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Hand Mirror Cells and Hypercalcemia

A Rare Presentation of Pediatric Acute Lymphoblastic Leukemia

Cacciotti, Chantel MD*,†; Leber, Brian MD; Cox, Stephanie RN*; Arredondo, Jorge MD§; Bassilious, Ereny MD†,∥; Athale, Uma MD*,†

Journal of Pediatric Hematology/Oncology: November 20, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPH.0000000000001352
Clinical and Laboratory Observations: PDF Only

Hand mirror cell (HMC) leukemia is a variant of acute lymphoblastic leukemia previously described in the adult population where lymphoblasts manifest distinctive hand mirror morphologic features. HMC has been previously identified in 23% of childhood acute lymphoblastic leukemia patients, but its prognostic significance in children is not well understood. Hypercalcemia is also uncommon in childhood leukemias. Hypercalcemia associated with HMC leukemia has not been previously reported. We report a 5-year-old boy with HMC B-lymphoblastic leukemia who presented with hypercalcemia.

*Division of Pediatric Hematology/Oncology

Division of Pediatric Endocrinology, McMaster Children’s Hospital

Department of Pediatrics, McMaster University

Department of Medicine, Hamilton Health Sciences and McMaster University

§Department of Pathology, McMaster Children’s Hospital and McMaster University, Hamilton, ON

The authors declare no conflict of interest.

Reprints: Chantel Cacciotti, MD, Department of Pediatrics, Division of Pediatric Hematology/Oncology, McMaster Children’s Hospital, 1280 Main Street West, HSC room 3N27, Hamilton, ON, Canada L8S 4K1 (e-mail:

Received July 14, 2018

Accepted October 11, 2018

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