Skip to main content
editor@theusajournals.com | Oscar Publishing Services Journal Home
Login

International Journal of Medical Sciences And Clinical Research

Peer Reviewed | Open Access | E-ISSN: 2771-2265
Published Article

Orbital Manifestation of Acute Myeloid Leukemia: A Multidimensional Clinical Analysis of Bilateral Proptosis with Systematic Literature Review

Orbital Manifestation of Acute Myeloid Leukemia: A Multidimensional Clinical Analysis of Bilateral Proptosis with Systematic Literature Review

Authors

  • Dr. Hassan Al-Maliki
    Department of Clinical and Translational Medicine, Baghdad Academy of Medical Sciences, Baghdad, Iraq

Keywords:

Acute Myeloid Leukemia Bilateral Proptosis Orbital Leukemic Infiltration

Abstract

Acute myeloid leukemia (AML) is a hematological malignancy characterized by clonal proliferation of myeloid precursors with potential for widespread systemic and extramedullary infiltration. Orbital involvement, though uncommon, represents a clinically significant manifestation that may precede systemic diagnosis. This paper presents a multidimensional clinical analysis of AML presenting as bilateral proptosis, integrating evidence from a systematic literature review restricted to documented cases of orbital and ocular leukemic involvement. The study synthesizes clinical, radiological, and pathological findings to delineate patterns of disease presentation, diagnostic challenges, and prognostic implications.

The orbital infiltration in AML often reflects aggressive disease biology and is associated with myeloid sarcoma formation. Literature demonstrates that orbital involvement may present as unilateral or bilateral proptosis, extraocular muscle infiltration, or eyelid swelling, frequently mimicking inflammatory or infectious conditions (Chen et al., 2004; Chaudhry et al., 2012). A recurring clinical observation across multiple studies is delayed diagnosis due to nonspecific ophthalmic manifestations (Bidar et al., 2007).

This review further highlights the importance of early recognition of sinonasal-orbital leukemic infiltration, as previously described in chloroma cases (Bhat VK et al., 2005), which remains a foundational reference for understanding orbital AML pathology. The findings underscore the need for multidisciplinary diagnostic approaches combining ophthalmology, hematology, and radiology to improve patient outcomes.

References

Allan JM. Genetic susceptibility to breast cancer in lymphoma survivors. Blood. 2019;133(10):1004-6. [PMID: 30846507, https://doi.org/10.1182/blood-2019-01-894279].

Almalki AMJ, Alotaibi FA, Jabr HF, Mastan AR. Unilateral Proptosis As An Initial Sign Of Acute Myeloid Leukemia In A Child: A Case Report. Int Med Case Rep J. 2019;12:319-23. [PMID: 31695517, PMCID: PMC6817491, https://doi.org/10.2147/IMCRJ.S206596].

Ansari S, Rauniyar RK, Dhungel K, Sah PL, Ahmad K, Gupta MK, et al. Acute myeloid leukemia presenting as bilateral proptosis and right temporal swelling. Oman J Ophthalmol. 2014;7(1):35-7. [PMID: 24799802, PMCID: PMC4008900, https://doi.org/10.4103/0974-620X.127927].

Athukuri P, Khan AB, Gadot R, Haque M, Lee S, Gallagher KK, et al. Myeloid sarcoma of the skull base: A case report and systematic literature review. Surg Neurol Int. 2022;13:220. [PMID: 35673665, PMCID: PMC9168333, https://doi.org/10.25259/SNI_255_2022].

Basharat M, Khan SA, Din NU, Ahmed D. Immunophenotypic characterisation of morphologically diagnosed cases of Acute Myeloid Leukaemia (AML).Pak J Med Sci.2019;35(2):470-6. [PMID: 31086535, PMCID: PMC6500804, https://doi.org/10.12669/pjms.35.2.614].

Bhat VK, Naseeruddin K, Narayanaswamy GN. Sino-orbital chloroma presenting as unilateral proptosis in a boy. Int J Pediatr Otorhinolaryngol. 2005;69(11):1595-8. [PMID: 15939484, https://doi.org/10.1016/j.ijporl.2005.03.044].

Bidar M, Wilson MW, Laquis SJ, Wilson TD, Fleming JC, Wesley RE, et al. Clinical and imaging characteristics of orbital leukemic tumors. Ophthalmic Plast Reconstr Surg. 2007;23(2):87-93. [PMID: 17413619, https://doi.org/10.1097/IOP.0b013e3180333a85].

Byrd JC, Edenfield WJ, Shields DJ, Dawson NA. Extramedullary myeloid cell tumors in acute nonlymphocytic leukemia: a clinical review. J Clin Oncol. 1995;13(7):1800-16. [PMID: 7602369, https://doi.org/10.1200/JCO.1995.13.7.1800].

Cao X, Dai H, Cui Q, Li Z, Shen W, Pan J, et al. CD7-directed CAR T-cell therapy: a potential immunotherapy strategy for relapsed/refractory acute myeloid leukemia. Exp Hematol Oncol. 2022;11(1):67. [PMID: 36175988, PMCID: PMC9523980, https://doi.org/10.1186/s40164-022-00318-6].

Chandra T, Khan P, Khan L, Gupta A. Bilateral Proptosis - Initial and Rare Presentation: Aml. Indian Journal of Applied Research. 2021:17-8. [https://doi.org/10.36106/ijar/0610699].

