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155112 Pathology

A 66-year-old man has experienced fatigue, a 5-kg weight loss, night sweats, and abdominal discomfort for 10 months. On physical examination, he has marked splenomegaly; there is no lymphadenopathy. Laboratory studies show hemoglobin, 10.1 g/dL; hematocrit, 30.5%; MCV, 89 gm3; platelet count, 94,000/mm3; and WBC count, 14,750/mm3 with 55% segmented neutrophils, 9% bands, 20% lymphocytes, 8% monocytes, 4% metamyelocytes, 3% myelocytes, 1% eosinophils, and 2 nucleated RBCs per 100 WBCs. The peripheral blood smear also shows teardrop cells. The serum uric acid level is 12 mg/dL. A bone marrow biopsy specimen shows extensive marrow fibrosis and clusters of atypical megakaryocytes. Which of the following is most likely to account for the enlargement in this patient’s spleen?

AExtramedullary hematopoiesis
BGranulomas with Histoplasma capsulatum
CHodgkin lymphoma
DMetastatic adenocarcinoma
Pathology
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