Occult intestinal angiosarcoma presenting as refractory anemia during tyrosine kinase inhibitor therapy for chronic myeloid leukemia: A case report

Table 1 Key laboratory values before and at presentation

Parameter	May 2024 (baseline)	September 2024 to October 2024 (acute presentation)
Hemoglobin (g/dL)	13.0	5.2
MCV (fL)	86	68.7 (microcytic)
Ferritin (ng/mL)	137	26.4 (low-normal)
Reticulocytes (%)	-	1.2
White blood count (× 109/L)	14.9	- (not significantly changed)
BCR-ABL1 (%)	0.0061	< 0.0030 (stable MR4.5)
Bilirubin (total/direct; mg/dL)	-	0.24/0.11
Haptoglobin (mg/dL)	-	365 (high)
Lactate dehydrogenase (U/L)	-	168
FIT	-	Negative
Vitamin B12/folate	Normal	Normal

MCV: Mean corpuscular volume; FIT: Fecal immunochemical test.

Table 2 Chronological summary of clinical events following diagnosis

Date	Event	Details/findings
January 2025	Neurological deterioration	Brain MRI: Numerous new hemorrhagic intra-axial masses in supratentorial and infratentorial regions
February 2025 to March 2025	Brain radiotherapy	3D conformal IGRT was well-tolerated
March 2025 to January 2025	Systemic therapy	Weekly paclitaxel, Bevacizumab was not added owing to the patient’s ongoing and recurrent bleeding risk
Follow-up	Disease progression	Thoracic CT scan: Extensive new pulmonary nodules; new pleural nodular involvement
Final decline	Clinical deterioration	Rapid thoracic disease progression despite ongoing management
Death	Cause of death	Uncontrolled thoracic hemorrhage before initiation of further therapy

MRI: Magnetic resonance imaging; IGRT: Image-guided radiotherapy; CT: Computed tomography.