A 57 year old man complains of fatigue and weakness

Question Number 0828
A 57 year old man complains of fatigue and weakness. He starts to notice abdominal fullness and discomfort in his upper left abdominal quadrant. He sees his doctor. On physical examination, he is found to have a low grade fever, splenomegaly and mild hepatomegaly. Laboratory tests are done, including a CBC with differential. He is found to be anemic and thrombocytopenic. His white blood count is 4,000/cu mm. His blood smear shows an unusual cell with cytoplasm projections. These cells are positive for acid phosphatase and resistant to tartaric acid. No Auer rods are visualized. He is negative for Philadelphia chromosome. A bone marrow aspiration was attempted, but no specimen was obtained. Which of the following is most likely?
a) acute lymphoblastic leukemia
b) acute myelogenous leukemia
c) chronic lymphoblastic leukemia
d) chronic myelogenous leukemia
e) hairy cell leukemia

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