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A Case of Synchronous Primary Pancreatic DLBCL and Incipient CML
Yu Sonia1, Oentoro Jaymie2, Guin Rohini3
1Division of Hematology and Oncology, Department of Medicine, Stony Brook University Hospital, New York.
Journal of the Association of Genetic Technologists
|December 26, 2025
Summary
This case report details a rare instance of concurrent diffuse large B-cell lymphoma (DLBCL) and Philadelphia chromosome-positive chronic myeloid leukemia (CML) in a patient. It underscores the need for thorough cytogenetic testing in diagnosing synchronous hematologic malignancies.
Area of Science:
- Hematology
- Oncology
- Genetics
Background:
- A 75-year-old male presented with symptoms including back pain and weight loss.
- Imaging revealed a pancreatic head mass, initially suspected to be malignant.
- Biopsy confirmed diffuse large B-cell lymphoma (DLBCL).
Purpose of the Study:
- To report a rare case of synchronous chronic myeloid leukemia (CML) and DLBCL.
- To emphasize the importance of comprehensive diagnostic workup for hematologic neoplasms.
- To discuss the therapeutic challenges in managing concurrent myeloid and lymphoid malignancies.
Main Methods:
- Initial diagnosis involved biopsy of the pancreatic mass and staging workup.
- Chemotherapy was administered for DLBCL, leading to remission.
- Fluorescence in situ hybridization (FISH) was performed on bone marrow and peripheral blood samples.
- Targeted therapy was initiated for CML.
Main Results:
- The patient achieved radiographic remission for DLBCL.
- FISH analysis unexpectedly identified Philadelphia chromosome-positive (Ph+) cells, indicating concurrent CML.
- Despite targeted therapy for CML, BCR::ABL1 transcripts remained detectable at follow-up.
- This highlights a rare coexistence of lymphoid and myeloid neoplasms.
Conclusions:
- Comprehensive staging and cytogenetic testing are crucial for diagnosing synchronous hematologic neoplasms.
- Managing patients with concurrent DLBCL and Ph+ CML presents significant therapeutic challenges.
- Further research is needed to optimize treatment strategies for such rare presentations.
