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20. A 70-year-old male presents with increasing fatigue
for the last 6 months. Hematologic workup reveals a CBC
with a hemoglobin concentration of 9.5 g/dL, hematocrit of
28%, MCV of 90fL, platelet count of 120,000//xL, and
WBC count of 42,000//xL. The peripheral blood smear
shows absolute lymphocytosis with a monotonous popula-
tion of small, round, mature-looking lymphocytes. Flow
cytometry shows the cells to be CD19 +, CD5 +, and TdT-.
Cytogenetic and molecular analysis of the cells in the
blood is most likely to reveal
C) (A) t(9;22) leading to bcr-abl rearrangement
O (B) Clonal rearrangement of immunoglobulin (Ig)
O (C) Clonal rearrangement of T-cell receptor genes
O (D) t(8;14) leading to c-rnyc overexpression
C) (E) t(14;18) leading to bcl-2 overexpression




(B) The clinical history, the peripheral blood smear,
and the phenotypic markers are characteristic of chronic
lymphocytic leukemia. This is a clonal B-cell neoplasm in
which immunoglobulin genes are rearranged and T-cell re-
ceptor genes are in germline configuration. The t(9;22) is a
feature of chronic myeloid leukemia. The t(8;14) transloca-
tion is typical of Burkitt lymphoma; this occurs in children
at extranodal sites. The t(14;18) translocation is a feature
of follicular lymphomas. These are distinctive B-cell tu-
mors that involve the nodes and produce a follicular pat-
tern. The lymphoma cells can be present in blood, but they
do not look like mature lymphocytes.

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