Clinical note
Chronic myeloid leukemia detected on FDG PET/CT imaging in a patient with renal cell carcinoma
Leucemia mieloide crónica detectada con FDG PET/TAC en un paciente con carcinoma de células renales
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Varoglu, B. Kaya, O. Sari" "autores" => array:3 [ 0 => array:3 [ "nombre" => "E." "apellidos" => "Varoglu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "B." "apellidos" => "Kaya" "email" => array:1 [ 0 => "bugrakaya01@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "O." "apellidos" => "Sari" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Konya University, Meram Medical Faculty, Department of Nuclear Medicine, Konya, Turkey" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Selcuk University, Selcuklu Medical Faculty, Department of Nuclear Medicine, Konya, Turkey" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Leucemia mieloide crónica detectada con FDG PET/TAC en un paciente con carcinoma de células renales" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 819 "Ancho" => 1830 "Tamanyo" => 146310 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">FDG PET/CT images demonstrating bone marrow infiltration in the patient with chronic myeloid leukemia.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder of pluripotent hematopoietic stem cells, characterized by increased proliferation, and decreased apoptosis of myeloid progenitor with peripheral leukokocytosis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> CML is a malignant disorder of the stem cell due to reciprocal balanced translocation of genetic material between the long arms of chromosomes 9 and 22.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Leukemias are characterized by diffuse replacement of bone marrow with proliferating leukemic cells, abnormal numbers and forms of immature white blood cells in the blood and widespread infiltrates in the liver, spleen, lymph nodes, and other sites throughout the body. Leukemias are classified as lymphocytic or myelocytic, according to the type of white blood cells involved.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> CML is a pluripotential stem cell disease characterized by anemia, extreme blood granulocytosis, granulocytic immaturity, basophilia, often thrombocytosis, and splenomegaly.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Whole-body fluorine-18 (<span class="elsevierStyleSup">18</span>F) FDG positron emission tomography (PET) has been useful in the management of a variety of malignancies. In patients with chemotherapy followed by bone marrow stimulants such as granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor, the bone marrow will have diffuse increased FDG accumulation. Therefore, diffuse bone marrow FDG uptake is commonly attributable to the effect of hematopoietic cytokines. However, diffuse bone marrow FDG uptake can also be caused by bone marrow involvement by malignancy, inflammatory conditions, after chemotherapy and idiopathic myelofibrosis.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–8</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 60-year-old male patient was referred for FDG PET/CT imaging for detecting recurrence or metastasis of renal cell cancer (RCC). He was diagnosed having RCC 5 years ago and he never had chemotherapy after first diagnoses of renal malignancy and before PET/CT examination. The patient underwent FDG PET/CT scan 60<span class="elsevierStyleHsp" style=""></span>min after intravenous injection of 370<span class="elsevierStyleHsp" style=""></span>MBq FDG. Disseminated infiltration and increased FDG uptake in bone marrow prominent in the vertebral bodies, pelvic bones and proximal parts of the upper and lower extremities (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) were demonstrated with FDG PET/CT imaging. Findings on FDG PET/CT were suspicious for bone marrow involvement or using of granulocyte colony-stimulating factor. However the patient had no history of using granulocyte colony-stimulating factor. Hemogram analysis showed white blood cell count 207<span