A 58 year-old man presents to your primary care office complaining of severe fatigue, night sweats and low-grade fevers for the last four weeks. In the review of systems, he says ‘yes’ to blurred vision and persistent and painful erections. On physical examination, you find tenderness over the sternum. You send him to the laboratory for tests, which reveal the following results: Test Result Normal range Leukocyte count (WBC) 115,000 /mm³ 4500-11,000/mm³ Platelets 640,000 /mm³ 150,000 – 400,000/mm³ Leukocyte Alkaline Phosphatase (LAP) 6 score 20 – 100 Bone marrow: hypercellular, left-shifted myelopoiesis Peripheral smear: multiple immature granulocytes The PCR testing of the peripheral blood and bone marrow detected BCR/ABL gene. Of the following, which is the most common physical finding in patients with this disorder?
