Chronic Myelomonocytic Leukemia as Part of a Primary Multiple Malignant Tumor: a Case Report

INTRODUCTION: Chronic myelomonocytic leukemia (CMML) is a rather rare hemoblastosis characterized by damage to the granulocytic and monocytic hematopoietic lineages with the development of relative and absolute monocytosis of the peripheral blood and respective manifestations in the bone marrow. The diagnosis of CMML, like other tumors of hematopoietic, lymphoid and related tissues, is difficult and includes examination of peripheral blood with determination of leukogram parameters, and examination of red bone marrow biopsy specimens. CMML rarely occurs as a part of a primary multiple malignant tumor.

AIM: To demonstrate a rare and difficult to diagnose clinical case of primary multiple tumor: a combination of prostate cancer with renal cell carcinoma and CMML.

In the considered clinical case, the postmortem examination of a patient with a primary multiple malignant tumor with the development of CMML, revealed lesions of lungs, liver, kidneys, spleen, pancreas, retroperitoneal tissue and colon. Based on clinical presentation, the patient was diagnosed with non-specific ulcerative colitis, which on autopsy was interpreted as leukemic lesion of the colon with the development of ulcerative-necrotic colitis. Death resulted from multiorgan failure with phenomena of tumor intoxication.

CONCLUSION: The presented clinical case of CMML demonstrates a polysystemic character of this disease, non-specific symptoms, difficulty in prescribing adequate treatment due to the development of conditions that complicated the main diagnosis, and also shows the probability of developing primary multiple metachronous tumors in patients with various genetic mutations.