Philadelphia chromosome-positive acute myeloid leukemia with masses and osteolytic lesions: finding of 18F-FDG PET/CT

doi:10.1007/s11684-017-0523-x

Front. Med.

2017, Vol. 11

Issue (3) : 440-444 https://doi.org/10.1007/s11684-017-0523-x

CASE REPORT

Philadelphia chromosome-positive acute myeloid leukemia with masses and osteolytic lesions: finding of 18F-FDG PET/CT

Zhan Su^1,², Fengyu Wu³, Weiyu Hu⁴, Xiaodan Liu², Shaoling Wu², Xianqi Feng², Zhongguang Cui², Jie Yang², Zhenguang Wang³, Hongzai Guan⁵, Hongguo Zhao², Wei Wang², Chunting Zhao²(

), Jun Peng¹(

)

¹. Department of Haematology, Qilu Hospital, Shandong University, Jinan 250012, China
². Department of Haematology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
³. PET/CT Center, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
⁴. Department of Hepatobiliary Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
⁵. Department of Haematology, Qingdao University Medical College, Qingdao 266071, China

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Abstract

Philadelphia chromosome-positive acute myeloid leukemia is controversial and difficult to distinguish from the blast phase of chronic myeloid leukemia. As a myeloid neoplasm, rare cases of this leukemia manifest multiple soft-tissue tumors or bone lytic lesions. In this paper, we describe a 49-year-old male patient who had an abrupt onset with sharp chest pain, fever, fatigue, emaciation, and splenomegaly. 18F-fluoro-deoxy-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) result showed diffuse and uneven hypermetabolic lesions in the bone marrow with peripheral bone marrow expansion, multiple soft tissue neoplasms with high 18F-FDG uptake, and lytic bone lesions. Bone marrow smear and biopsy detected aberrant blast cells expressing myeloid rather than lymphoid immunophenotype marker. For the existence of Philadelphia chromosome and BCR-ABL1 fusion gene together with complex chromosome abnormalities, a diagnosis of Philadelphia-positive acute myeloid leukemia was made, although the type (de novo or blast crisis) remained unclear.

Keywords Philadelphia chromosome acute myeloid leukemia mass osteolysis positron emission tomography

Corresponding Author(s): Chunting Zhao,Jun Peng

Just Accepted Date: 25 April 2017 Online First Date: 26 May 2017 Issue Date: 29 August 2017

Cite this article:

Zhan Su,Fengyu Wu,Weiyu Hu, et al. Philadelphia chromosome-positive acute myeloid leukemia with masses and osteolytic lesions: finding of 18F-FDG PET/CT[J]. Front. Med., 2017, 11(3): 440-444.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0523-x
https://academic.hep.com.cn/fmd/EN/Y2017/V11/I3/440

Fig.1 Morphological features and results of cytogenetic and molecular analyses. (A and B) May?Grümwald?Giemsa-stained blood and bone marrow smears (1000×). (C) Representative karyotype of leukemic cells with t(9;22)(q34;p11); arrows indicate the Ph translocation. (D) Sequencing results of BCR-ABL1 transcript. Sequences flanking the breakpoint are shown, and BCR exon b3 is fused to ABL1 exon a2.

Fig.2 (A) PET showed diffused and uneven high FDG uptake in the bone marrow and CT displayed density heterogeneously increased in those abnormal metabolic sites. Multiple soft tissue density foci were observed in the medullary cavity of bilateral femurs. (B) PET/CT showed multiple FDG-avid soft-tissue density masses in the right chest wall, around the sternum, the thoracic vertebra, and in the thoracic subcutaneous space. The biggest mass was located in the right chest wall, with osteolytic destruction in the 8th right rib. The spleen was considerably enlarged with diffused high FDG uptake.

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