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To our knowledge, this report represents the first confirmed case in Japan of a 15-year-old boy with acute lymphoblastic leukemia (ALL).L3 with hand-mirror cells (HMC) in the bone marrow. HMC lymphoid leukemia is an unusual variant of ALL in which the bone marrow lymphoblasts manifest distinctive hand-mirror morphologic features. HMC lymphoblast is characterized by an asymmetric foot-like cytoplasmic process that extends from the portion of the cell, thus giving it the light-microscopic appearance responsible for its name. Besides ALL, HMC has been reported in acute myeloblastic leukemia (AML), blastic crisis of chronic myelogenous leukemia, non-Hodgkin's lymphoma, and infectious mononucleosis. HMC has been reported to be prevalent in ALL.L1 and L2 as compared with L3.
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