|LETTER TO THE EDITOR
|Year : 2018 | Volume
| Issue : 6 | Page : 1442-1443
Priapism as a rare presentation of chronic myeloid leukemia
Pradeep Kumar, Khaliqur Rahman, Surabhi Kumari, Manish Kumar Singh, Ruchi Gupta, Soniya Nityanand
Department of Hematology, SGPGI, Lucknow, Uttar Pradesh, India
|Date of Web Publication||28-Nov-2018|
Department of Hematology, SGPGI, Lucknow - 226 014, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumar P, Rahman K, Kumari S, Singh MK, Gupta R, Nityanand S. Priapism as a rare presentation of chronic myeloid leukemia. J Can Res Ther 2018;14:1442-3
Priapism is persistent and painful erection of the penis without accompanied sexual arousal for more than 6 h. In about 20% of the cases, priapism is due to some hematological causes and leukemia accounts for 1%–5% of priapism.
We report three cases of chronic myeloid leukemia (CML) who presented with priapism as the first symptom. The clinicopathological profile is represented in [Table 1]. All the three patients presented to the emergency department with a history of the painful erection of penis for 5–7 days. They did not have any history of trauma or any other medication. Examination revealed rigid tender penile shaft with no mark of injury and a normal meatal opening. Other systemic examination showed the presence of splenomegaly in one, hepatosplenomegaly in other and no other abnormality in the third case. All of them were managed in the emergency department through aspiration and irrigation with phenylephrine and then winter's T shunt. The investigation revealed peripheral leukocytosis with shift to left, a hypercellular marrow with myeloid predominance and basophilia and a positive BCR-ABL transcript confirming the diagnosis of CML [Figure 1]. They were managed with hydrea initially, then switching to imatinib after the confirmation of BCR-ABL transcript report. All of them are on routine follow-up and are doing fine.
|Figure 1: Microphotograph of peripheral blood showing leukocytosis with shift to left and basophilia (a) MGG stain, ×10. Bone marrow aspiration shows hypercellular packed particle (b), the trails were cellular and showed maked myeloid proliferation with shift to left (c). Postpolymerase chain reaction gel electrophoresis showing a 347 base pair positive band of BCR-ABL p210 product, confirming the case as chronic myeloid leukemia (d)|
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Leukocytosis associated with leukemia causes stasis of venous blood and leads to “Low Flow” type of priapism also known as ischemic or anoxic priapism. Leukemia accounts for approximately 1%–5% of priapism. Of this, CML accounts for 50% of the cases. However, priapism as a presenting feature of CML is rare and is noted in 1%–2% of CML patients. Over the last 4 years, a total of 416 new cases of CML were diagnosed at our institute, of which only 3 (0.74%) cases presented with priapism. Priapism is a medical emergency because irreversible cell damage and fibrosis can occur if not treated within 24–48 h. First-line treatment is aspiration of blood from corpora cavernosa. The success rate with aspiration alone is approximately 30%. If the treatment is unsuccessful, instillation of the sympathomimetic agent phenylephrine hydrochloride every 5 min is used until the swelling of the penis is reduced or subsided. If conservative management fails then surgery (shunt procedure) can be considered. The underlying leukemic cause like CML should be treated simultaneously as well with cytoreductive therapy. In conclusion, priapism can be a rare presentation of CML. Hence, a complete blood count with peripheral blood examination should be carried out in the primary workup of priapism.
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