Slide of the Week: Increased WBC, April 14, 2011

A 54 year old female presents with symptoms of fatigue, unexplained weight loss, enlarged spleen and night sweats. Peripheral blood shows a markedly increased WBC. Examine the blood smear. (Click here to see the blood smear as a whole slide image).

1. Your diagnosis is:

  1. CLL
  2. AML
  3. Leukemoid reaction
  4. CML

2. Which of the following translocations would you expect?

  1. t(9;22) (q34;q11)
  2. t(8;14) (q24;q32)
  3. t(11;14)(q13;32)

Scroll below for the answers.


 

 

 

 

 

 

 

Answers: 1. CML, 2. t(9;22) (q34;q11)

Click here to see the comparative pathology.

Comment: A majority of CML patients have the BCR/ABL gene.  This gene is the result of a 9;22 translocation (aka Philadelphia chromosome), part of the BCR region from chromosome 22 fuses with the ABL gene on chromosome 9.  This abnormal gene generates tyrosine kinase that promotes increased cell growth.

Reference:

Branford S, Hughes TP  Mutational analysis in chronic myeloid leukemia: when and what to do? Curr Opin Hematol. 2011 Mar;18(2):111-6. PMID: 21245758

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