Chaudhry IA, Alaraj AM, Alkatan HM. Unilateral eyelid swelling, proptosis and diplopia as initial manifestation of acute myeloid leukemia. Saudi J Ophthalmol. 2012;26(2):241-4. [PMID: 23960999, PMCID: PMC3729485, https://doi.org/10.1016/j.sjopt.2012.03.004].

Chen E, Morrison DG, Donahue SP. Acute myeloid leukemia presenting as bilateral proptosis from diffuse extraocular muscle infiltration. Am J Ophthalmol. 2004;137(5):948-50. [PMID: 15126169, https://doi.org/10.1016/j.ajo.2003.10.050].

Creutzig U, Kutny MA, Barr R, Schlenk RF, Ribeiro RC. Acute myelogenous leukemia in adolescents and young adults. Pediatr Blood Cancer. 2018;65(9):e27089. [PMID: 29667722, PMCID: PMC6105504, https://doi.org/10.1002/pbc.27089].

Dohner H, Weisdorf DJ, Bloomfield CD. Acute Myeloid Leukemia. N Engl J Med. 2015;373(12):1136-52.[PMID: 26376137, https://doi.org/10.1056/NEJMra1406184].

Faderl S, Kantarjian HM. In: Clinical Manifestations and Treatment of Acute Myeloid Leukemia; 2018. p. 924-43. [PMCID: PMCID, https://doi.org/10.1016/b978-0-323-35762-3.00059-7].

Geetha N, Sreelesh KP, Priya MJ, Lali VS, Rekha N. Osteolytic Bone Lesions - A Rare Presentation of AML M6. Mediterr J Hematol Infect Dis. 2015;7(1):e2015017. [PMID: 25745544, PMCID: PMC4344168, https://doi.org/10.4084/MJHID.2015.017].

Gozdasoglu S, Yavuz G, Unal E, Tacyldz N, Cavdar AO. Orbital granulocytic sarcoma and AML with poor prognosis in Turkish children. Leukemia. 2002;16(5):962; author reply 963. [PMID: 11986967, https://doi.org/10.1038/sj.leu.2402449].

Harrison CJ, Hills RK, Moorman AV, Grimwade DJ, Hann I, Webb DK, et al. Cytogenetics of childhood acute myeloid leukemia: United Kingdom Medical Research Council Treatment trials AML10 and 12. J Clin Oncol. 2010;28(16):2674-81. [PMID: 20439644, https://doi.org/10.1200/JCO.2009.24.8997].

Huang YC, Wang SC, Chen SN, Jou JR.BilateralAcute Proptosis as Initial Manifestation of Acute Myeloid Leukemia.Orbit. 2015;34(5):248-52.[PMID: 26186043, https://doi.org/10.3109/01676830.2015.1049371.

Jaiprakash MP, Antia PK, Shetty PA. Extramedullary deposits in acute myelogenous leukaemia. Indian J Cancer. 1981;18(1):51-3. [PMID: 6943124].

Johnston DL, Alonzo TA, Gerbing RB, Lange BJ, Woods WG. Superior outcome of pediatric acute myeloid leukemia patients with orbital and CNS myeloid sarcoma: a report from the Children’s Oncology Group. Pediatr Blood Cancer. 2012;58(4):519-24. [PMID: 21618422, PMCID: PMC3165066, https://doi.org/10.1002/pbc.23201].

l-Mujaini A, Al-Shaaibi M, Al-Mughaizwi T, Wali Y, GaneshA. Unilateral Proptosis: A Rare Presenting Sign of Acute Myeloid Leukemia. Oman Med J. 2022;37(4):e400. [PMID: 35915765,PMCID: PMC9260739, https://doi.org/10.5001/omj.2022.10].

Nagarajan S, Ramesh PV, Rangasami S, Azad A. Behind the bulging eyes: A rare case of acute myeloid leukemia M2 presenting as bilateral proptosis. Indian Journal of Ophthalmology - Case Reports. 2025;5(1):131-3. [https://doi.org/10.4103/ijo.Ijo_2143_24].

Pecorella I, Manna N, Calbi V, Omona V, Okello TR. Bilateral proptosis as an early manifestation of juvenile myelomonocitic leukemia in an African child. Indian Journal of Pathology and Oncology. 2021;8(1):152-4. [https://doi.org/10.18231/j.ijpo.2021.028].

Schwyzer R, Sherman GG, Cohn RJ, Poole JE, Willem P. Granulocytic sarcoma in children with acute myeloblastic leukemia and t(8;21). Med Pediatr Oncol. 1998;31(3):144-9. [PMID: 9722895, https://doi.org/10.1002/(sici)1096-911x(199809)31:3<144::aid-mpo3>3.0.co;2-b].

Shahriari SF M. A case of unilateral proptosis: what is your diagnosis? Middle East Journal of Cancer. 2015.

Stein-Wexler R, Wootton-Gorges SL, West DC. Orbital granulocytic sarcoma: an unusual presentation of acute myelocytic leukemia. Pediatr Radiol. 2003;33(2):136-9. [PMID: 12557072, https://doi.org/10.1007/s00247-002-0834-0].

Sune P, Sune M. Bilateral proptosis as initial sign of acute myeloid leukemia: case report and review of literature. International Journal of Contemporary Pediatrics. 2014;1(2). [https://doi.org/10.5455/2349-3291.ijcp20140807].

Tanveer S, Khilji M, Hassan R, Tanveer S, Khilji A. Approach to a Child with Bilateral Proptosis as a Rare Presentation of Acute Myeloid Leukemia. American Journal of Health, Medicine and Nursing Practice. 2023;9(2):42-53. [https://doi.org/10.47672/ajhmn.1600].