Chronic Myeloid Leukemia (CML)

(M2.ON.16.74) 49-year-old man complains of no symptoms, but on a routine complete blood count (CBC) has a white blood cell count of 40,000 per uL. A peripheral blood smear demonstrates leukocytosis with myeloid cells present at various stages of differentiation, with more mature cells present at a greater percentage than less mature cells (Figure A). What is the likely diagnosis?

(M2.OMB.4876) A 57-year-old man presents to the emergency department with several days of malaise, weakness, and night sweats. Today, he experienced a headache with blurry vision, thus prompting his presentation. The patient has a history of diabetes and is followed closely by an endocrinologist. Otherwise, he has lost 10 pounds over the past month. His temperature is 100°F (37.8°C), blood pressure is 122/90 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 99% on room air. Physical exam is notable for a thin man but is otherwise unremarkable. His visual acuity is 20/100 in both eyes, though he says that he normally has 20/20 vision. His gait is mildly ataxic as well, but his neurological exam is otherwise nonfocal. Laboratory studies are ordered as seen below.

Hemoglobin: 10 g/dL
Hematocrit: 31%
Leukocyte count: 57,500/mm^3 with 35% blasts
Platelet count: 109,000/mm^3

Serum:
Na+: 139 mEq/L
Cl-: 100 mEq/L
K+: 4.1 Eq/L
HCO3-: 22 mEq/L
BUN: 20 mg/dL
Glucose: 99 mg/dL
Creatinine: 1.1 mg/dL
Calcium: 10.0 mEq/L

Which of the following is the most likely diagnosis?

(M3.ON.12.22) A 61-year-old woman presents to your office complaining of mild fatigue and weight loss over the past 6 months. She states she has felt generally unwell and has had decreased appetite during this time frame. Her temperature is 98.1°F (36.7°C), blood pressure is 122/80 mmHg, pulse is 88/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical exam reveals splenomegaly and a nontender abdomen. A complete blood count with differential shows the following:

Hemoglobin: 10 g/dL
Hematocrit: 30%
Leukocyte count: 166,500/mm^3
Segmented neutrophils 92%
Leukocyte alkaline phosphatase: Low
Platelet count: 92,000/mm^3

A bone marrow biopsy is performed demonstrating infiltration with a large number of normal-appearing neutrophils. Which of the following translocations is likely to be seen in this patient?