CHRONIC LYMPHOCYTIC LEUKEMIA INFILTRATION WITH GALLBLADDER INVOLVEMENT WITHOUT JAUNDICE: PRESENTATION OF A RARE CASE AND REVIEW OF LITERATURE

Abstract

Infiltration of small mature-appearing atypical B lymphocytes is a malignancy manifesting with two commonly known distinct entities, chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL), which are distinguished based on clinical and laboratory findings and their localization in blood, bone marrow, and lymph nodes. SLL typically presents as a systemic disease and also has nodal and extranodal forms. For CLL, however, the presence of clinically significant infiltration of CLL lymphocytes outside the bone marrow regardless of the presence of systemic diseases is defined as extramedullary CLL in some studies. CLL, which is frequently seen in developed countries among the individuals aged between 40-70 years, has an increasing incidence. Moreover, CLL remains largely incurable and is characterized by marked clinical heterogeneity. Primary and secondary involvement of the gallbladder in leukemia and lymphomas is rare. However, gallbladder wall infiltration in the presence of cholecystitis or cholelitiasis, or no symptoms has been shown in non-Hodgkin lymphomas. The present case, who was previously diagnosed with CLL, presented to our clinic with sudden-onset abdominal pain with no jaundice and was operated on with a prediagnosis of cholecystitis and cholelitiasis. Pathological examination of surgical specimens of the gallbladder and the surrounding lymph nodes indicated CLL infiltration. Existence of CLL/SLL and follicular lymphoma in the gallbladder and bile ducts is highly rare while diffuse large B-cell lymphoma, marginal-zone lymphoma, and MALT lymphomas are commonly seen in these sites. Moreover, gallbladder involvement without jaundice, as seen our patient, is much rarer. Therefore, gallbladder involvement should be considered in the differential diagnosis of the CLL/SLL patients presenting with symptoms such as cholecystitis. Further studies are needed to investigate whether gallbladder infiltration is an extension of the infiltration of surrounding lymph nodes and/or liver in such patients.