DING Mei, LI Ying, FANG Xiao-sheng, WANG Jian-hong and WANG Xin

    To the editor: A 15-year-old girl presented to the Hematology Outpatient Department of the Provincial Hospital Affiliated to Shandong University (China) with anemia and thrombocytopenia. Clinical investigation revealed pale lips, a few petechiae in her upper and lower limbs. Specifically, the firm, immobile and painless breast masses were noted to be approximately 8 cm. The preliminary bone marrow morphology in the community hospital indicated that the percentage of blast-like cells was high to 90.5% and she was diagnosed as acute leukemia. Further leukemia immunophenotyping of single cell suspension showed the abnormal cells in bone marrow expressing CD56, CD81, partly expressing CD57, and rarely expressing CD117, CD34, HLA-DR, CD7, CD28, CD19, CD138, GlyA, cCD3, CD41a, cMPO, and cCD79a.
    After ultrasound-guided percutaneous aspiration biopsy of the right breast, pathology indicated neuroblastoma. And the computed tomography (CT) scan revealed an expansile soft tissue mass in her pelvic cavity, which was considered the primary tumor, and lymphatic metastasis to pelvic cavity and bilateral inguina. We ultimately diagnosed the patient as neuroblastoma (stage IV).