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A LJ8-year-old male presen ts to the emergency room for further evaluation of a 3-week history of progressively worsening Fatigue. Physical examination reveals pal lor and dif-Fuse petech iae over lower extremities. Laboratory evaluation shows a total leukocyte cou nt of 2 3, LJOO/,uL. hemoglobin 9.8 g/dl. and platelet count of 1 3, 000/,uL. Periph-eral blood smear and bone marrow aspirate are shown.
What is the most likely diagnosis?
- Acute lymphoblastic leukemia (ALL)
- Acute myeloid leukemia (AML)
- Prolymphocytic leukemia (PLL)
- Chronic myeloid leukemia (CML)
- Chronic lymphocytic leukemia (CLL)
Medicine
B. Peripheral slide demonstrates large leukocytes with fine, uncondensed chromatin structure with high nuclear to cytoplasmic ratio characteristic of blasts. The presence of Auer rods is pathognomonic of acute myeloid leukemia. A bone marrow aspirate disclosed 36% blasts with salmon granules and a perinuclear hof. Fluorescence in situ hybridization (FISH) revealed t(8;21).AML with t(8;2 1) results in the fusion of RUNX1 and RUNX1 Tl, which disrupts function of the core binding factor. AML t(8;21) accounts for about 8% of AML and is associated with a favorable prognosis.
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