Name: Catherine Gouveia

Theme: Chronic Leukaemia

OPTION LIST

A	B-cell chronic lymphocytic leukaemia	I	Multiple myeloma
B	T- cell chronic lymphocytic leukaemia	J	Non-hodgkin’s lymphoma
C	Hairy cell leukaemia	K	Mantle cell lymphoma
D	Acute myeloid leukaemia	L	Essential thrombocythaemia
E	Burkitt’s lymphoma	M	Primary myelofibrosis
F	Hodgkin’s disease	N
G	Acute lymphoblastic leukaemia	O
H	Chronic myeloid leukaemia	P

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

1. A 45yr old woman presents with a two month history of tiredness, intermittent pyrexia and night sweats. On examination she has a palpable spleen, 7cm below the costal margin. FBC shows a high white cell count and the blood film shows mature neutrophils. Cytogenetic analysis detects the Philadelphia chromosome.

2. A 11yr old African boy presents with a large swelling in his jaw. X-ray shows a lytic lesion not infiltrating his teeth. Biopsy of the lesion shows a “starry sky” appearance and Epstein-Barr virus related antigens.

3. A 70 yr old man presents with a six month history of worsening back pain, which is tender on palpation. X-rays show lytic lesions in the lumbar verterbrae. FBC shows a mild anaemia, normal WCC and platelets. ESR > 100mm/hr and CRP is normal. Calcium is raised with a normal alkaline phosphatase. Bone marrow biopsy shows >30% abnormal plasma cells.

4. A 65 yr old man is found to have a raised WCC on a routine blood test. There were increased peripheral lymphocytes, mainly B-cells. Blood film shows smear cells and a normocytic, normochromic anaemia. Physical examination was unremarkable. He was later discharged with no treatment given, and follow-up appointment was made.

5. A 40yr old woman presents with a painless neck lump. FBC shows a mild anaemia. On examination non-tender neck and axilllae lymphadenopathy is found. Lymph node biopsy shows a Reed-Steinberg cell.

ANSWERS

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