A 15-Year-Old Boy Is Brought to the Emergency Department Due

question 769

Multiple Choice

A 15-year-old boy is brought to the emergency department due to progressive shortness of breath.  The patient has no chronic medical conditions.  Temperature is 37.1 C (98.8 F) , pulse is 130/min, and respirations are 32/min.  Pulse oximetry is 94% on room air.  Lung examination demonstrates diffusely diminished breath sounds.  Clusters of enlarged cervical lymph nodes are palpable bilaterally.  A large mediastinal mass is visualized on chest x-ray.  The leukocyte count is elevated, and a peripheral blood smear shows abnormal white blood cells, as shown in the image below: Specialized staining shows the cells are positive for terminal deoxynucleotidyl transferase (TdT) and CD3; they are negative for CD19 and myeloperoxidase (MPO) .  Which of the following is the most likely diagnosis?

• A)Acute myeloid leukemia
• B)B-lymphoblastic leukemia
• C)Burkitt lymphoma
• D)Hodgkin lymphoma
• E)T-lymphoblastic leukemia