1. An 18-year-old female student presented with progressive lethargy, fever, and body aches for one month. She had a history of similar symptoms since age 12. 2. Initial examinations found splenomegaly but no clear diagnosis. Imaging showed a liver mass. Biopsies and further testing were needed to determine the cause. 3. The patient ultimately underwent laparotomy and biopsy of the liver mass. Post-operative histopathological examination revealed the diagnosis and further testing was done.

2. Surgical team FROM Gneneral surgical Hospital Dr.Qhazi Zebari (USA) DR.Rzhan fouad Dr.Qalandar Kasnazani Dr Aram Ahmad Kaka rash Dr.Tahsin Dr.Omed Histo pathologist Professor Michael D. Hughston

14. U / S of her mother

26. At 1 st March 2009 Rheumatolgical consultation and patient was admitted for further screening like:

41. Initial Abdominal US examination

42. Depending on her clinical signs spleenomegaly, wt loss, high spiking fever at night, and still not clue for reaching diagnosis and possibility of hematological malignancies we decided for doing BM examination

44. Later on we requested another US examination, which through it we get our pearl for close approach to the patient

52. Optionally Patient went to Hawler and seeking more advise and surgical consultation

76. Gross appearance

79. Histopathological examination

100. Postoperative investigation

101. post operative liver function

103. Recent investigations