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A 56-year-old man presents to his physician complaining of severe fatigue. He began to feel increasingly tired about 6 months ago, but believes that his fatigue has been worsening over the past 3 weeks. He also notes that he has had a nonproductive cough for about 2 weeks, and has experienced several episodes of drenching night sweats. On examination, he has several large bruises on his extremities but recalls no injuries. Abdominal examination reveals massive enlargement of both the liver and the spleen, without any lymphadenopathy.

Laboratory tests show:
WBC count 12,000/mm3
Neutrophils 58%
Eosinophils 7%
Lymphocytes 30%
Monocytes 0%
Basophils 5%
RBC count 3.0/mm3
Hemoglobin 7.5 mg/dL
Platelet count 18,000/mm3
Peripheral blood smear reveals irregular nuclei and cell membranes, as well as cytoplasmic projections.

What is the patient’s most likely diagnosis?
(A) Acute lymphocytic leukemia
(B) Hairy cell leukemia
(C) Idiopathic thrombocytopenic purpura
(D) Infectious mononucleosis
(E) Nodular sclerosing Hodgkin’s lymphoma
 
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