case_images: PMC10948221_01
case_images: MRI of the abdomen showing ill-defined mass in the inferior pancreatic head/uncinate process with small hypervascular component and large hypovascular component measuring 1.9 x 2.0 cm. There is adjacent side branch ectasia but no dilatation of the main pancreatic duct.
case_images: CRIGM2024-5513857.001.jpg
case_images: PMC10948221_01_CRIGM2024-5513857.001.jpg
case_images: fig1
case_images: Magnetic resonance imaging (MRI) illustrated an ill-defined pancreatic mass in the inferior pancreatic head/uncinate process with large hypovascular and small hypervascular components and upstream biliary ductal dilation (Figure 1).
case_images: EUS demonstrating a hypoechoic area near the distal CBD/pancreatic head measuring approximately 20 mm.
case_images: CRIGM2024-5513857.002.jpg
case_images: PMC10948221_01_CRIGM2024-5513857.002.jpg
case_images: fig2
case_images: EUS with fine needle biopsy which demonstrated a 20 mm hypoechoic pancreatic mass near the distal common bile duct (CBD) and pancreatic head (Figure 2). ERCP delineated a high-grade distal biliary stricture with upstream dilation for which a complete biliary sphincterotomy was performed and a plastic stent was placed.
case_images: (a) Core needle biopsy with atypical hematopoietic cells. (b) Positive stain for CD45, which is commonly expressed in myeloid sarcomas.
case_images: CRIGM2024-5513857.003.jpg
case_images: PMC10948221_01_CRIGM2024-5513857.003.jpg
case_images: fig3
case_images: The core sample illustrated atypical hematopoietic cells dissecting through the pancreatic parenchyma, immunoreactive for MPO and CD45, confirming a diagnosis of myeloid sarcoma (Figure 3).
case_images: (a) Initial ERCP showing a high-grade distal biliary stricture. (b) Following chemotherapy, repeat ERCP illustrates resolution of the stricture.
case_images: CRIGM2024-5513857.004.jpg
case_images: PMC10948221_01_CRIGM2024-5513857.004.jpg
case_images: fig4
case_images: The previous distal biliary stricture from MS had completely resolved, and the patient did not require further biliary prosthesis (Figure 4).