Chronic Myeloid Leukemia Masked by Massive Splenomegaly: Splenectomy as a Strategy in a Resource-Limited Setting

Massive splenomegaly may obscure the diagnosis of underlying hematologic malignancies, particularly in resource-limited settings. Chronic myeloid leukemia (CML) typically presents with marked leukocytosis; however, atypical presentations may lead to diagnostic delay and inappropriate initial management. A 40-year-old male presented with progressive splenomegaly and abdominal fullness. Preoperative laboratory evaluation demonstrated leukocytosis with associated mild anemia. Imaging revealed massive hepatosplenomegaly, and a provisional diagnosis of Banti syndrome was made. The patient underwent open splenectomy for symptomatic massive splenomegaly. Histopathological examination of the resected spleen was non-diagnostic. Postoperatively, persistent, progressive leukocytosis and thrombocytosis prompted further hematologic evaluation. Bone marrow examination suggested a myeloproliferative neoplasm. Due to limited access to molecular diagnostics, confirmatory testing was delayed. Subsequent real-time polymerase chain reaction (PCR) confirmed BCR-ABL1 positivity, establishing the diagnosis of classical CML. The patient was treated with cytoreductive therapy, followed by imatinib, with a favorable clinical and hematologic response. This case highlights the potential for massive splenomegaly to mask CML and emphasizes the importance of early molecular testing. Splenectomy may unmask underlying hematologic malignancy through significant postoperative hematologic changes.