Most reported chromosome 10q deletions occur in the distal region. This case series describes three unrelated patients with a rare 10q21.1q21.3 deletion linked to neurodevelopmental delays, musculoskeletal disorders, and distinct facial features. Key genes in the deleted region, ANK3, BICC1, and TFAM, are critical for brain development, kidney function, and skeletal formation, respectively. We summarized genotype-phenotype correlations, emphasizing early diagnosis and management of similar cases. These findings underscore the value of affordable genetic testing for identifying and addressing such chromosomal defects. (By Dr Dibyendu Dutta, https://jmg.bmj.com/content/early/2025/02/04/jmg-2024-110367 )