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Childhood leukemia presenting as a diaphyseal radiolucency
Clinical Orthopaedics and Related Research
|September 1, 1978
Summary
Acute lymphocytic leukemia can present as a destructive bone lesion in children, mimicking other conditions like osteomyelitis. Careful peripheral blood smear interpretation is crucial before invasive tests for pediatric bone lesions.
Area of Science:
- Pediatric Oncology
- Skeletal Radiology
- Hematology
Background:
- Symptomatic diaphyseal destructive lesions of the femur in children often prompt investigations for common conditions such as osteomyelitis or malignancy.
- Differential diagnoses typically include infectious processes, histiocytosis X, and round cell sarcomas.
Observation:
- A 41-month-old child presented with a symptomatic destructive lesion of the femur and increased uptake on bone scan, initially suspected to be osteomyelitis or sarcoma.
- The child also had an upper respiratory tract infection, a common co-occurrence in pediatric patients.
Findings:
- Open biopsy revealed numerous blast cells, confirming a diagnosis of acute lymphocytic leukemia (ALL).
- The presence of blast cells in the bone lesion was unexpected given the initial differential diagnoses.
Implications:
- Acute leukemia should be considered in the differential diagnosis of symptomatic diaphyseal destructive bone lesions in pediatric patients.
- Peripheral blood smear analysis is a critical, non-invasive diagnostic step that should be performed before undertaking more invasive procedures for bone lesions.