PBL #2 Synthesis The symptoms presented on the problem all point out acute lymphoblastic leukemia.

Being abrupt on onset of the first symptoms, it is acute. Symptoms related to depression of marrow function include fatigue due to anemia; fever and night sweating, reflecting infections secondary to neutropenia; and bleeding due to thrombocytopenia ( being easily bruised). The mass effects caused by neoplastic infiltration include the bone pain from marrow expansion and infiltration of the subperiosteum (thus the tenderness in ankle and shank); generalized lymphadenopathy (generalized if lymph nodes are enlarged in two or more noncontiguous areas), hepatomegaly and splenomegaly. Several laboratory procedures should be performed to establish the diagnosis further. Complete blood count with differential to know : the number of red blood cells and platelets, the number and type of white blood cells, the amount of hemoglobin (the protein that carries oxygen) in the red blood cells, the portion of the blood sample made up of red blood cells (hematocrit). Peripheral blood smear to check for blast cells, the number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells. Bone marrow aspiration and biopsy, the removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for abnormal cells. Acute lymphoblastic leukemia/lymphoma (ALL) are neoplasms composed of immature B (pre-B) or T (pre-T) cells which are referred to as lymphoblast. In leukemic presentations, the marrow is hypercellular and packed with lymphoblasts,which replace the normal marrow elements. Mediastinal thymic masses occur in 50% to 70% of TALLs, which are also more likely to be associated with lymphadenopathy and splenomegaly. In both B- and T-ALL, the tumor cells have scant basophilic cytoplasm and nuclei somewhat larger than those of small lymphocytes. The nuclear chromatin is delicate and finely stippled, and nucleoli are either absent or inconspicuous. In many cases the nuclear membrane is deeply subdivided, imparting a convoluted appearance. In keeping with the aggressive clinical behavior, the mitotic rate is high. As with other rapidly growing lymphoid tumors, interspersed macrophages ingesting apoptotic tumor cells may impart a starry sky appearance. Prepared by: Gerald John A. PazMT1041 Sources: Robbins and Cotran Pathologic Basis of Disease Hematology: Clinical Principles and Applications. (Rodak, et.al.) http://www.cancer.gov/cancertopics/pdq/treatment/adultALL/patient http://www.aafp.org/afp/1998/1015/p1313.html