Resident Program - Case of the Month
August 2019 - Presented by Dr. Tahera Iqbal (Mentored by Dr. Nam Ku)
Clinical History
Presentation: 25 yo previously healthy male presented with fever, sore throat, night sweats and weight loss found to have leukocytosis.
CBC
|
WBC |
23.1 |
|
RBC |
2.22 |
|
Hemoglobin |
7.9 |
|
Hematocrit |
24.5 |
|
MCV |
110.4 |
|
MCH |
35.3 |
|
MCHC |
32.0 |
|
RDW |
17.6 |
|
Platelet Count |
170 |
Images:
(Click image to enlarge)
Figure 1: Peripheral blood smear
Figure 2: Aspirate
Figure 3: Aspirate
Figure 4: Aspirate
Figure 5: Aspirate with MPO stain
Figure 6: Aspirate with MPO stain
Immunophenotype:
(+): CD3 (subset), CD34, CD117, Tdt, cCD3, CD7, CD13, CD15, MPO (cytochemical stain)
(-): CD20, PAX 5, CD1a, CD4, CD8, CD14
The correct answer is:
B.) Mixed phenotype acute leukemia (MPAL)
The patient’s peripheral blood smear had circulating blasts and bone marrow biopsy showed a hypercellular marrow with sheets of blasts. The flow cytometry showed that the majority of blasts had T cell differentiation (cytoplasmic CD3, CD7, supported by CD3 IHC).
> Learn more about this diagnosis.
B.) Mixed phenotype acute leukemia (MPAL)
The patient’s peripheral blood smear had circulating blasts and bone marrow biopsy showed a hypercellular marrow with sheets of blasts. The flow cytometry showed that the majority of blasts had T cell differentiation (cytoplasmic CD3, CD7, supported by CD3 IHC).
> Learn more about this diagnosis.
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