History 51 year old male. Seen by local physician for routine preoperative exam prior to dental surgery. Found to have low hemoglobin and a large left upper quadrant mass. Physical Exam Marked splenomegaly (subsequently confirmed by CT scan) extending from the left costal margin to just above the iliac crest. No other organomegaly. CBC (with microscopic differential) RBC 3.36 x 1012/L HGB 10.9 g/dL HCT 31.2 % MCV 92.8 fL MCH 32.4 pg MCHC 34.9 g/dL WBC 9.3 N 14 L 15 x 109/L % abnormal cells 71 (shown) PLT 59 x 109/L Bone marrow biopsy: Aspirate: Marrow was difficult to obtain. A small amount of fluid was aspirated, and the differential showed 78.1% abnormal cells similar to those in the blood. Sections: Hypocellular with a diffuse loosely structured infiltrate of mononuclear cells. Increased areas of fibrosis. Cytochemistry: Tartrate resistant acid phosphatase (TRAP) stain of abnormal cells: positive Immunophenotyping: Not done.