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ASPHO December 2016 Case Quiz

Page 1 Questions

Feelin’ the blues
Soumitra Tole, MD MSc, Fellow, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
Samuele Renzi, MD, Fellow, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
Ahmad Alhanshani, MD, Fellow, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
Angela Punnett, MD, Staff Physician, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada

A 15-year-old girl presented to the emergency department with a 1-month history of abdominal pain, weight loss, and vomiting. She had been previously healthy. The family is of African descent and are nonconsanguineous. On examination, she appeared well. She had a temperature of 36.6° C, a heart rate of 100/minute, a respiratory rate of 20/minute, a blood pressure of 110/70 mmHg, and an oxygen saturation of 99% on room air. She had tenderness at the epigastrium. 

An abdominal ultrasound revealed a large mass arising from the lesser curvature of the stomach. Her bloodwork revealed:

CBC: Hemoglobin 110 g/L, Platelets 272x10^9/L, WBC 10.8 x 10^9/L, ANC 5.6x10^9/L.

Chemistries: Sodium 147 mmol/L, Potassium 4.3 mmol/L, Phosphate 1.59 mmol/L, Calcium 2.56 mmol/L, Urea 3.1 mmol/L, Creatinine 60 mcmol/L, Bilirubin conjugated 24 mcmol/L, Bilirubin unconjugated 0 mcmol/L, AST 50 U/L, LDH 4306 U/L,  Urate 933 U/L.

1.  What is the most likely diagnosis?