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A LJ9-year-old male presen ted for further evaluation secondary to weakness and fatigue. Physical examination revealed splenomegaly with no peripheral lymphadenopathy. Labo-ratory workup showed leukocyte count of 1 8 , 500/pl. hemoglobin of 9.3 g/dl. and platelet count of 11 Q.OOO/pl. Peripheral .blood smear is shown below.
What is the most likely diagnosis?
- Chronic lymphocytic leukemia (CLL)
- Chronic myeloid leukemia (CML)
- Hairy cell leukemia (HCL)
- Large granular lymphocyte leukemia (LGL)
- Prolymphocytic leukemia (PLL)
Medicine
C. Peripheral blood smear reveals the presence of lymphocytes with abnormal "hairy" cytoplasmic projections, which in the context of splenomegaly and absent peripheral lymphadenopa-thy are highly suggestive of HCL. Hairy cell leukemia is a rare indolent lymphoproliferative disorder that occurs primarily in males. Patients typically present with weakness, fatigue, and left upper quad- rant pain due to splenomegaly. Monocytopenia is a characteristic finding in the peripheral blood.
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