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March 1994

Pathological Cases of the Month: Case 2

Author Affiliations

From the Division of Hematopathology, Department of Pathology, University of Pittsburgh (Pa).

Arch Pediatr Adolesc Med. 1994;148(3):285-286. doi:10.1001/archpedi.1994.02170030055012

A PREVIOUSLY healthy 15-year-old white boy was admitted to Children's Hospital of Pittsburgh (Pa) with generalized bone pain and fever. Physical examination showed no hepatosplenomegaly, lymphadenopathy, or soft-tissue masses. Laboratory findings were as follows: hemoglobin level, 113 g/L; hematocrit, 0.32; white blood cell count, 11.2×109/L; and platelet count, 56×109/L. A peripheral blood smear showed a leukoerythroblastic picture including a 3% large mononuclear "blast" that had a deep blue cytoplasm. Levels for serum lactate dehydrogenase were 484 U/L (normal, <170 U/L); for serum aspartate aminotransferase, 126 U/L (normal, <40.0 U/L); for serum alanine aminotransferase, 465 U/L (normal, <40.0 U/L); and for serum alkaline phosphatase, 403 U/L (normal, <40.0 U/L). Imaging studies, computed tomography, and magnetic resonance imaging showed no tumor mass. Because of the possible diagnosis of acute leukemia, an iliac crest bone marrow aspiration and bone marrow biopsy were performed, and imprint smears were stained with