1. Clinical History 42 year-old Fillpino male who had a reported history of persistent eosinophilia for many years and was evaluated at an outside hospital without treatment In October 2008, the patient was also found to have right axillary mass (LN) and was biopsied at that hospital and had subsequently completed 4 cycles of chemotherapy since then The patient was transferred to COHNMC for further management

2. Pathology in COH After admission in COH The outside axillary LN biopsy was reviewed and additional immunohistochemical studies were performed A bone marrow biopsy was performed and reviewed at COH

3. Right axillary LN biopsy in 10/2008

5. CD3

6. TDT

7. CD4 CD8

8. Peripheral blood and bone marrow biopsy in 11/2008

11. MPO

12. CD117

13. In 12/2009, the patient suddenly developed marked leukecytosis and numerous circulating blasts, leading to a prompt peripheral blood and bone marrow examination

16. TdT PAX-5