September 2018 - Presented by Trevor Starnes, M.D.

Clinical History

A previously healthy adolescent male presents with one week of jaundice and abdominal pain. Liver enzymes are elevated, and a CBC is normal. Radiology imaging reveals an obstructing mass at the pancreatic head. A biopsy of the mass is obtained. Bone marrow biopsies and peripheral blood flow cytometry (not shown) are normal.

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Key MRI image showing mass in pancreatic headFigure 1: Key MRI image showing mass in pancreatic head.

Biopsy of the pancreatic mass, 40xFigure 2: Biopsy of the pancreatic mass, 40x

Biopsy of the pancreatic mass, 400xFigure 3: Biopsy of the pancreatic mass, 400x

Immunohistochemical stain of mass for AE1/AE3, 40xFigure 4: Immunohistochemical stain of mass for AE1/AE3, 40x

Immunohistochemical stain of mass for CD45, 40xFigure 5: Immunohistochemical stain of mass for CD45, 40x

Immunohistochemical stain of mass for myeloperoxidase, 40xFigure 6: Immunohistochemical stain of mass for myeloperoxidase, 40x

Which is the most likely diagnosis?

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The correct answer is

D.) Myeloid sarcoma

> Learn more about this diagnosis.