JCU MB4 Term 2 Week 2 (Leukaemia)

1

78yo, anaemia and fatigue for 2 years. Splenomegaly. Peripheral blood smear shown. What is the likely diagnosis?

Blood Film - CLL


  Acute Myeloid Leukaemia

  Hodgkins Lymphoma

  Acute Lypmatic Leukaemia

  Chronic Myeloid Leukaemia

  Chronic Lymphatic Leukaemia


In CML, many neutrophils would be present.

2

58yo, anaemia, splenomegaly. Peripheral blood smear shown. What is the likely diagnosis?

Blood Film - CML


  Infectious mononeucleosis

  CLL

  Lymphoma

  Bacterial sepsis

  CML


Many neutrophils present. With EBV you would see many reactive lymphocytes.

3

38yo, 3 days of fever with a sore throat. Peripheral blood smear shown. What is the likely cause?

Blood Film - Allergy


  Viral infection

  Allergic reaction

  Malaria

  Bacterial infection

  Fungal infection


Note the presence of many eosinophils; associated with allergic reaction.

4

10yo boy, right groun pain and two enlarged lymph nodes for 7 days. He has an infected toenail. Lymph node biopsy shown. What is the likely diagnosis?

Lymph node - Infection


  Hodgkins lymphoma

  Non-Hodgkins lymphoma

  ALL with 2° infection

  Reactive lympadenitis

  Abscess


History is too short for lymphoma. Prominent lymphoid follicles with central germinal centre and mantle zone intact. Sinusoids also visible. Macrophages visible in high power view.

5

48yo, fever, splenomegaly, enlarged lymph nodes. Lymph node biopsy shown. What is the likely diagnosis?

Lymph node biopsy - Hodgkins Lymphoma


  Acute Leukaemia

  Chronic Leukaemia

  Non-Hodgkins Lymphoma

  Hodgkins Lymphoma

  Metstatic carcinoma


Note the presence of Reed-Sternberg binucleated cell characteristic of Hodgkin's lymphoma. Splenomegaly indicates chronic cause rather than acute - malignancy or chronic infection.

6

38yo, four week fever, hepatosplenomegaly. Peripheral blood smear shown. What is the likely cause?

Blood Film - ALL


  Viral infection

  Lymphoma

  Acute leukaemia

  Myeloma

  Chronic leukaemia


Note very large blast cells, likely myeloid due to age of patient.

7

58yo male, cervical lymphadenopathy 6 months. Fever, weight loss. Biopsy of 2cm of lymph node tissue reports multiple well-formed granulomas with central caseous necrosis. What is the most likely diagnosis?


  Sarcoidosis

  Fungal infection - Histoplasma

  Hodgkins nodular sclerosis

  Tuberculosis

  Cat-scratch disease


Sarcoidosis also gives rise to granulomas but without necrosis. Fungal infection would show only giant cells with fibrosis. Hodgkins nodular sclerosis does not produce granulomas. Cat-scratch disease results in neutrophilic abscesses.

8

38yo, 3 days of fever, sore throat. Peripheral blood smear shown. What is the likely cause?

Blood Film - Bacterial Infection


  Viral infection

  Allergic reaction

  Parasitic infestation

  Bacterial infection

  Fungal infection


Neutrophilia associated with bacterial infection.

9

6yo girl, 1 month of fatigue, headache, vomiting and fever. Hb 80g/L, Platelets 56k, WCC 32,550. Flow cytometry reported 70% CD10 & CD10 +ve. Peripheral blood smear shown. What is the likely diagnosis?

Blood Film - ALL


  AML

  CML

  ALL

  CLL

  NHL


Blood film consistent with acute leukaemia, likely lymphoblastic given the patient's age. CD19 is a B-cell antigen and CD10 is a pre-B-cell antigen, confirming lymphoblastic rather than myeloid type leukaemia.

10

38yo, high fever. Peripheral blood smear shown. What is the likely cause?

Blood Film - Reactive Lymphocytes


  Viral infection

  Allergic reaction

  Parasitic infection

  Bacterial infection

  Fungal infection


Film shows reactive lymphocytes, characteristic of viral infections.

11

A 28yo man, mediastinal lymphadenopathy. Reports recurrent fever, night sweats, mild weight loss for 6 months. Enlarged cervical lymphnodes. Image shows lymph node biopsy. What is the most likely diagnosis?

Lymph node - Hodgkin's Lymphoma


  Follicular lymphoma

  Lymphoblastic lymphoma

  Hodgkins lymphoma

  Diffuse large cell lymphoma

  Multiple myeloma

12

42yo, fever for 3 weeks, hepatomegaly. Peripheral blood smear shown. What is the likely diagnosis?

Blood Film - AML


  Megaloblastic anaemia

  ALL

  Chronic leukaemia

  Non-Hodgkins lymphoma

  AML


Blood film and history consistent with acute leukaemia. Given the age of the patient, likely myeloid.

13

65yo male, splenomegaly, bleeding tendency. Hb 13g/dL. Peripheral blood smear shown. What is the likely diagnosis?

Blood Film - Essential Thrombocytosis


  Chronic lymphatic leukaemia

  Essential polycythemia

  Megakaryocytic leukaemia

  Chronic myeloid leukaemia

  Essential thrombocytosis


Note that despite bleeding, plenty of platelets are still present. This is characteristic of essential thrombocytosis, a myeloproliferative disorder.

