Related Experiment Videos
Vertebral collapse in childhood leukemia
P L Meehan1, S Viroslav, E W Schmitt
1Department of Orthopaedics, Emory University, Atlanta, Georgia 30322, USA.
Insights
Pediatric leukemia can present with spinal involvement and normal blood counts. This highlights the importance of considering leukemia even with seemingly normal initial diagnostic tests.
Area of Science:
- Pediatric Oncology
- Hematology
- Skeletal Radiology
Background:
- Leukemia is the most common childhood cancer, but initial presentations vary.
- Skeletal involvement is common in pediatric leukemia, particularly appendicular sites.
- Spinal involvement in pediatric leukemia is infrequently documented, with unclear incidence.
Observation:
- A review identified only 31 cases of spinal involvement in pediatric leukemia.
- Among series reporting frequency, only 16 of 615 cases showed spinal involvement.
- In most reported cases, patients had abnormal peripheral blood counts at diagnosis.
Findings:
- This study reports two pediatric cases of acute lymphocytic leukemia with spinal involvement.
- Crucially, both patients presented with normal peripheral blood cell counts.
- This challenges the assumption that abnormal blood counts are always present.
Implications:
- Pediatric leukemia can manifest with significant skeletal symptoms and radiographic signs despite normal peripheral blood counts.
- Clinicians should consider leukemia in children with spinal symptoms and normal blood work.
- Early recognition is vital for timely diagnosis and treatment of pediatric leukemia.
Abstract:
Leukemia is the most common form of cancer in children. At the time of initial presentation, 10% of children have normal peripheral blood counts. Appendicular skeletal involvement occurs in approximately 50% of cases. The literature does not clearly define the incidence of spinal involvement, with only a total of 31 cases located in a review of the literature. If case reports are excluded and series that reported the frequency of spinal involvement are summarized, only 16 of 615 cases had spinal involvement. In only one of 31 was it clear that the patient had a normal peripheral blood count at the time of diagnosis. This article adds to the literature two patients who had normal peripheral blood counts and spinal involvement with acute lymphocytic leukemia. Patients with leukemia may have significant symptoms and radiographic signs with normal peripheral cell blood counts at the time of initial presentation.