robin082006
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Ms. Parker, a 46-year-old bank executive, is referred by her dentist. She had complaints of swollen and bleeding gums for 6 weeks. She appears pale and complains of feeling weak. She smokes half a pack of cigarettes and drinks socially. Her family history is not significant. Her vitals are stable and she is afebrile. CBC reveals:
WBC 44,100mm3
Hemoglobin 10.0
Hematocrit 32%,
Platelets 16,000mm3
The leukocyte distribution is as follows
Blast forms 79%
Promonocytes 12%
Monocytes 8%
Lymphocytes 1%
Cytochemical tests are ordered and they are as under:
Sudan Black Slightly positive
Alpha-naphthyl esterase Positive
PAS reaction Negative
What is the most probable diagnosis?
A. Acute myeloblastic leukemia with maturation
B. Acute promyelocytic leukemia
C. Acute lymphoblastic leukemia
D. Acute erythro leukemia
E. Acute monocytic leukemia
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| prathapdoctor
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acute myeloblastic myeloma with maturation.
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| Guptashutosh
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i think this is ac. promyelocytic leukemia with DIC,.. option B
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| robin082006
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Try again, both of you.
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The Key to Succeed is Patience.
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| prathapdoctor
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sudan black and non specific esterase are negative in ALL and pas is positive in ALL and lymphocytes in this case are very low so its excluded.
PAS is positive in erythroleukemia variant of AML
but how can we differentiate among variants of AML by looking at peripheral picture,we can say about acute promyelocytic leukemia by seeing Auer rods in peripheral picture ,but in this case both monocytes and blast forms are increased in counts.
generally in AML infiltration of gingivae is seen in monocytic variants like myelomoncytic and monocytic variants,in this case there is enlargment of gingivae with bleeding,but bleeding can be due to thrombocytopenia.
so my next probable choice is acute monocytic leukemia.
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