Leukemia and Lymphoproliferative Disorders

A patient has recently been diagnosed with acute myeloid leukemia and is presented for evaluation. He has no bleeding or fever. In what circumstances would the patient require a blood transfusion?

A young female has presented with symptoms of pallor, fatigue, and bruising. Laboratory investigations indicate a hemoglobin level of 8.7 g/dL and a white blood cell count of 55,000. Examination of the peripheral blood film reveals the presence of blasts and Auer rods. What is the likely diagnosis in this case?

A 50-year-old male has presented with symptoms of shortness of breath on exertion, early satiety, and a sense of heaviness in the left upper abdomen. On examination, he appears pale and exhibits splenomegaly. Laboratory investigations reveal a hemoglobin level of 9.5 and a white blood cell count of 70,000. Examination of the peripheral blood film shows the presence of myelocytes, metamyelocytes, and elevated basophils. Which of the following findings would be anticipated in this patient’s case?

A patient has been recently diagnosed with chronic myeloid leukemia. How should the patient be treated?

A patient was recently diagnosed with chronic myeloid leukemia and initiated treatment. After a few days, the patient developed pleural effusion. Which of the following medications is likely responsible for this side effect?

A patient arrived at the emergency department with complaints of a persistent and painful erection. The patient also has a fever, appears pale, and exhibits a rash on their body. Which of the following conditions is most commonly associated with this presentation?

A young male presents with a history of excessive fatigue, shortness of breath on exertion, and fever. Clinical examination reveals lymphadenopathy and bony tenderness. Laboratory investigations indicate a

• White blood cell count: 120,000 with 70% blasts
• Hemoglobin: 6.9
• Platelet count: 45,000.
• Creatinine: 2.4
• Potassium: 5.5
• Calcium: 6.4
• Phosphorus: 7.2,
• Uric acid: 13.

How should this patient be managed or treated?

A patient presented to OPD with complaints of body lumps and left upper abdominal pain. Upon examination, lymphadenopathy and splenomegaly were noted. Laboratory investigations revealed

• White blood cell count: 30,000
• Platelet count: 70,000
• Hemoglobin: 9
• Peripheral blood film: Pale blue cytoplasm, prominent nucleoli, and projections on white blood cell surface.

What is the diagnosis?

The patient presented at the outpatient department (OPD) with complaints of gum bleeding and fever persisting for a duration of 10 days. Initial investigations revealed a hemoglobin (Hb) level of 7, a white blood cell count of 70,000, and a decreased platelet count of 55,000. A bone marrow biopsy was performed, which indicated a hypercellular marrow with 80% blast cells, and these cells stained positive for Tdt. Furthermore, a chest X-ray unveiled the presence of a mass in the mediastinum. What is the diagnosis?

An old lady came to OPD with complaints of lumps in her neck. On examination, she has cervical lymphadenopathy and splenomegaly. Investigations showed

• Hb: 13
• WBC: 30,000 and 82% lymphocytes
• Platelets: 235000
• Peripheral film: Smudge cells present

What is the most appropriate treatment?

A 54-year-old male presents with a four-month history of progressive fatigue, early satiety, and a recurrent right leg cellulitis that has been poorly responsive to oral antibiotics. He is a non-smoker with no significant past medical history.

On examination, he is pale with petechiae on his shins. Abdominal palpation reveals massive splenomegaly (9 cm below the costal margin) and mild hepatomegaly.

Investigations:

• Hb: 4 g/dL
• WBC: 2100 (Neutrophils: 9 Monocytes: 0.02)
• Platelets: 52,000
• Serum Uric Acid: 2 mg/dL
• Bone Marrow Aspirate: Dry tap
• Trephine Biopsy: Diffuse infiltration of lymphoid cells with abundant pale cytoplasm, creating a “honeycomb” appearance.
• Immunophenotype: Positive for Annexin A1 and CD103.

What is the most likely diagnosis?

A 42-year-old man was brought to the Emergency Department with a 3-day history of worsening headache, confusion, and spontaneous gum bleeding. His family notes he has been unusually fatigued for two weeks and developed red spots on his chest yesterday.

On examination, he is febrile (100.4 F), tachycardic, and appears distressed. He has a generalized petechial rash and multiple ecchymoses over his limbs. Abdominal exam reveals palpable hepatosplenomegaly. Chest auscultation shows bibasilar crackles.

