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Difficulty: EasyHematology and Oncology

Match each classic clinical presentation to the most likely hematologic diagnosis.

  • A 65-year-old man with progressive lower back pain, hypercalcemia, and acute kidney injury.Multiple myeloma
  • A 25-year-old woman with painless cervical lymphadenopathy and a widening mediastinum on chest x-ray.Hodgkin lymphoma
  • A 60-year-old man with fatigue, early satiety due to massive splenomegaly, and a BCR-ABL1 mutation.Chronic myeloid leukemia
  • A 70-year-old asymptomatic man found to have marked, isolated absolute lymphocytosis on routine blood work.Chronic lymphocytic leukemia

Answer

The patient with back pain and hypercalcemia matches Multiple myeloma. The young woman with a mediastinal mass matches Hodgkin lymphoma. The patient with massive splenomegaly and BCR-ABL1 matches Chronic myeloid leukemia. The asymptomatic elderly man with lymphocytosis matches Chronic lymphocytic leukemia.
Each clinical vignette provides pathognomonic or highly characteristic features for its respective malignancy. Multiple myeloma features CRAB criteria. Hodgkin lymphoma classically affects young adults with cervical and mediastinal adenopathy. Chronic myeloid leukemia is defined by the BCR-ABL1 translocation and often presents with splenomegaly. Chronic lymphocytic leukemia typically presents as an incidental extreme lymphocytosis in older adults.

Step-by-Step Solution

1
Analyze the first presentation (back pain, hypercalcemia, kidney injury).
Identifies the diagnosis as Multiple myeloma.
These symptoms fulfill the CRAB criteria (Calcium, Renal, Anemia, Bone) characteristic of this plasma cell dyscrasia.
2
Analyze the second presentation (young female, painless lymphadenopathy, mediastinal mass).
Identifies the diagnosis as Hodgkin lymphoma.
This matches the classic bimodal age distribution and typical nodal involvement of this lymphoma.
3
Analyze the third presentation (splenomegaly, BCR-ABL1 mutation).
Identifies the diagnosis as Chronic myeloid leukemia.
Early satiety from splenomegaly and the BCR-ABL1 mutation are the hallmark diagnostic features.
4
Analyze the fourth presentation (elderly, asymptomatic lymphocytosis).
Identifies the diagnosis as Chronic lymphocytic leukemia.
This is the most common presentation of CLL, often discovered incidentally on routine laboratory testing.

Key Concept

Classic clinical presentations of major hematologic malignancies
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Topics

Hematology and Oncology

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