class="elsevierStyleHsp" style=""></span>k/ul (normal ranges: 4–10<span class="elsevierStyleHsp" style=""></span>k/ul), hemoglobin 13.2<span class="elsevierStyleHsp" style=""></span>g/dl (normal: 12.1–17.2<span class="elsevierStyleHsp" style=""></span>g/dl), mean corpuscular volume 90<span class="elsevierStyleHsp" style=""></span>Fl (normal: 82.2–99<span class="elsevierStyleHsp" style=""></span>Fl), and platelet count 214,000<span class="elsevierStyleHsp" style=""></span>ul<span class="elsevierStyleSup">−1</span> (normal: 150–400) with neutrophils 91.7%, lymphocytes 2.62%, and monocytes 7.11%, LDH 763<span class="elsevierStyleHsp" style=""></span>u/l (normal ranges: 98–192). For hyperleukocytosis, he was admitted to the hematology clinic and was diagnosed as a case of chronic myeloid leukemia based on peripheral blood smear and bone marrow examination. Bone marrow aspiration and biopsy revealed hypercellular bone marrow with prominent myeloid hyperplasia. He was given hydroxyurea, and allopurinol was also started for potential tumor lysis syndrome.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">The diffuse increase in FDG uptake in the bone marrow not only may be caused by malignancy or hematopoietic disease, but also may be due to an inflammatory reaction, recent chemotherapy, or administration of hematopoietic growth factors. A diffuse increase in FDG uptake has also been reported in hyperplastic bone marrow as seen an idiopathic myelofibrosis.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–11</span></a> To determine the effect of granulocyte colony stimulating factor and granulocyte-macrophage colony stimulating factor on bone marrow glucose metabolism, the specific uptake of FDG in bone marrow has been evaluated. It was shown that a substantial increase in bone marrow FDG uptake is rapidly induced by colony stimulating factor treatments and should not be misinterpreted as diffuse bone metastases or bone marrow disease.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> FDG PET can also be used for the evaluation of CML. Nakajo et al. have reported in their study that patients with CML in the chronic phase that showed increased FDG uptake in the bone marrow in pretreatment period and follow-up FDG PET scan findings after termination of treatment had demonstrated reduced FDG uptake in the bone marrow.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Chiang et al. reported a patient with diffuse bone marrow involvement of Hodgkin's disease that appears indistinguishable from hematopoietic cytokine-mediated FDG bone marrow uptake.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Inoue et al. reported diffuse bone marrow uptake on <span class="elsevierStyleSup">18</span>F FDG PET in two patients with myelodysplastic syndromes.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">FDG PET/CT is useful in the diagnosis, initial staging, follow-up, and restaging of patients with bone marrow malignancy. It is also well known that increased bone marrow uptake of FDG after administration of colony stimulating factor is one of the most important cause of visualization of bone marrow in FDG PET/CT imaging. This case suggests that the various pathologic and idiopathic clinical conditions should be kept in mind to avoid misinterpretation of the images for reporting patients with increased bone marrow involvement in FDG PET/CT.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare not to have any conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres119458" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec106737" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres119457" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec106738" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-03-06" "fechaAceptado" => "2012-04-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec106737" "palabras" => array:4 [ 0 => "Leukemia" 1 => "Positron emission tomography/computed tomography" 2 => "Fluorodeoxyglucose" 3 => "Renal cell carcinoma" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec106738" "palabras" => array:4 [ 0 => "Leucemia" 1 => "Tomografía por