acute leukemia. Which one? | Figure 1

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acute leukemia. Which one?

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6 year old male with a generalized lymphadenopathy for 6 months. Initially treated with steroids in Mexico. Biopsy of cervical node that was reportedly normal (done after he’d been on steroids). Cervical, axillary and inguinal lymphadenopathy on exam. Imaging revealed prominent mediastinal and abdominal lymph nodes and hepatosplenomegaly with an echogenic liver. Labs show neutro/leukopenia, transaminitis. photo 1/2 - peripheral smear, photo 3- cervical node biopsy. Bad diagnosis. Good outcome.



A 56-year-old female commences induction therapy with rituximab and hyper-CVAD chemotherapy for her Philadelphia chromosome-negative, CD20+ precursor B-cell acute lymphoblastic leukemia (ALL). Staging studies following her induction treatment, including bone marrow biopsy and laboratory analysis, reveal that she has attained a complete remission. However, PCR analysis reveals that she is minimal residual disease (MRD) positive (>0.1%). She has an outstanding performance status. Which of the following therapies would you recommend?



Frontal (image 1) and lateral (image 2) radiograph of the chest shows a lobulated mediastinal mass (arrow). Axial contrast-enhanced CT image of the chest shows the lobulated mass. The patient was later diagnosed with T-cell lymphoblastic leukemia. Lymphoma is the most common anterior mediastinal mass in children. Other causes of mediastinal mass include acute lymphoblastic leukemia, teratoma, germ cell tumors, and cysts. Mediastinal masses can be difficult to differentiate from the normal thymus in young children. In this patient, the lobulated margin of the thymus suggest that the mass represents tumor. The thymus has a smooth margin with gentle curves.



A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.



A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.



A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.



Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?