A 60-year-old woman has had headaches and dizziness for the past 5 weeks. She has been taking cimetidine for heartburn and omeprazole for ulcers. On physical examination, she is afebrile and normotensive, and her face has a plethoric to cyanotic appearance. There is mild splenomegaly, but no other abnormal findings. Laboratory studies show hemoglobin, 21.7 g/dL; hematocrit, 65%; platelet count, 400,000/mm3; and WBC count, 30,000/mm3 with 85% polymorphonuclear leukocytes, 10% lymphocytes, and 5% monocytes. The peripheral blood smear shows abnormally large platelets and nucleated RBCs. The serum erythropoietin level is undetectable, but the ferritin level is normal. Which of the following is most characteristic of the natural history of this patient's disease?
(A) Transformation into acute B lymphoblastic leukemia
(B) Marrow fibrosis with extramedullary hematopoiesis
(C) Spontaneous remissions and relapses without treatment
(D) Increase in monoclonal serum immunoglobulin
(E) Development of a gastric non-Hodgkin lymphoma

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14-12-2022
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A 60-year-old woman has had headaches and dizziness for the past 5 weeks. She has been taking cimetidine for heartburn and omeprazole for ulcers. On physical examination, she is afebrile and normotensive, and her face has a plethoric to cyanotic appearance. There is mild splenomegaly, but no other abnormal findings. Laboratory studies show hemoglobin, 21.7 g/dL; hematocrit, 65%; platelet count, 400,000/mm3; and WBC count, 30,000/mm3 with 85% polymorphonuclear leukocytes, 10% lymphocytes, and 5% monocytes. The peripheral blood smear shows abnormally large platelets and nucleated RBCs. The serum erythropoietin level is undetectable, but the ferritin level is normal. Which of the following is most characteristic of the natural history of this patient's disease?
(A) Transformation into acute B lymphoblastic leukemia
(B) Marrow fibrosis with extramedullary hematopoiesis
(C) Spontaneous remissions and relapses without treatment
(D) Increase in monoclonal serum immunoglobulin
(E) Development of a gastric non-Hodgkin lymphoma

Answer :

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The statement that represents the most characteristic of the natural history of this patient's disease is the development of a gastric non-Hodgkin lymphoma. Thus, the correct option for this question is E.

What is Mild splenomegaly?

Mild splenomegaly may be characterized as a type of circumstance in which there is an enlargement of the spleen observed during the ultrasound. It is an enlarged spleen that usually doesn't cause symptoms. It's often discovered during a routine physical exam. A doctor usually can't feel the spleen in an adult unless it's enlarged.

According to the context of this question, the symptoms that are represented in the passage determined that it is most probably the development of gastric non-Hodgkin lymphoma. This is represented due to intake of omeprazole for ulcers.

Therefore, the correct option for this question is E.

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