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.