Chronic Lymphocytic Leukemia: A Rare Cause of Pathological Fracture of the Femur

Abstract

The incidence rate of chronic lymphocytic leukemia (CLL) in the United States is approximately 0.005%; men are at slightly higher risk than women. Bony involvement or pathological fracture rarely occurs in CLL, and it may be the initial presentation. An 85-year-old woman presented with acute respiratory failure secondary to pneumonia. Symptomatology included dyspnea. She was found to have pathological fracture of the femur caused by CLL. The diagnosis of CLL had been made 6 years previously, but the patient had refused therapy. On admission, the patient required endotracheal intubation, mechanical ventilation, and admission to the medical intensive care unit. Endotracheal intubation extubation was successful after 48 hours. The patient then complained of severe left knee pain. Bone radiograph and femoral computed tomography scan revealed acute pathological fracture of the left distal femur. There was no history of trauma. The fracture was stabilized with extension lock splint. Pathological fracture in patients with CLL is associated with hypercalcemia, Richter’s transformation, or multiple myeloma. This patient exemplifies the fact that pathological fracture can be caused by CLL in the absence of hypercalcemia, Richter’s transformation, or multiple myeloma and can be the initial presentation of CLL.

A case of bone lesion in a patient with relapsed chronic lymphocytic leukemia and review of the literature

“…In 11 on 22 cases of the literature, patients had the axial skeleton or proximal long bones involved, 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 and in rare cases, fractures were localized to the skull or facial bones. 17 , 22 , 23 Multiple fractures were reported in 8 cases.…”

A case of bone lesion in a patient with relapsed chronic lymphocytic leukemia and review of the literature

“…[7][8][9] Some cases in literature have already described the presence of lytic lesions in patients affected by CLL, and one of them was previously described by our group. 10 In 11 on 22 cases of the literature, patients had the axial skeleton or proximal long bones involved [10][11][12][13][14][15][16][17][18][19][20][21] and in rare cases fractures were localized to the skull or facial bones. 17,22,23 Multiple fractures were reported in 8 cases.…”

Exosomal CLIC1 released by CLL promotes HUVECs angiogenesis by regulating ITGβ1‐MAPK/ERK axis

“…CLL is one of the most common hematologic malignancies in older adults, which clinical manifestations range from asymptomatic, thrombocytopenia, and lymph node, spleen, and liver infections 3,19 . Growing evidences have suggested that exosomes released by CLL were perceived to have essential regulatory roles in many disease‐related events, including TME and angiogenesis 10,20,21 .…”

“…Chronic lymphocytic leukemia (CLL) is a malignant tumor originating form hematopoietic tissue with complex etiology, and remains lack of effective treatment in current conditions 1 . According to clinical statistics, the susceptibility was higher in men than women, and genetic factors may occupy a certain position in the pathogenesis of the disease 1–3 . Additionally, CLL can transform into other malignant lymphoproliferative diseases, such as prolymphocytic leukemia, diffuse large B‐cell lymphoma, or Hodgkin lymphoma, which due to the continuous recirculation of leukemic cells to bone marrow and lymph nodes 4 .…”