A 51-year-old man with hypertension presented with left upper quadrant (LUQ) pain, fatigue, and 10kg weight loss over 6months. He had no fever or lymphadenopathy. Physical examination was significant for hepatomegaly palpable 6cm below the coastal margin and spleen palpable 12cm below the costal margin. Laboratory evaluation revealed a white blood cell (WBC) count of 206.3×103/uL, with 34% neutrophils, 9% blasts, 11% eosinophils, 18% basophils, 8% metamyelocytes, and 18% myelocytes. Hemoglobin level was 9.4g/dL and platelet count was 455,000/uL.