P1090 - Myeloid Sarcoma of the Pancreas Causing Obstructive Jaundice

Laura E. Lavette, , Angela G. Niehaus, MD, Jason D. Conway, MD, MPH, FACG, Girish Mishra, MD, MS, FACG, Darius A. Jahann, MD
Wake Forest University School of Medicine, Winston-Salem, NC

Introduction: Obstructive jaundice is a common clinical manifestation of pancreatic cancer (PC), over 90% of which are ductal adenocarcinoma. Myeloid sarcoma (MS) is an extramedullary manifestation of acute myeloid leukemia which rarely occurs in the pancreas. We report a rare cause of obstructive jaundice- MS of the pancreas in the oldest patient and second to require endoscopic retrograde cholangiopancreatography (ERCP) reported in the literature.¹

Case Description/Methods: A 70-year-old man with recently diagnosed leukemia of the eyelid presented with epigastric abdominal pain and jaundice. Labs were notable for total bilirubin 12.1 mg/dL, AST 261 IU/L, ALT 435 IU/L, and alkaline phosphatase 670 IU/L. MRI illustrated a pancreatic mass with a large hypovascular and small hypervascular component with upstream biliary ductal dilation (Fig 1A). The patient underwent endoscopic ultrasound (EUS) with fine needle biopsy which demonstrated a 20 mm hypoechoic pancreatic mass (Fig 1B). The core sample had atypical hematopoietic cells dissecting through the pancreatic parenchyma, immunoreactive for CD45 and MPO, confirming the myeloid nature of the neoplasm (Fig 1DE). ERCP delineated a high grade distal biliary stricture with upstream dilation for which a plastic stent was placed (Fig 1C). The patient was initiated on chemotherapy for definitive treatment.

Discussion: Pancreatic MS is a rare malignancy that can easily pose as a pancreatic adenocarcinoma. With less than 15 case reports over the past two decades, current understanding of pancreatic MS is incredibly limited.² Despite the rarity of this case, there are several key points regarding atypical causes of biliary obstruction. EUS is a useful tool and should be utilized early when there are atypical features of the mass on imaging that suggests an alternative diagnosis to adenocarcinoma. This was critical in this case because the clinical prognosis and management of pancreatic MS and PC are so dissimilar, allowing the patient to be instituted on curative chemotherapy without delay.

1. Ravandi-Kashani F, Estey E, Cortes J, et al. Granulocytic sarcoma of the pancreas: a report of two cases and literature review. Clin Lab Haematol 1999;21:219–24.
2. Wu K, Zhang X, Zhang B. Myeloid sarcoma of the pancreas: a case report and literature review. Medicine. 2021 April 2;10(13).



Disclosures:


Laura E. Lavette, , Angela G. Niehaus, MD, Jason D. Conway, MD, MPH, FACG, Girish Mishra, MD, MS, FACG, Darius A. Jahann, MD. P1090 - Myeloid Sarcoma of the Pancreas Causing Obstructive Jaundice, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.