0
A 28-year-old male presents with a 2 -month history of fatigue and weakness. Physical exam reveals splenomegaly. Laboratory workup shows a leukocyte count of 27 LJ ,OOO/ J.LL, hemoglobin of 7.2g/d l, and a platelet count of 1 3 .000/J.LL. A chest fi lm is normal . The peripheral blood smear is shown . Flow cytometry shows expression of CD2+. CD3+. CDS +. CD7+. H LA-DR+ . and TdT + . The peripheral blood smear is shown.
What is the most likely diagnosis?
- B-cell acute lymphoblastic leukemia (B-ALL)
- T-cell acute lymphoblastic leukemia (T-ALL)
- Chronic myelogenous leukemia (CML)
- Acute myeloid leukemia (AML)
Medicine
B. The peripheral blood shows cells of variable size with a high nuclear-cytoplasmic ratio, indistinct nucleoli, fine to condensed chromatin, and round to irregular nuclei. The leukocyte mor-phology and immunophenotype are characteristic ofT-ALL, which accounts for approximately 15% to 25% of adult ALL cases. Patients with T-ALL are older than patients with B-ALL and usually present with very high leukocyte counts, splenomegaly, and lymphadenopathy. A mediastinal mass maybe present. Adults with T-ALL may have a better prognosis than cases of B-ALL. B-ALL is usually positive for CDlO, CD19, CD22, CD79a, HLA-DR, and TdT. The immunophenotype of AML is CD13+, CD33+, HLA-DR+, and CD34+. However, myeloid antigens may be expressed on lymphoblasts, and CD13 and CD33 have been described in ALL with the ETV6-RUNX1 mutation. The blood smear is not compatible with CML; there is no myeloid lift shift or basophilia.
need an explanation for this answer? contact us directly to get an explanation for this answer