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Chronic Neutrophilic Leukemia: A Rare and Difficult Diagnosis of Exclusion

James Ziai, Richard Torres, and Christopher A. Tormey

Chronic neutrophilic leukemia (CNL) is an extremely rare myeloproliferative disorder that presents diagnostic challenges for both pathologists and treating clinicians. Because this disease entity is very rare, and because it is typically a diagnosis of exclusion, it is important for pathologists and hematologists to be familiar with CNL when approaching the patient with a myeloproliferative clinical picture. Thus, the objectives of this report are: 1) to detail the clinical case of a 59 year old male veteran with initial presentation of hyperleukocytosis, 2) to review the differential diagnosis of a granulocytic myeloproliferative presentation and demonstrate the laboratory and clinical criteria utilized to establish a diagnosis of CNL in this case, and 3) to briefly review the current literature on the diagnosis and treatment of CNL.