Myeloid sarcoma of the pancreas

Abstract

Introduction: Myeloid sarcoma (MS) is an extramedullary mass, consisting of myeloid blasts with or without maturation, which efface the normal tissue architecture. It occurs mainly in lymph nodes, skin and soft tissue, testis, bone, peritoneum, and gastrointestinal tract, but rarely in the pancreas. Because their clinical courses, treatments, and prognoses are quite different, it is crucially important to distinguish between MS and pancreatic cancer. Patient concerns: We herein report a rare case of acute myeloid leukemia (AML) which presented with a pancreatic mass that mimicked pancreatic cancer. Diagnosis: The diagnosis of MS was established based on immunohistochemical (IHC) analysis and bone marrow examination which revealed neoplastic cells with CD34+/CD117+. Interventions: The patient was actively treated with chemotherapy. Outcomes: After 4 cycles of chemotherapy, the lesion in pancreas was significantly reduced, and the patient is still receiving further chemotherapy. Conclusion: When we encounter a patient suspected of pancreatic cancer with blood cell abnormalities and no significant increase in carbohydrate antigen 19-9 (CA19-9), we need to be aware of the possibility of pancreatic MS. Preoperative pathological biopsy and IHC are indispensable. Misdiagnosis is common if we rely solely on imaging.

Multimodal imaging study of pancreatic myeloid sarcoma: a case report and literature review

“…However, there are currently very few reports on the imaging findings of pancreatic MS. Pancreatic MS appears as a homogeneous slightly hypodense or isodense mass on non-contrast-enhanced CT and is prone to cystic change when the mass volume is large ( 12 , 14 , 15 ). On contrast-enhanced CT, it appears as a mild enhancement ( 4 , 8 , 9 ). There are only a few literature reports on the MRI signs of pancreatic MS, which include a slightly lower signal on T1WI, equal or slightly higher signal on T2WI, and limited diffusion on DWI ( 4 , 10 ).…”

“…Case reports or case series of pancreatic isolated MS published in the English language until May 1, 2023, were retrieved from the Web of Science, PubMed, and Science Direct databases. After detailed screening of each article, 13 patients in 12 articles met the inclusion criteria ( 4 – 15 ). Table 1 summarizes the clinical features, imaging findings, and immunohistochemistry of the 14 cases of isolated pancreatic MS (including the present case).…”

Myeloid Sarcoma: A Primer for Radiologists

“…The authors also noted that orbital and paranasal MS enhanced homogenously only with intravenous contrast. 20 In a combined case report and retrospective review of pancreatic MS, Wu et al 24 used abdominal CT imaging to visualize abnormalities in the pancreatic head as well as possible metastases in the liver taking the form of mildly enhancing foci. In their review of 11 other cases of pancreatic MS in the literature, the authors reported that MS can sometimes visualize as homogeneous masses on CT imaging and noted that this may aid in differentiating MS from pancreatic cancer, which usually presents as a hypodense mass.…”

“…In their review of 11 other cases of pancreatic MS in the literature, the authors reported that MS can sometimes visualize as homogeneous masses on CT imaging and noted that this may aid in differentiating MS from pancreatic cancer, which usually presents as a hypodense mass. 24…”

Isolated myeloid sarcoma of the pancreas: a case report

“…Misdiagnosis is inevitable if we rely only on imaging. [9] Surgery with systemic chemotherapy can achieve complete remission according to recent reports. [10] We report a patient with isolated MS of the pancreas, aiming to provide the experience for the diagnose and treatment of MS. We emphasize the importance of preoperative histopathological examination.…”