iatroX Rounds #39
The clues
- 1
A 58-year-old man presents with a four-month history of increasing fatigue, unintentional weight loss of 6kg, and drenching night sweats.
- 2
He reports a dull ache in the left upper quadrant of his abdomen and feels full very quickly after starting a meal.
- 3
The patient has no significant medical history but recalls being monitored as a child following accidental radiation exposure at a local facility.
- 4
On examination, he appears pale and has a palpably firm mass in the left upper quadrant extending 12cm below the costal margin, which moves with respiration.
- 5
A full blood count shows a haemoglobin of 105 g/L and a white cell count of 165 x 10^9/L, with a differential showing a full spectrum of myeloid cells and 4 percent basophils.
- 6
Cytogenetic analysis of a bone marrow aspirate identifies a reciprocal translocation between the long arms of chromosomes 9 and 22.
Chronic myeloid leukaemia (CML) is a myeloproliferative neoplasm resulting from the clonal expansion of haematopoietic stem cells. It typically presents in middle age with symptoms of hypermetabolism, anaemia, and massive splenomegaly caused by splenic sequestration of leucocytes.
- Massive splenomegaly and early satiety
- Marked leucocytosis with a left-shifted differential
- Increased basophil and eosinophil counts
- Presence of the Philadelphia chromosome
for education and entertainment. not medical advice.