Case 65-1963

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Abstract
Presentation of Case First admission. A sixty-two-year-old woman entered the hospital because of abdominal pain.Eighteen years previously she was admitted to another hospital because of fatigue, headaches and pain in the arms, legs and lower dorsal spine. On physical examination the spleen was palpable 1 fingerbreadth below the left costal margin, and there was an appendectomy scar; the liver was not enlarged. Examination of the blood revealed anemia, with nucleated red cells and immature white cells in the peripheral blood. X-ray films of the lumbar spine and pelvis were normal. A biopsy of the sternal bone marrow showed . . .

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