Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Necrotic Bone Involvement in an Adult Afflicted with B-Cell Precursor Acute Lymphoblastic Leukemia Mimicking Osteomyelitis: A Case Report

성인환자에서 골수염으로 오인된 B 전구세포급성 림프모구 백혈병의 괴사성 골침범: 증례 보고

  • Kim, Hae Won (Department of Radiology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kwon, Soon-Yong (Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Chong, Yosep (Department of Hospital Pathology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Park, Jeongmi (Department of Radiology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine)
  • 김혜원 (가톨릭대학교 의과대학 여의도성모병원 영상의학교실) ;
  • 권순용 (가톨릭대학교 의과대학 여의도성모병원 정형외과학교실) ;
  • 정요셉 (가톨릭대학교 의과대학 여의도성모병원 병리학교실) ;
  • 박정미 (가톨릭대학교 의과대학 여의도성모병원 영상의학교실)
  • Received : 2017.07.19
  • Accepted : 2017.09.07
  • Published : 2018.01.01
⟨ Previous Next ⟩

Abstract

A 41-year-old female presented with complaint of left hip and buttock pain. Magnetic resonance imaging (MRI) showed multi-focal bone marrow signal intensity changes in left iliac bone, sacrum and femur with an area of necrosis. The primary radiological differential diagnosis was multi-focal tuberculous osteomyelitis. Subsequent pelvic bone biopsy and bone marrow biopsy confirmed the diagnosis of B-cell precursor acute lymphoblastic leukemia with extensive necrosis, which is infrequent in leukemia. When musculoskeletal symptoms precede peripheral blood abnormalities and MRI scanning reveals multi-focal necrotic lesions rather than diffuse signal change, it can be difficult to identify and/or advance leukemia as differential diagnosis.

41세 여성이 왼쪽 골반과 엉덩이 통증을 주소로 내원하였다. 자기공명영상에서 좌측 장골, 천골 및 대퇴골에서 괴사 부위를 동반한 다발성 골수 신호 강도 변화가 있었다. 영상의학적 감별진단으로 다발성 결핵성 골수염을 우선적으로 고려하였으며 이후 골반 뼈 생검과 골수 생검을 통해 백혈병에서는 드문 광범위한 괴사를 동반한 B 전구세포 급성 림프모구 백혈병의 진단을 확진하였다. 근골격계 증상이 말초 혈액 이상보다 먼저 나타나고 자기공명영상에서 미만성의 신호 강도 변화가 아닌 다발성의 괴사성 병변으로 나타나는 경우 백혈병의 진단이 어렵다.

Keywords

References

  1. Moulopoulos LA, Koutoulidis V. MRI of the abnormal bone marrow: diffuse pattern. In Moulopoulos LA, Koutoulidis V, eds. Bone Marrow MRI: a pattern-based approach. Milano: Springer 2014:101-114
  2. Yoshikawa T, Tanizawa A, Suzuki K, Tanaka N, Hayashi T, Tsuda M, et al. The usefulness of T1-weighted magnetic resonance images for diagnosis of acute leukemia manifesting musculoskeletal symptoms prior to appearance of peripheral blood abnormalities. Case Rep Pediatr 2016;2016: 2802596
  3. Kan JH, Hernanz-Schulman M, Frangoul HA, Connolly SA. MRI diagnosis of bone marrow relapse in children with ALL. Pediatr Radiol 2008;38:76-81
  4. Navarro SM, Matcuk GR, Patel DB, Skalski M, White EA, Tomasian A, et al. Musculoskeletal imaging findings of hematologic malignancies. Radiographics 2017;37:881-900 https://doi.org/10.1148/rg.2017160133
  5. Borowitz MJ, Chan JKC. B lymphoblastic leukemia/lymphoma with recurrent genetic abnormalities. In Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, Vardiman JW, eds. WHO classification of tumours of haematopoietic and lymphoid tissues, 4th ed. Springer 2008: 171-175
  6. Kaygusuz I, Toptas T, Guven A, Firatli-Tuglular T, Tecimer T, Bayik M. Precursor B cell lymphoblastic lymphoma presenting as a solitary bone tumor: a case report and review of the literature. Int J Hematol 2010;92:757-761 https://doi.org/10.1007/s12185-010-0715-5
  7. Mika J, Schleicher I, Gerlach U, Adler CP, Uhl M, Knoeller SM. Primary bone lymphomas thought to be osteomyelitis urgently demand a rapid diagnosis in bone pathology. Anticancer Res 2012;32:4905-4912
  8. Tang YM, Jeavons S, Stuckey S, Middleton H, Gill D. MRI features of bone marrow necrosis. AJR Am J Roentgenol 2007; 188:509-514 https://doi.org/10.2214/AJR.05.0656
  9. Hwang S, Panicek DM. Magnetic resonance imaging of bone marrow in oncology, part 2. Skeletal Radiol 2007;36:1017-1027 https://doi.org/10.1007/s00256-007-0308-4
  10. Badar T, Shetty A, Bueso-Ramos C, Cortes J, Konopleva M, Borthakur G, et al. Bone marrow necrosis in acute leukemia: clinical characteristic and outcome. Am J Hematol 2015;90: 769-773 https://doi.org/10.1002/ajh.24074