Case presentation

A 50-year-old female presented with progressively increasing upper abdominal swelling of one-month duration. She also has easy fatigability, unquantified but significant weight loss, and loss of appetite
The patient has no history of trauma or heavy lifting. She also denied any previous episodes of bleeding and her family history was also negative for bleeding disorders.
Physical examination was significant for splenomegaly of 8 cm along the splenic growth line, a 20x10 cm hard, non-tender mass on the right side of the umbilicus (figure 1), and ascites. Her laboratory evaluation reveals a complete blood count with a WBC of 97,900, hemoglobin of 9.6, and platelet count of 919,000. Abdominal ultrasound found a right anterior thoracoabdominal mass and splenomegaly measuring 20cm.
Abdominopelvic contrast CT was significant for a right abdominal wall (intramuscular) huge hematoma collection (figure 2) and massive splenomegaly. Lactate dehydrogenase was elevated to 949 IU/L.
Renal function tests, liver enzymes, coagulation profile, and serum electrolytes were in the normal range.
Bone marrow examination showed myeloid hyperplasia (with myeloid to erythroid ratio of 15:1). Neutrophils and bands 68%, metamyelocytes 6%, promyelocytes 8%, blasts 3% suggestive of CML-chronic phase. The diagnosis of CML was confirmed after RT-PCR was done on the patient’s blood and was positive for BCR/ABL1.
Ultrasound-guided fine needle aspiration from the mass revealed inflammatory cells with a hemorrhagic background.