INTRODUCTION
Hematologic malignancies (HM) represent a burden on the health care system worldwide, mainly due to their prevalence among the pediatric population, and have always been well recognized among other types of cancer by the effective use of genetic analyses to establish the diagnosis, classification and prognosis (1). HM include leukemias, lymphomas, myeloproliferative neoplasms (MPNs), mast cell neoplasms, plasma cell neoplasms, histiocytic tumors, and dendritic cell neoplasms. However, leukemias and lymphomas comprise the majority of malignant cases, with acute lymphoblastic leukemia being the most common malignancy in children (2). Chronic leukemias include lymphocytic and myelogenous leukemias, which carries an overall more benign course than acute leukemias and occurs typically in the adult population (3). Chronic myeloid/ myelogenous leukemia (CML) is one of the MPNs and accounts for 15% of newly diagnosed leukemia in adults; it is characterized by the presence of BCR-ABL1 fusion oncogene; this rearrangement is known as the Philadelphia chromosome (4). CML can range from an asymptomatic course, which accounts for almost 50% of cases diagnosed in the United States, to a wide array of signs and symptoms, including fatigue, weight loss, fever, abdominal discomfort, and many other manifestations (4). Among the various presentations, gastrointestinal (GI) involvement has been well recognized, though it is more common in acute leukemias than chronic, and is becoming even less common due to improved chemotherapy (5).
Here we present a case of a 36-year-old male who presented with right lower abdominal pain and was accidentally found to have a very high white blood cell (WBC) count during routine workup 317.3 x109/L (4-10 x109/L).