Table 1.

Summary of the patient’s clinical characteristics and lab findings upon diagnosis. Abbreviations: CT, computed tomography; FISH, fluorescence in situ hybridization; MLL, mixed lineage leukemia; TdT, terminal deoxynucleotidyl transferase; WBC, white blood cell.

Physical Exam	Peripheral Blood Labs	Bone Marrow Aspiration and Biopsy	Genetic Markers	Cerebrospinal Fluid Analysis	Imaging
Initial concerning signs: right thigh and cheek pain and numbness Difficulty opening mouth Mild hepatomegaly Decreased sensation on the face in cranial nerve V2–V3 distribution, right facial droop, extraocular movements intact No testicular masses palpated	White blood cells: 70,000 cells/μL Hemoglobin: 7.2 g/dL Platelets:11,000 cells/μL Peripheral blasts: 83%	94% blasts, CD10+, CD19+, CD20+ [variable positive], CD22+, CD34−, CD38+ [decreased but positive], CD45− Hyper-diploid blasts identified No T-cell surface markers identified Negative for TdT and myeloperoxidase	Blasts with chromosome 6q deletion Negative for FISH BCR-ABL fusion protein, MYC gene rearrangement, MLL gene rearrangement	Blasts in the presence of peripheral blood detected	CT scan of the head: no intracranial abnormalities with preservation of gray-white differentiation