Leucemia Mielomonocítica Aguda em paciente com diagnóstico recente de Adenocarcinoma de reto

Abstract

Introduction: Colorectal Cancer (CRC) and Acute Myeloid Leukemia (AML) are distinct neoplasms in terms of origin and clinical manifestation, but in rare cases, they can coexist in the same patient. CRC is a solid neoplasm with progressive growth and metastatic potential, with high incidence and mortality due to câncer in Brazil and worldwide, however, with high survival rates when diagnosed in the early stages. AML is a hematologic neoplasm with proliferation and accumulation of immature myeloid cells essentially in the bone marrow and peripheral blood, resulting in bone marrow failure, being less frequent and more aggressive than CRC. Case report: A 68-year-old female patient admitted with a clinical presentation suspected for colorectal neoplasia, confirmed invasive adenocarcinoma of the rectum complicated by pericolic abscess, having manifested peripheral hematologic and cutaneous alterations during the postoperative period of rectosigmoidectomy. Acute Myelomonocytic Leukemia was diagnosed through peripheral blood immunophenotyping. The patient exhibited dermatological lesions and underwent a skin biopsy that confirmed leukemia cutis. Immunohistochemistry showed leukemic infiltration adjacent to rectal adenocarcinoma. Discussion: Patient with a rare circumstance of concomitant two neoplasms, one solid and one hematological, having manifested hematological alterations and cutaneous lesions of AML during hospitalization for treatment of a solid tumor. Presenting mutation in the NPM1 gene associated a priori with favorable prognosis, but with extramedullary manifestations, considered uncommon and leading to worse prognosis and reduced survival. Conclusion: The simultaneous occurrence of acute myeloid leukemia with extramedullary infiltration in a patient with newly diagnosed rectal adenocarcinoma is a rarity and reports such as this are essential to broaden clinical recognition of these atypical presentations, in order to avoid delays in treatment and improve clinical outcomes.