Pathology Notes

Practice questions answers Myeloid neoplasms III © Jun Wang, MD, PhD 1. D. This patient has elevated red cell and platelet count with normal range white cells. Peripheral blood reveals immature red cells (upper right corner, adjacent to a neutrophil, and the two at lower left corner), but no blast is seen. Bone marrow has erythroid and megakaryocytic hyperplasia. This is most consistent with polycythemia vera , a type of myeloproliferative neoplasms . In order to make a diagnosis of polycythemia vera , essential thrombocythemia , or primary myelofibrosis , the presence of JAK2, CAL or MPL mutation needs to be demonstrated, and JAK2V617F is usually tested first. Splenomegaly in myeloproliferative neoplasms is caused by extramedullary hematopoiesis or functional hypersplenism, and sonographic exam and biopsy findings of spleen in myeloproliferative neoplasms are nonspecific. Cytogenetics studies can detect chromosome abnormalities, but not mutation. Myeloproliferative neoplas

Practice questions Myeloid neoplasms III © Jun Wang, MD, PhD 1. Use this case and image for the next three questions. A 59-year-old man presents with fatigue, dizziness, and periodic headache for a month. He has had vague left upper abdomen discomfort for 6 months. He denies history of other symptoms including fever. His past medical history is unremarkable. He does not smoke cigarette or drink alcohol. His vital signs are within normal range, except a blood pressure of 180/110 mm Hg. Physical examination reveals moderate ruddy tone on both cheeks. No rash or edematous changes are seen on his skin. His abdomen is slightly distended. His spleen is 5 cm below left costal margin. No lymphadenopathy nor other abnormalities are noted. Laboratory tests reveal a hemoglobin of 19.5 g/dl (normal 14-18 g/dl), white cell count of 7.5 x 10 9 /L (normal 5-11 x 10 9 /L), platelet count 545 x 10 9 /L (normal 150-450 x 10 9 /L). PT and aPTT are within normal range. An image of his pe