14

A 9yo girl develops widespread pinpoint skin haemorrhages. She recovered from a flu-like illness 1 week earlier. Laboratory findings reveal a platelet count of 20,000/uL but no other abnormalities. Her bone marrow shows an increased number of megakaryocytes. The platelet count is normal after 2 months. What is the most likely diagnosis?


  Essential thrombocythaemia

  DIC

  AML M6

  Idiopathic thrombocytopenic purpura

  Thrombotic thrombocytopenic purpura


A common presentation in young children, particularly females. Present with a bleeding tendency following a flu-like illness that resolves spontaneously later on.

15

2yo male, fever for 3 weeks with enlarged lymph nodes (++). Peripheral blood smear shown. What is the likely diagnosis?

Blood Film - ALL


  Megaloblastic anaemia

  ALL

  Chronic leukaemia

  Non-Hodgkins lymphoma

  AML


Blood smear consistent with acute leukaemia, likely ALL due to patient's age.

16

61yo female presents with cough, fever, SOB, rigors and tachycardia for 3 days. Peripheral blood smear shown. What is the likely diagnosis?

Blood Film - Neutrophila


  Bacterial pneumonia

  Lung abscess

  Aspergillosis

  Tuberculosis

  COPD


Neutrophilia indicates neutrophilia consistent with bacterial infection. Aspergillosis is a chronic illness most commonly seen in the setting of immunodeficiency.

17

78yo fever, splenomegaly, lymphadenopathy. Peripheral blood smear shown. What is the likely diagnosis?

Blood Film - CLL


  Megaloblastic anaemia

  Acute leukaemia

  Chronic leukaemia

  Non-Hodgkins lymphoma

  Hodgkins lymphoma

18

A 72yo retired man. Sever back pain, confusion, pale. Has had polyuria and polydipsia for 3 week, recurrent fever for 3 months. Labs: Hb 9g/dL, WBC 6.8x10^9^/L, ESR 80mm/h, Spine XR shows multiple punched out lytic lesions in ribs and vertebrae. What is the most likely diagnosis?


  Chronic Lymphatic Leukaemia

  High grade lymphoma

  Acute Myeloid Leukaemia

  Multiple Myeloma

  Chronic Myeloid Leukaemia


ESR raised due to large quantity of paraprotein in the blood.

19

48yo, fever, splenomegaly, lymphadenopathy. Lymph node biopsy shown. What is the likely diagnosis?

Lymph node - Hodgkins


  Acute leukaemia

  Chronic leukaemia

  Non-Hodgkins lymphoma

  Hodgkins lymphoma

  Metastatic carcinoma


Characterist Reed-Sternberg cells observed.

20

57yo male, fever, splenomegaly, lymphadenopathy for 6 months. Lymph node biopsy shown. What is the likely diagnosis?

Lymph Node - Non-Hodgkins


  Acute leukaemia

  Chronic leukaemia

  Non-Hodgkins lymphoma

  Hodgkins lymphoma

  Metastatic carcinoma

21

42yo female, pale, splenomegaly. Peripheral blood smear shown. What is the likely diagnosis?

Blood Film - Haemolysis


  Iron deficiency anaemia

  Polycythemia

  Megaloblastic anaemia

  Acute leukaemia

  Haemolytic anaemia


Presence of polychromatic cells and spherocytes indicates haemolysis.

22

57yo male, fever, splenomegaly, lymphadenopathy for 6 months. Lymph node biopsy shown. What is the likely diagnosis?

Lymph node - NS HL


  Acute leukaemia

  Chronic leukaemia

  Non-Hodgkins lymphoma

  Hodgkins lymphoma

  Metastatic carcinoma


This is the characteristic appearance of the nodular-sclerotic Hodgkins subtype: branching bands of fibrosis (no fibrous tissue should be present in normal lymph node).

23

A 2yo boy, high fever and weakness for 12 days. Skin purpura and bleeding lips. Mild splenomegaly. No lymph node enlargement. Most likely diagnsosis?


  Follicular lymphoma

  Lymphoblastic lymphoma

  Acute Myeloid Leukaemia

  Acute Lymphoblastic Leukaemia

  Multiple Myeloma


Skin purpura and bleeding suggests leukaemia. Quick onset and age are consistent with ALL.

24

22yo male, fever, sore throat for 6 days. Generalised lymphadenopathy. Mild macrocytosis. Monospot test positive. Peripheral blood smear shown. What is the likely diagnosis?

Blood Film - Agglutination


  Non-Hodgkins lymphoma

  G6PD deficiency

  Megaloblastic anaemia

  Cold antibody haemolytic anaemia

  Hodgkins lymphoma


Likely secondary to a lymphoma (associated with EBV infection).

25

60yo male, weight loss, fatigue, upper abdominal discomfort. Splenomegaly. Hb 9g/L, MCV 102fL, WCC 40,000/uL. Blood film shows mature and immature granulocytes, myelocytes, basophils and occasional myeloblasts. What is the most likely diagnosis?


  Acute Lymphoblastic Leukaemia

  Acute myeloid leukaemia

  Chronic lymphocytic leukaemia

  Chronic myelogenous leukaemia

  Megaloblastic anaemia