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

What is most likely the diagnosis?

Choose one answer and submit.




B-acute lymphoblastic leukemia

 

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.