emisión de positrones/tomografía axial computarizada" 2 => "Fluorodeoxiglucosa" 3 => "Carcinoma de células renales" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">It is well known that hematopoietic cytokine stimulation can cause increased fluorodeoxyglucose (FDG) accumulation in bone marrow on PET/CT imaging, which simulates that seen in patients with bone marrow metastases. However, increased bone marrow FDG uptake can be caused by other etiologies. We report a patient with operated renal cell carcinoma had no history of hematopoietic cytokine stimulation. The FDG PET/CT images showed increased bone marrow FDG uptake, and the patient was diagnosed as chronic myeloid leukemia. This case revealed that increased FDG uptake on bone marrow may be related to neoplastic disease of the hematopoietic tissues.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Es por todos conocido que la estimulación citocina hematopoyética puede causar un aumento en la acumulación de fluorodeoxiglucosa (FDG) en la medula ósea en las imágenes del PET/TAC de pacientes con metástasis en la medula ósea. Sin embargo, la captación aumentada por la medula ósea puede deberse a otras etiologías. Presentamos el caso de un paciente operado de carcinoma de células renales sin una historia de estimulación hematopoyética. Las imágenes de la FDG PET/TAC muestran la captación aumentada de FDG en la medula ósea y el paciente fue diagnosticado de leucemia mieloide crónica. Este caso muestra que la captación aumentada de FDG en la medula ósea puede relacionarse con la enfermedad neoplástica de los tejidos hematopoyéticos.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 819 "Ancho" => 1830 "Tamanyo" => 146310 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">FDG PET/CT images demonstrating bone marrow infiltration in the patient with chronic myeloid leukemia.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting chronic leukaemias from assessment of complete peripheral blood counts" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 September | 7 | 0 | 7 |
| 2024 June | 3 | 0 | 3 |
| 2024 May | 8 | 2 | 10 |
| 2024 January | 3 | 0 | 3 |
| 2023 October | 1 | 0 | 1 |
| 2022 February | 1 | 0 | 1 |
| 2021 February | 3 | 0 | 3 |
| 2020 August | 1 | 0 | 1 |
| 2020 February | 420 | 0 | 420 |
| 2020 January | 202 | 0 | 202 |
| 2019 October | 1 | 0 | 1 |
| 2018 July | 0 | 1 | 1 |
| 2018 May | 1 | 0 | 1 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 24 | 2 | 26 |
| 2018 January | 28 | 5 | 33 |
| 2017 December | 18 | 3 | 21 |
| 2017 November | 18 | 4 | 22 |
| 2017 October | 22 | 5 | 27 |
| 2017 September | 16 | 7 | 23 |
| 2017 August | 22 | 11 | 33 |
| 2017 July | 32 | 5 | 37 |
| 2017 June | 45 | 15 | 60 |
| 2017 May | 56 | 18 | 74 |
| 2017 April | 44 | 10 | 54 |
| 2017 March | 49 | 26 | 75 |
| 2017 February | 40 | 5 | 45 |
| 2017 January | 27 | 0 | 27 |
| 2016 December | 34 | 6 | 40 |
| 2016 November | 36 | 1 | 37 |
| 2016 October | 53 | 10 | 63 |
| 2016 September | 60 | 13 | 73 |
| 2016 August | 33 | 15 | 48 |
| 2016 July | 33 | 2 | 35 |
| 2016 June | 28 | 11 | 39 |
| 2016 May | 25 | 6 | 31 |
| 2016 April | 12 | 8 | 20 |
| 2016 March | 25 | 12 | 37 |
| 2016 February | 13 | 9 | 22 |
| 2016 January | 17 | 8 | 25 |
| 2015 December | 12 | 6 | 18 |
| 2015 November | 16 | 6 | 22 |
| 2015 October | 21 | 8 | 29 |
| 2015 September | 16 | 7 | 23 |
| 2015 August | 46 | 5 | 51 |
| 2015 July | 63 | 3 | 66 |
| 2015 June | 29 | 5 | 34 |
| 2015 May | 36 | 3 | 39 |
| 2015 April | 36 | 8 | 44 |
| 2015 March | 28 | 7 | 35 |
| 2015 February | 20 | 1 | 21 |
| 2015 January | 17 | 4 | 21 |
| 2014 December | 31 | 5 | 36 |
| 2014 November | 15 | 4 | 19 |
| 2014 October | 22 | 10 | 32 |
| 2014 September | 15 | 1 | 16 |
| 2014 August | 10 | 4 | 14 |
| 2014 July | 22 | 3 | 25 |
| 2014 June | 18 | 4 | 22 |
| 2014 May | 12 | 2 | 14 |
| 2014 April | 16 | 2 | 18 |
| 2014 March | 12 | 5 | 17 |
| 2014 February | 17 | 2 | 19 |
| 2014 January | 13 | 3 | 16 |
| 2013 November | 1 | 0 | 1 |
| 2013 June | 3 | 0 | 3 |
| 2013 May | 3 | 0 | 3 |
| 2013 January | 477 | 0 | 477 |
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