Bony Lesions in Pediatric Acute Leukemia: Pictorial Essay

Abstract

Acute leukemia is the most common malignancy in childhood, which mainly involves children less than 15 years of age. The growing skeleton is the main site of involvement in children. Leukemic cells proliferate within the massive red bone marrow in children. So besides the pallor, petechia, purpura and ecchymosis in the skin and mucosal surfaces, bone pain and other bony lesions are other manifestations of leukemia.On the other hand, bony lesions are more prevalent in children than adults with no poor prognosis in comparison to patients without bone lesions. These bony lesions may precede other laboratory tests so familiarity with these presentations is very important for earlier diagnosis.In this pictorial essay, we tried to gather the most common bony lesions that may be seen in acute leukemia in different cases admitted to our hospital with general malaise and localized tenderness and discomfort leading us to perform plain X-ray for further evaluation. Finding these bony lesions helps clinicians to reach the diagnosis quickly. These findings include metaphyseal lucent band and erosion, periosteal reaction, small lucent bone lesion and permeative appearance, reduced bone density and collapsed vertebra.

B-acute lymphoblastic leukaemia

“…It is not uncommon to find osteolytic lesions without circulating blasts in peripheral blood in patients of ALL (box 1). Many such cases have been reported in the literature 1 3 5 9. Therefore, ALL should always be kept as a differential in any child having multiple osteolytic lesions and hypercalcaemia even in the presence of normal peripheral blood findings.…”

“…Acute lymphoblastic leukaemia (ALL) is the most common malignancy in the paediatric age group 1. Symptoms of ALL include anaemia, fever, bleeding tendency and fatigue 2.…”

Femoral diaphyseal stress fracture as the initial presentation of acute leukaemia in an adolescent

“…Patients with leukaemia presenting with fractures usually have vertebral crush fractures 2 3 6 7. There has been one report of a case of osteochondral fracture of the left femoral epiphysis secondary to avascular necrosis 6…”

Imaging of Malignant Bone Tumors

“…It forms about 41% of malignancies in children younger than 15 years [6]. When a child is below 15 years, acute lymphocytic leukemia is the commonest subtype [6].…”

“…Acute leukemia is the most common malignancy in childhood, which mainly involves children less than 15 years of life [6]. It forms about 41% of malignancies in children younger than 15 years [6].…”