A 45-year-old man presents to the clinic with fatigue, unintentional weight loss, and night sweats over the past few months. Blood tests reveal a markedly elevated white blood cell count with a left shift, including numerous immature myeloid cells. Bone marrow aspiration shows hypercellularity with increased granulopoiesis. Cytogenetic analysis reveals a reciprocal translocation between chromosomes 9 and 22, resulting in the fusion of the BCR gene on chromosome 22 with the ABL1 gene on chromosome 9. This fusion creates a constitutively active tyrosine kinase. What is the most likely diagnosis?
A 68-year-old man presents to his primary care physician with fatigue and recurrent infections over the past several months. Physical examination reveals painless cervical lymphadenopathy and mild splenomegaly. Blood tests show a significant lymphocytosis with an absolute lymphocyte count of 45,000/µL. A peripheral blood smear reveals a large number of small, mature-appearing lymphocytes. Many of these cells appear disrupted or broken, creating characteristic cellular debris on the smear. What is the name of the characteristic cells seen in this condition?
A 55-year-old man presents to the clinic with fatigue, easy bruising, and a feeling of fullness in his abdomen. On physical examination, he has significant splenomegaly but no lymphadenopathy. Blood tests reveal pancytopenia with a marked reduction in all cell lines. A bone marrow biopsy is performed, and the specimen is noted to be difficult to aspirate ("dry tap"). Cells found in the peripheral blood smear stain positive for TRAP (Tartrate-Resistant Acid Phosphatase). What are these characteristic cells called?
A 70-year-old man with a history of chronic lymphocytic leukemia (CLL) presents to the clinic with rapidly worsening fatigue, night sweats, and significant unintentional weight loss over the past few weeks. He also reports new, rapidly enlarging lymph nodes, particularly in the cervical region. A recent blood test shows a sudden increase in lactate dehydrogenase (LDH) levels. A biopsy of one of the enlarged lymph nodes reveals large, atypical cells with a high mitotic index. What is the most likely diagnosis?
A 5-year-old boy with Down syndrome is brought to the pediatric clinic by his parents due to persistent fatigue, easy bruising, and frequent infections over the past few weeks. Physical examination reveals pallor, petechiae, and hepatosplenomegaly. Blood tests show pancytopenia with blasts in the peripheral blood smear. A lumbar puncture is performed, revealing the presence of leukemic cells in the cerebrospinal fluid. Ultrasound of the scrotum reveals abnormal masses in the testes. What is the most likely diagnosis?
