Rami Daya, MD

An 84-year-old woman presented to her hematologist’s office with an asymptomatic leukocytosis and associated lymphocytosis seen on routine blood work. She noted complaints of fatigue and had an unintentional weight loss of 15 lb within 1 year. At the time of initial consultation, her blood work showed a total white blood cell count of 25,000 cells/mcL with 75% lymphocytes, which fluctuated to as high as 33,000 cells/mcL with 76% lymphocytes. She also had a normocytic anemia and normal renal function, but workup revealed an elevated serum globulin level, elevated lactate dehydrogenase, and a beta-2 microglobulin of 7,303. Peripheral smear exam was consistent only with small lymphocytes

The patient is an 86-year-old woman with a history of right breast infiltrative lobular carcinoma 16 years before presentation.

A 55-year-old woman presented to our center for restaging PET/CT. Her history was significant for recurrent breast cancer in the mediastinum and lungs. She initially underwent left mastectomy, adjuvant chemotherapy and radiotherapy. She was started on palliative chemotherapy. Her initial staging PET/CT showed subcentimeter medistinal lymph nodes (maximal SUV 8.4), right lower lobe mass 1.4 × 1.2 cm (SUV 5.3), scattered subcentimeter nodules in the lung. Her restaging scan with a PET/CT after chemotherapy showed progressive disease with right axillary lymph nodes measuring 1 cm (SUV 2.0), medistinal lymph nodes measuring 1 cm (SUV 3.6 to 10.1), right lower lobe mass measuring 2.1 × 1.4 cm (SUV 7.1), relatively stable pulmonary nodules and new left pleural effusion.