Contributed by Ashok Nambiar, MD, Ander Pindzola, MD and Lydia Contis, MD
Published on line in January 2001
The patient is a 72 year-old white male who presented to an outside facility with chest pain of 24 hours duration. The past medical history is significant for sick sinus syndrome for which he recently underwent a cardiac pacemaker placement. Additionally, he has noticed a 20- pound weight loss in the past 8 weeks. Clinical examination, EKG, cardiac enzymes, echocardiography and stress testing were negative for ischemic heart disease. He was however noted to have a markedly elevated WBC count with a lymphocytosis and 55% 'blasts' on the peripheral smear. A bone marrow biopsy was performed, and he was subsequently transferred to the University of Pittsburgh Medical Center with a presumptive diagnosis of acute myelogenous leukemia.
Physical examination showed hepatosplenomegaly. Computerized tomography of the thorax and abdomen showed bilateral pleural effusions, small lymph nodes in the axillae, marked splenomegaly with multiple low-density lesions, and extensive retroperitoneal lymphadenopathy. Bone marrow biopsy was repeated, and the aspirate was sent for flow cytometric immunophenotypic, cytogenetic and molecular genetic studies. No other tissue biopsies were performed.
PERIPHERAL BLOOD AND BONE MARROW