A Large-Scale Study of Bone Marrow Involvement in Patients with Hodgkin's Lymphoma

Levis, Alessandro; Pietrasanta, Daniela; Godio, Laura; Vitolo, Umberto; Ciravegna, G; Vito, F.; Gavarotti, Paolo; Guglielmelli, Tommasina; Orsucci, Lorella; Raviolo, E; Scalabrini, Delia Rota; Salvi, Flavia; Tonso, Anna; Aglietta, Massimo; Boccadoro, Mario; Gallamini, Andrea; Saglio, Giuseppe; Scassa, Enzo; Gallo, Eugenio

doi:10.3816/clm.2004.n.010

Cited by 35 publications

(26 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, primary nodal lymphomas may secondarily spread to bone and other extranodal sites [2,3,8]. Thus, lymphoma was an initial major differential diagnosis for the diffuse osseous involvement seen on MR images and whole-body scan in our patient [2,8,15]. The patient's diffuse pain and malaise, although nonspecific, are not unusual presenting symptoms of lymphoma [2,3].…”

Section: Discussion and Treatmentmentioning

confidence: 82%

“…Lymphoma most commonly arises in lymph nodes, but it also may arise as a primary process in extranodal sites, including bone [2,3]. Additionally, primary nodal lymphomas may secondarily spread to bone and other extranodal sites [2,3,8]. Thus, lymphoma was an initial major differential diagnosis for the diffuse osseous involvement seen on MR images and whole-body scan in our patient [2,8,15].…”

Section: Discussion and Treatmentmentioning

confidence: 86%

“…Lymphoma is a malignancy composed of clonal populations of either B or T lymphocytes or related hematopoietic cells [2,8]. Lymphoma most commonly arises in lymph nodes, but it also may arise as a primary process in extranodal sites, including bone [2,3].…”

Section: Discussion and Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

A 26-year-old Woman With Bilateral Leg Pain and Pruritus

Morell

Gardner

Suva

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Section: Discussion and Treatmentmentioning

confidence: 82%

Section: Discussion and Treatmentmentioning

confidence: 86%

See 1 more Smart Citation

A 26-year-old Woman With Bilateral Leg Pain and Pruritus

Morell

Gardner

Suva

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

“…However, localized or patchy intramedullary involvement at initial presentation of myelodysplastic syndrome (MDS) or AML with discrepant results from sampling bilateral iliac crests has been assumed to be rare, in contrast to the relatively frequent pattern of focal marrow involvement by lymphoplasmacytic neoplasms or solid tumors [3][4][5][6]. In AML, the marrow is usually diffusely hypercellular throughout the axial skeleton due to massive expansion of clonal myeloid blasts [7], and this is reflected in results of imaging studies that visualize the red marrow, including magnetic resonance imaging (MRI) [8,9] (MRI was not performed in this case).…”

Section: Discussionmentioning

confidence: 99%

An extreme example of focal bone marrow involvement in acute myeloid leukemia

et al. 2012

View full text Add to dashboard Cite

A 59-year-old man presented to the Emergency Department (ED) with a 2 month history of progressive fatigue, dyspnea, and exertional chest pain. For 9 years, he had had chronic, mild fluctuating cytopenias of uncertain etiology. A bone marrow biopsy of the left iliac crest at the onset of the cytopenias demonstrated aplasia, but a followup biopsy of the contralateral iliac crest 2 months later revealed a hypercellular marrow with mild erythroid hyperplasia and no dysplasia. Given these discrepant results, an extensive investigation for potential causes of cytopenias was undertaken, but failed to yield a specific diagnosis. Several subsequent bone marrow biopsies from both iliac crests showed only a severely hypocellular marrow with a normal male karyotype, but a sternal aspirate performed 8 years prior to presentation was hypercellular and without morphologic abnormalities. Four months prior to ED presentation, the patient had a normal complete blood count (CBC).On presentation to the ED, CBC revealed hemoglobin of 7.8 g/dL, hematocrit of 21.7%, white cell count of 0.81 3 10 9 /L (absolute neutrophil count 190/mm 3 ), and platelets of 103 3 10 9 /L. Peripheral blood smear showed evidence of dysplasia, with poikilocytosis, anisocytosis, basophilic stippling, and hypogranular neutrophils, but no circulating blasts. Bone marrow aspirate and biopsy of the left iliac crest was performed, which was again hypocellular and non-diagnostic, but a few suspicious blasts were observed. Due to the patient's unusual history, [18 F] fluorodeoxyglucose positron emission tomography (FDG-PET) was performed, with concurrent non-contrast helical computed tomography (CT) to enable anatomic correlation and attenuation correction of the PET images.FDG-PET/CT revealed scattered, patchy high-intensity FDG uptake in the sternum, part of the right ilium and pelvis, and 8 of 24 vertebral bodies, as seen in the coronal section PET image in Fig. 1A. The remainder of the marrow, including the left iliac crest (Fig. 1B) was markedly photopenic, in keeping with the findings of a hypocellular marrow on previous aspirates. Figure 1C,D demonstrates different FDG uptake in two adjacent vertebrae, showing how the T12 vertebral body (Fig. 1C) is highly FDG-avid, while the L1 vertebral body (Fig. 1D) is not. Normal marrow shows low metabolic activity on FDG-PET and appears nearly black.Bone marrow aspirates targeted to FDG-avid areas of the right ilium and sternum showed 51% and 56% blasts, respectively, with a myeloid phenotype (expressing CD34, dim CD45, HLA-DR, and the myeloid markers CD13, Image 1. Panels A-D depict FDG uptake in several vertebral bodies and patchy areas of the pelvic bones, including the right iliac crest, on PET/CT scanning of a patient with focal involvement by AML. Other vertebral bodies (panel D) and the left iliac crest are photopenic, and the left iliac crest was hypocellular (panel G) and non-diagnostic upon biopsy. Panels E and F depict a cellular marrow with myeloblasts, obtained from a PET-avid area of the pelvis; panel G...

