title: Aleukaemic leukaemia presenting with pathological fracture.
abstract: A 19-month-old Chinese girl presented with pathological fracture of her right distal tibia. Peripheral blood revealed no abnormal cells, electrolytes were normal and bone biopsy at the fracture site only showed small aggregates of unremarkable lymphocytes. A bone marrow study could not provide a definitive diagnosis of acute leukaemia on morphology and immunohistochemistry. A diagnosis of precursor B-cell acute lymphoblastic leukaemia was unequivocally confirmed by a cytogenetic study which showed a hyperdiploid clone with gain of chromosome 4 among other trisomies.
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong, Hong Kong.
authors.forename: Gilbert T
authors.initials: GT
authors.lastname: Chua
authors.affiliation: Department of Pediatrics, Conde Sao Januario Central Hospital, Macao, Macao.
authors.forename: Kam Ching
authors.initials: KC
authors.lastname: Chow
authors.affiliation: Department of Pathology, Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong.
authors.forename: Jason Chi Chiu
authors.initials: JC
authors.lastname: So
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong.
authors.forename: Daniel Ka Leung
authors.initials: DK
authors.lastname: Cheuk
mesh_terms: D002894:Chromosomes, Human, Pair 4; D005260:Female; D005598:Fractures, Spontaneous / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007223:Infant; D007938:Leukemia; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000175:diagnosis* / Q000235:genetics; D014314:Trisomy