A four year old boy was admitted with a history of abdominal pain and fever for two months maculopapular rash for ten days, and dry cough. dyspnea and wheezing_ for three days. On examination Ii er and spleen were enlarged 4 cm and 3 cm respecimey bekm the eastal ntargin. His hemoglobin vas 10.0 gidl. platelet count 3.7 x 10% and total leukocyte count 70 x 10%, which included 80% eosinophils Bone marrow examination revealed a cellular marrow comprising of 45% blasts and 34% Eosinophils and cosinophill pre-cursors. The blasts stained negative for my eloperoxidase and non- specific esterase and were positive for CD19. CD 10, CD22 and CD20. Which one of the following statements is not true about disease?
A four year old boy was admitted with a history of abdominal pain and fever for two months maculopapular rash for ten days, and dry cough. dyspnea and wheezing_ for three days. On examination Ii er and spleen were enlarged 4 cm and 3 cm respecimey bekm the eastal ntargin. His hemoglobin vas 10.0 gidl. platelet count 3.7 x 10% and total leukocyte count 70 x 10%, which included 80% eosinophils Bone marrow examination revealed a cellular marrow comprising of 45% blasts and 34% Eosinophils and cosinophill pre-cursors. The blasts stained negative for my eloperoxidase and non- specific esterase and were positive for CD19. CD 10, CD22 and CD20. Which one of the following statements is not true about disease?
💡 Explanation
**Core Concept**
The patient's presentation and laboratory findings are consistent with a diagnosis of Acute Lymphoblastic Leukemia (ALL) with eosinophilia. ALL is a type of cancer of the blood and bone marrow characterized by the production of immature white blood cells, known as lymphoblasts or leukemic blasts.
**Why the Correct Answer is Right**
The patient's blasts are positive for CD19, CD10, CD22, and CD20, which are surface antigens typically expressed on normal B cells and B cell precursors. This suggests that the patient's leukemia is of B cell origin. The presence of eosinophilia and eosinophil precursors in the bone marrow is a characteristic feature of certain subtypes of ALL. The blasts are negative for myeloperoxidase and non-specific esterase, which helps to rule out a diagnosis of Acute Myeloid Leukemia (AML).
**Why Each Wrong Option is Incorrect**
**Option A:** This option is not relevant to the scenario, as the patient's diagnosis is already established as ALL with eosinophilia. However, if we were considering other options, we might evaluate them based on the clinical presentation and laboratory findings.
**Option B:** This option is incorrect because it does not accurately describe the patient's diagnosis. The patient's blasts are positive for CD19, CD10, CD22, and CD20, which indicates that the leukemia is of B cell origin.
**Option C:** This option is incorrect because it does not accurately describe the patient's diagnosis. The patient's diagnosis is Acute Lymphoblastic Leukemia (ALL) with eosinophilia, not Acute Myeloid Leukemia (AML).
**Option D:** This option is incorrect because it does not accurately describe the patient's diagnosis. The patient's blasts are negative for myeloperoxidase and non-specific esterase, which rules out a diagnosis of AML.
**Clinical Pearl / High-Yield Fact**
It's essential to remember that ALL can present with a wide range of clinical features, including fever, rash, and eosinophilia. The diagnosis of ALL is typically made based on the presence of abnormal lymphoblasts in the bone marrow or peripheral blood, which express specific surface antigens such as CD19, CD10, CD22, and CD20.
**Correct Answer:** D.
✓ Correct Answer: D. Inv (16) is often detected in the blasts and the eosinophils
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