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A LJ 1 -year-old African American female patient is referred for evaluation of leukopenia. She reports she is generally in good health . but she has noted increasing shortness of breath in recent weeks. She has a history of ovarian carci noid tumor that was trea ted surgical ly. Complete blood count shows leukocyte count 2.1 00/fLL. hemoglobin 1 2 .2 g/dl. and platelet count 2 30,000/ fLl. Physical exam shows no splenomegaly or lymphadenopathy. I mages below are from CT chest and bone marrow biopsy.
What is the most likely diagnosis?
- Ovarian carcinoid metastatic to lung and bone
- Sarcoidosis
- Hodgkin lymphoma
- Non-Hodgkin lymphoma
Medicine
B. Sarcoidosis, especially when presenting with cytopenias and extrapulmonary involve-ment, can be found in the bone marrow as evidenced by the image above showing noncaseating granu-lomas. In addition, CT scan depicts bilateral hilar adenopathy. The other choices could be considered in the initial differential diagnosis of this patient, but are less consistent with the overall clinical pre-sentation and bone marrow biopsy specimen.
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