Chameleonic Chloroma: A Case of Myeloid Sarcoma Presenting as a Pancreatic Head Mass

Abstract

We report a case of pancreatic myeloid sarcoma (MS), an extremely rare manifestation of acute myeloid leukemia (AML), in a 35-year-old male who presented with epigastric pain and watery stools. Initial diagnostic testing was inconclusive; however, following an extensive evaluation, endoscopic biopsies suggested AML, which was confirmed by a bone marrow biopsy. Given that few cases are documented in the literature, pancreatic MS without a preexisting hematologic malignancy poses a significant diagnostic challenge.

Keywords: acute myeloid leukemia (aml); chloroma; granulocytic sarcoma; myeloid sarcoma; pancreatic cancer.

Figure 1. Magnetic resonance cholangiopancreatography (coronal view) demonstrating a 4.8 x 4.0 x 3.7 cm homogeneous hypo-enhancing mass (red arrow) in the pancreatic head region and common bile duct dilation.

Figure 2. 3D reconstruction of the pancreaticobiliary system demonstrating abrupt cessation of the common bile duct and pancreatic duct, or double duct sign (red arrows).

Figure 3. Abdominal computed tomography (axial view) with oral and IV contrast re-demonstrating homogeneous mass, 5.6 cm in the longest dimension, in the region of the pancreatic head circumferentially surrounding the common bile duct stent.

Figure 4. Contrast artifact versus food products versus later discovered gastric mass can be seen in the lesser gastric curvature (white arrow); notably, this was not commented on in the original radiography report. The red arrow shows the pancreatic head mass.

Figure 5. Endoscopic image of the retrograde view of a large, smooth mass along the lesser gastric curvature. Gross bleeding is present following an excisional biopsy of the mass.

Figure 6. Positron emission tomography (coronal view) demonstrating abnormally elevated F-FDG uptake in the pancreatic head (white arrow) and gastrum (red arrow).