, and salvage chemotherapy with fludarabine, cytarabine, and granulocyte colony-stimulating factor was begun. After 8 months, his symptoms resolved and follow-up esophagogastroduodenoscopy revealed a complete resolution of previously noted lesion and the obtained biopsy specimen showed no leukemic cells (Figure 2).Figure 1.: Esophagogastroduodenoscopy revealed mucosal edema with erythema and subepithelial hemorrhage, which resembled a snakeskin pattern in the fundus of the stomach.Figure 2.: A follow-up esophagogastroduodenoscopy revealed complete resolution of previous noted lesion.Extramedullary gastrointestinal relapse, despite its rarity, should be considered as a cause of gastrointestinal symptoms in patients with AML who have undergone allo-HSCT. Relapse after allo-HSCT for leukemia commonly occurs in bone marrow, and extramedullary relapse is rare. Extramedullary gastric relapse of AML has been rarely reported in the literature. In reported cases, patients usually have vague and nonspecific symptoms such as abdominal discomfort, dyspepsia, nausea, and gastrointestinal bleeding. It should be noted that these symptoms can also occur in patients with graft-versus-host disease. Therefore, endoscopy and accurate pathological diagnosis are important for differential diagnosis and appropriate treatment. DISCLOSURES Author contributions: J. Hong wrote the article and approved the final manuscript. Y. Joo approved the final manuscript and is the article guarantor. Financial disclosure: None to report. Informed consent was obtained for this case report.