A 6-Year-Old Boy Is Brought to the Clinic Due to Recurrent

A 6-year-old boy is brought to the clinic due to recurrent nosebleeds over the last couple of weeks.  The patient has no chronic medical conditions and takes no medications.  Vital signs are normal.  On physical examination, there is conjunctival pallor.  The nares have dried, crusted blood with no active bleeding.  The oropharynx is clear.  Neck examination shows enlarged, palpable lymph nodes bilaterally.  Cardiopulmonary examination is unremarkable.  The abdomen is soft and nontender, with the liver measuring 4 cm below the costal margin.  There are scattered petechiae along the trunk.  Complete blood count is as follows: Flow cytometry of the peripheral blood demonstrates a distinct population of cells that express terminal deoxynucleotidyl transferase (TdT) , CD10, and CD19.  Myeloperoxidase (MPO) is negative.  Which of the following is the most likely diagnosis?

A) Acute promyelocytic leukemia
B) B-lymphoblastic leukemia
C) Disseminated Burkitt lymphoma
D) Mature T-cell leukemia
E) T-lymphoblastic leukemia

Correct Answer:

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