Introduction: Extramedullary tumors can occur in patients with Acute Myeloid Leukemia (AML) patients at any time during their disease course.Acute pancreatitis can be the initial extramedullary presentation when diagnosing AML but no documentation of AML cells in the pancreas were found in our extensive literature review (1).
Case Description/Methods: A 69 year-old-woman with a history of AML and myelodysplasia treated with chemotherapy and bone marrow transplant ten years ago in remission, presented with acute onset chest pain, acid reflux, intermittent nausea and vomiting and unintentional weight loss of 10 pounds in four months. On initial evaluation, she had ALP 158 and normal lipase 87. CT abdomen and abdominal ultrasound showed diffuse interval pancreatic enlargement with a 4.5 cm x 3.8 cm sized in the pancreatic body. CA 19-9 was elevated at 178. EGD with EUS revealed a lobulated mass in the pancreatic head, genu, and the pancreatic body suspicious for adenocarcinoma. The mass also encircled the portal vein and was staged T3N1MX by endosonographic criteria. Interestingly, she had no traditional risk factors for pancreatic adenocarcinoma with an absence of history of alcohol or tobacco use. FNA of the lobulated pancreatic head mass and peripancreatic lymph node revealed an atypical lymphoid infiltrate, highly suspicious for recurrent AML. IHC staining of the atypical cells showed positivity for CD45, CD34, CD117, CD20, and Ki-67, showing 20-30% cells in the cycle with some pan-cytokeratin-positive cells and therapy with FOLFIRINOX was initiated.
Discussion: The presentation of AML as an extramedullary myeloid tumor is usually associated with leukemic transformation or crisis. In AML patients, acute pancreatitis is a rare but highly important manifestation that usually arises during the course of chemotherapies (1). The presence of leukemic cells on pancreatic biopsy has not been documented previously as a manifestation of extramedullary AML.
1.Yang WX, An K, Liu GF, Zhou HY, Gao JC. Acute pancreatitis as initial presentation of acute myeloid leukemia-M2 subtype: A case report. World J Clin Cases. 2023;11(6):1385-1392. doi:10.12998/wjcc.v11.i6.1385
Figure: Figure 1 is without any mass. Figure 2 shows the growth of new pancreatic mass around the splenic vein 20 months later.
Disclosures:
Alexandria Dennison indicated no relevant financial relationships.
Shruti Verma indicated no relevant financial relationships.
Ajay Iyer indicated no relevant financial relationships.
Syed Jafri indicated no relevant financial relationships.
Alexandria Dennison, MD1, Shruti Verma, MD2, Ajay Iyer, MD2, Syed Jafri, MD2. P0082 - Recurrent AML Found in the Pancreas, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
