A Case of Synchronous Primary Pancreatic DLBCL and Incipient CML

A 75-year-old male presented with back pain, abdominal discomfort, and weight loss, and was subsequently found to have a pancreatic head mass. Biopsy confirmed diffuse large B-cell lymphoma (DLBCL), and the patient achieved radiographic remission with chemotherapy. However, fluorescence in situ hybridization (FISH) analysis unexpectedly revealed Philadelphia chromosome-positive (Ph+) cells in the bone marrow and peripheral blood, establishing concurrent chronic myeloid leukemia (CML). Despite targeted therapy for CML, at last follow-up, the patient still has detectable BCR::ABL1. This rare case highlights the diagnostic importance of comprehensive staging and cytogenetic testing, as well as the therapeutic challenge of managing synchronous lymphoid and myeloid neoplasms.