Investigations:

• Hemoglobin: 5 g/dL
• White Cell Count: 18,000/µL
• Platelets: 20,000/µL
• Creatinine: 1\mg/dL
• Glucose: 180 mg/dL
• Prothrombin Time (PT): 24 seconds (Ref: 11-14)
• APTT: 46 seconds (Ref: 25-35)
• Fibrinogen: 60 mg/dL (Ref: 150-450)
• D-dimer: Significantly elevated
• Peripheral Smear: Numerous large, granulated blasts; some contain bundles of Auer rods.

What is the most appropriate immediate management for this patient?

A 46-year-old male is referred to the hematology clinic due to persistent fatigue, worsening breathlessness on exertion, and an episode of prolonged bleeding following a routine dental scaling last week. He also mentions having dark spots appearing on his shins and forearms over the past ten days. He has a history of Type 2 Diabetes Mellitus and hyperuricemia, for which he takes Metformin and Allopurinol.

On examination, he is pale and has multiple non-blanching petechiae over his lower limbs. There is no significant lymphadenopathy, but the tip of the spleen is just palpable on deep inspiration. Systemic examination is otherwise unremarkable except for a few scattered ecchymoses.

Investigations:

• Hemoglobin (Hb): 8 g/dL
• White Cell Count (WCC): 2
• Platelet Count: 42,000/µL
• Serum Creatinine: 1 mg/dL
• Serum Uric Acid: 2 mg/dL
• Random Blood Sugar: 165 mg/dL
• Bone Marrow Aspirate: 35% blasts, many showing heavy azurophilic granulation and occasional bundles of Auer rods
• Cytogenetic Analysis: 46,XY, t(15;17)(q24;q21)

What is the most likely diagnosis?

A 29-year-old road construction worker presented with a 5-day history of worsening headache, blurred vision, and profound heaviness in his head. His family reports that he has been increasingly drowsy over the last 24 hours. He has no significant prior medical history, but mentions that his gums have been bleeding and “growing over his teeth” for the past two weeks. He is a smoker (10 cigarettes/day) and has no known allergies.

On examination, he is lethargic with a GCS of 14/15. Significant gingival hyperplasia is noted. There are multiple ecchymoses over his trunk and palpable cervical and inguinal lymphadenopathy. Abdominal examination reveals splenomegaly (4 cm below the costal margin) and hepatomegaly (2 cm below the costal margin). Fundoscopy reveals dilated, tortuous retinal veins with multiple flame-shaped hemorrhages.

Investigations:

• Hemoglobin (Hb): 3 g/dL
• White Cell Count (WCC): 353,000/µL
• Platelet Count: 8,000/µL
• Peripheral Smear: 85% blasts with voluminous cytoplasm, indented/folded nuclei, and prominent nucleoli; Non-specific esterase (NSE) stain is strongly positive.
• Uric Acid: 2 mg/dL (Ref: 3.4–7.0 mg/dL)
• Serum Creatinine: 4 mg/dL
• APTT: 45 seconds (Ref: 25–35 seconds)

What is the most appropriate immediate intervention to address this patient’s neurological symptoms?

A patient was diagnosed with Hodgkin’s lymphoma. Which of the following features is present in almost all such patients?

A patient was diagnosed with lymphoma and presented with neurological symptoms. CNS involvement of lymphoma is suspected. Which lymphoma has the highest chances of CNS involvement?

A 42-year-old male presents with a three-month history of progressive, painless swelling in the right side of his neck and left axilla. He denies any fever, drenching night sweats, or unintentional weight loss. On physical examination, there are multiple firm, non-tender, discrete lymph nodes in the cervical and axillary regions, the largest measuring 3.5 cm. There is no evidence of hepatosplenomegaly.

Laboratory investigations reveal:

• Hemoglobin: 11.2 g/dL
• White Blood Cell Count: 14,500/µL
• Platelet Count: 95,000/µL
• LDH: 480 U/L
• Excisional biopsy of the lymph node: Complete effacement of the nodal architecture by a sheet-like proliferation of large lymphoid cells with vesicular nuclei, prominent nucleoli, and scant cytoplasm. Mitotic figures are frequent.

Which of the following immunophenotypic markers is most likely to be expressed on the malignant cells in this patient?