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A LJ7 -year-old male presen ts for further evaluation secondary to worsening fatigue of 2 weeks' duration . Laboratory evaluation reveals elevated leukocyte count at LJ 7 .000/ ,LLL. hemoglobin of 1 0.3 g/dl. platelet count of 67.000/,LLL. and LDH of 2.300/,LLL. Peripheral blood smear is obtai ned and is shown below.
Patien t is admitted to the hospital. and bone marrow aspiration is obtained as shown below.
Flow cytometry revealed an i ncreased popu lation of cel ls bearing CD1 0, CD 1 9 , CD20, CD79a with negative expression of CDS, termi nal deoxytransferase (TdT) , myeloper-oxidase (MPO) , and eye lin D 1 .
What is the most likely diagnosis?
- Acute monoblastic leukemia (AML)
- Chronic myeloid leukemia (CML)
- Mantle cell lymphoma in leukemic phase (MCL)
- Acute lymphoblastic leukemia (ALL)
- Burkitt lymphoma/leukemia (BL)
Medicine
E. Peripheral slide reveals increased number of leukocytes exhibiting high nuclear-to-cytoplasmic ratio with basophilic cytoplasm and prominent vacuoles in the cytoplasm and overlying the nucleus. These are the typical features of Burkitt lymphoma/leukemia. Negativity for MPO and the presence ofB-cell markers on flow cytometry rules out AML. Negativity for TdT differentiates BL from ALL that is virtually always positive for TdT.
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