Bone scintigraphy as a prognostic factor in patients with adult T-cell leukemia-lymphoma

[Differential diagnosis of reduced uptake images revealed by bone scan: about a case of acute lymphoblastic leukemia]

If increased uptake during bone scan usually bring to light many bone pathologies, reduced uptakes are a rare occurrence and they require careful analysis to avoid erroneous interpretations. We report the case of a 17-year old admitted with diffuse bone pain, hypercalcemia and thrombopenia. Bone scan showed areas of low uptakes. Bone marrow tests allowed the diagnosis of acute lymphoblastic leukemia. This case report aims to discuss the main differential diagnoses based on such bone scan abnormalities.

Asymmetric and Diffuse Uptake of Left Femur in a 3-Year-Old Child Bone Scan: An Unusual Aspect in Acute Lymphoblastic Leukemia

Acute leukemia is a severe disease frequently encountered in childhood, often diagnosed in later stages because of nonspecific symptoms. It is known to produce uptake in bone scan, and previously described patterns have shown symmetrical abnormalities. However, we report the unusual aspect of the bone scan in a 3-year-old child who was referred to explore an isolated pain of his lower left limb, with hyperthermia and markers of inflammation. A bone scan showed an intense, asymmetrical uptake of the entire left femur. A few days later, his blood count showed circulating blast cells, leading to the diagnosis of leukemia.

Elevation of IL-6 in ATL patient with a pathological fracture

Hypercalcemia and osteolytic bone lesion are important complications in the prognosis of patients with adult T cell leukemia/lymphoma (ATL). We report a 61-year-old Japanese woman who died of ATL and had multiple osteolytic lesions and pathological fractures of her extremities. Highly increased serum levels of Interleukin-6 (IL-6) and a parathyroid hormone-related protein (PTHrP) together with a high level of serum calcium observed at the time of fractures suggested their contribution to the formation of the bone lesions.

Numerous sites of increased uptake shown on bone scintigraphy in a case of adult T-cell leukemia

Bone scintigraphy was performed in a 69-year-old male patient with adult T-cell leukemia suffering from right lower limb pain. Numerous sites of increased uptake were seen in the skull, left clavicle, bilateral humeri, bilateral radii and right femur and tibia. Bone radiographs showed multiple osteolytic lesions, most of which corresponded to the abnormal deposits on the bone scans with 740 MBq of 99mTc-hydroxymethylene diphosphonate. This pattern is rarely reported, but bone involvement of adult T-cell leukemia is not uncommon. Bone involvement was remarkable on the appendicular skeleton when compared with common metastatic bone tumors. Bone scintigraphy may be useful in detecting bone involvement in adult T-cell leukemia.