65 year old man has complaints of fatigue

Question Number 0816
65 year old man has complaints of fatigue. He sees his doctor for his annual physical examination. On physical examination, he is found to have lymphadenopathy and hepatosplenomegaly. Laboratory tests are done, including a CBC with differential. His white blood count is 20,000/cu mm. 80% of the white blood cells are small, well differentiated lymphocytes. They are found to be B lymphocytes. No Auer rods are visualized. The pathologist commented that there were many 'smudge' cells. He is negative for Philadelphia chromosome. 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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