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Raj B K A, Singh KA, Shah H. Orthopedic manifestation as the presenting symptom of acute lymphoblastic leukemia. J Orthop 2020; 22:326-330. [PMID: 32675920 PMCID: PMC7340973 DOI: 10.1016/j.jor.2020.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/24/2020] [Accepted: 05/31/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The diagnosis of Acute lymphoblastic leukemia (ALL) is delayed due to vague presentation and normal hematological investigations. OBJECTIVE The objectives were to identify the frequency of ALL cases presented to the orthopedic department and with normal hematological investigations. MATERIAL AND METHODS 250 consecutive ALL cases were retrospectively evaluated to identify cases with musculoskeletal manifestations, and laboratory investigations. RESULTS Twenty-two patients (4- vertebral compression fractures, 12- joint pain, 6- bone pain), presented primarily to the orthopedic department. Six patients had a normal peripheral smear. CONCLUSION The primary physician should maintain a high index of suspicion despite a normal peripheral smear.
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Affiliation(s)
- Amrath Raj B K
- Department of Orthopaedics, Kasturba Hospital, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | | | - Hitesh Shah
- Department of Orthopaedics, Kasturba Hospital, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Morais SA, du Preez HE, Akhtar MR, Cross S, Isenberg DA. Musculoskeletal complications of haematological disease. Rheumatology (Oxford) 2015; 55:968-81. [DOI: 10.1093/rheumatology/kev360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Indexed: 01/19/2023] Open
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Arimoto MK, Nakamoto Y, Nakatani K, Ishimori T, Yamashita K, Takaori-Kondo A, Togashi K. Increased bone marrow uptake of 18F-FDG in leukemia patients: preliminary findings. SPRINGERPLUS 2015; 4:521. [PMID: 26405641 PMCID: PMC4573748 DOI: 10.1186/s40064-015-1339-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/10/2015] [Indexed: 01/05/2023]
Abstract
The aim of this retrospective study was to evaluate the characteristics of increased bone marrow uptake of 18F-FDG in patients with leukemia who underwent whole-body 18F-FDG PET/CT. The 18F-FDG PET/CT images of 9 patients with histologically proven leukemia were reviewed. The accumulation of 18F-FDG in the bone marrow was evaluated, and was compared with histological subtype, clinical course, and hematological findings. Nine patients (4 males, 5 females; age range, 5-58 years) had increased bone marrow uptake of 18F-FDG, including 6 patients with acute lymphoblastic leukemia, 1 with acute myeloid leukemia, 1 with chronic myeloid leukemia, and 1 with mature B cell neoplasm. Bone marrow uptake was generally diffuse but focal or inhomogeneous uptake was common, especially in the upper and lower extremities. Patients with increased bone marrow uptake of 18F-FDG commonly complained of fever and bone pain. No correlations between 18F-FDG uptake and peripheral blood findings were observed. Patients with leukemia may have increased bone marrow uptake of 18F-FDG on PET/CT, possibly reflecting leukemic cell activity. Leukemia can be included in the differential diagnosis when increased bone marrow uptake of 18F-FDG is observed.
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Affiliation(s)
- Maya Kato Arimoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Kyoto 606-8507 Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Kyoto 606-8507 Japan
| | - Koya Nakatani
- Department of Diagnostic Radiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-0052 Japan
| | - Takayoshi Ishimori
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Kyoto 606-8507 Japan
| | - Kouhei Yamashita
- Department of Hematology and Oncology, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Kyoto 606-8507 Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Kyoto 606-8507 Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Kyoto 606-8507 Japan
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Nguyen TV, Melville A, Nath S, Story C, Howell S, Sutton R, Zannettino A, Revesz T. Bone Marrow Recovery by Morphometry during Induction Chemotherapy for Acute Lymphoblastic Leukemia in Children. PLoS One 2015; 10:e0126233. [PMID: 25962143 PMCID: PMC4427405 DOI: 10.1371/journal.pone.0126233] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 03/30/2015] [Indexed: 02/05/2023] Open
Abstract
Bone marrow architecture is grossly distorted at the diagnosis of ALL and details of the morphological changes that accompany response to Induction chemotherapy have not been reported before. While marrow aspirates are widely used to assess initial response to ALL therapy and provide some indications, we have enumerated marrow components using morphometric analysis of trephine samples with the aim of achieving a greater understanding of changes in bone marrow niches. Morphometric analyses were carried out in the bone marrow trephine samples of 44 children with ALL, using a NanoZoomer HT digital scanner. Diagnostic samples were compared to those of 32 control patients with solid tumors but without marrow involvement. Samples from patients with ALL had significantly increased fibrosis and the area occupied by bony trabeculae was lower than in controls. Cellularity was higher in ALL samples due to leukemic infiltration while the percentage of normal elements such as megakaryocytes, adipocytes, osteoblasts and osteoclasts were all significantly lower. During the course of Induction therapy, there was a decrease in the cellularity of ALL samples at day 15 of therapy with a further decrease at the end of Induction and an increase in the area occupied by adipocytes and the width of sinusoids. Reticulin fibrosis decreased throughout Induction. Megakaryocytes increased, osteoblasts and osteoclasts remained unchanged. No correlation was found between clinical presentation, early response to treatment and morphological changes. Our results provide a morphological background to further studies of bone marrow stroma in ALL.
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Affiliation(s)
- Tuong-Vi Nguyen
- Erasmus University, Rotterdam, The Netherlands; SA Pathology at Women's and Children's Hospital, Adelaide, Australia
| | - Anna Melville
- Women's and Children's Research Institute, Adelaide, Australia
| | | | - Colin Story
- SA Pathology at Women's and Children's Hospital, Adelaide, Australia
| | - Stuart Howell
- Data Management & Analysis Centre, Discipline of Public Health, University of Adelaide, Adelaide, Australia
| | - Rosemary Sutton
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Andrew Zannettino
- Faculty of Health Science, University of Adelaide, Adelaide, Australia; Centre for Cancer Biology, SA Pathology, Adelaide, Australia
| | - Tamas Revesz
- SA Pathology at Women's and Children's Hospital, Adelaide, Australia; Faculty of Health Science, University of Adelaide, Adelaide, Australia
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