Isolated granulocytic sarcoma of the pancreas: a tricky diagnostic for primary pancreatic extramedullary acute myeloid leukemia

Abstract

We report two clinical cases of primary granulocytic sarcoma of the pancreas that were diagnosed on the surgical specimen. Atypical clinical and morphological presentations may have lead to pretherapeutic biopsies of the pancreatic mass in order to indicate primary chemotherapy. Literature review of this rare clinical presentation may help physicians to anticipate diagnostic and therapeutic strategies.

Figure 1

Fixed, paraffin-embedded tissue sections of i) pancreatic invasion (A, case n°1, magnification at ×100) of medium sized cells, with CD43 positive expression signing myeloid lineage, inset shows contiguous lymph node with high CD43 expression (internal positive control of myeloid lineage); and of ii) omentum invasion (B, case n°2, hematoxylin and eosin staining, magnification at ×400) by myeloid-like cells, some with mitotic activity (arrow head), surrounding fat cells (arrow), inserts show myeloperoxydase (MPO), CD43, and CD34 expression (arrow head showing internal positive control with vessel).

Figure 2

Abdominal computed tomodensitometry, with injection of contrast product, portal sequence. Axial (A) projection showing Wirsung dilatation (arrow head). Axial (B) and frontal (C) projections showing low density pancreatic mass (arrow heads), case n°2.