show abstract

“…Many pathological studies have proven that blind iliac BMB has a low sensitivity for detecting BMI lesions in various malignancies [2]. The fact that a unilateral iliac BMB missed 26-50% of BMI cases in lymphoma patients (based on the findings of bilateral iliac BMB) [3][4][5][6] provided strong evidence that a significant number of BMI lesions would be missed even if a bilateral iliac BMB was performed. In addition, multiple studies revealed that FDG-PET or PET/CT detects more BMI than iliac BMB [7][8][9][10][11][12].…”

mentioning

confidence: 99%

The diagnostic value of FDG–PET cannot be judged by iliac bone marrow biopsy

Cheng¹

2012

The British Journal of Radiology

View full text Add to dashboard Cite

The diagnostic value of FDG-PET cannot be judged by iliac bone marrow biopsyThe Editor, We read with great interest a recent publication by Muzahir et al [1] on the value of 18-fludeoxyglucosepositron emission tomography (FDG-PET)/CT in the detection of bone marrow involvement (BMI) in Hodgkin's lymphoma (HL). However, we cannot agree with the authors on the definition of BMI. We believe that the data were not reliable because the authors defined a positive bone marrow lesion based solely on a positive finding on iliac bone marrow biopsy (BMB), and because the authors regarded diffuse FDG uptake in bone marrow as a positive PET finding.BMB is traditionally performed in the iliac crests. When the technique was first advocated, it was not known which part of the bone marrow would have tumour infiltration; the iliac crest was chosen because of its convenient location and richness of bone marrow. BMB performed in this way has a high false-negative rate and cannot accurately reflect the status of lymphoma in the bone marrow. Many pathological studies have proven that blind iliac BMB has a low sensitivity for detecting BMI lesions in various malignancies [2]. The fact that a unilateral iliac BMB missed 26-50% of BMI cases in lymphoma patients (based on the findings of bilateral iliac BMB) [3][4][5][6] provided strong evidence that a significant number of BMI lesions would be missed even if a bilateral iliac BMB was performed. In addition, multiple studies revealed that FDG-PET or PET/CT detects more BMI than iliac BMB [7][8][9][10][11][12]. BMI typically manifests as multifocal FDG abnormalities on FDG-PET imaging [9,10,12]. Multifocal lesions on an FDG-PET scan are often indicated as true-positive BMI if other conditions (fractures, osteomyelitis etc.) can be ruled out, even if BMB (performed blindly in the iliac crests) is negative. This often indicates a false-negative finding for BMB, owing to the fact that if a repeat BMB was performed at the bone region where abnormal FDG uptake is noticed, BMB would very likely be positive for BMI [10,13,14]. Using the BMB finding to judge the FDG-PET finding would render BMI lesions detected with FDG-PET as false-positive findings, leading to a low specificity for FDG-PET and, more importantly, understaging for patients.In addition, taking diffuse FDG uptake in the bone marrow as a positive PET finding in this paper also contributed to the authors' conclusion that FDG-PET performed poorly. It is well recognised that diffuse FDG uptake in the bone or bone marrow is more likely to be due to inflammatory changes [15] or reactive myeloid hyperplasia [13] than to lymphoma infiltration. Current guidelines have made it clear that diffuse uptake in the bone or bone marrow, even if more intense than in the liver, should not be interpreted as BMI [16,17]. Thus, taking diffuse FDG uptake as a positive finding on PET will lead to a lot of false-positive findings on PET and will decrease the positive predictive value (PPV) of FDG-PET.As a result, we cannot agree with the authors' conclusio...

show abstract

A Large-Scale Study of Bone Marrow Involvement in Patients with Hodgkin's Lymphoma

Cited by 35 publications

References 31 publications

A 26-year-old Woman With Bilateral Leg Pain and Pruritus

A 26-year-old Woman With Bilateral Leg Pain and Pruritus

An extreme example of focal bone marrow involvement in acute myeloid leukemia

The diagnostic value of FDG–PET cannot be judged by iliac bone marrow biopsy

Contact Info

Product

Resources

About