Abstract
Growth arrest at the secondary growth plate, also known as the acrophysis, is a rare phenomenon with only very few known published case reports. We report on a case of formation of ghost secondary ossification centers at the acrophyses of the knee joint in a 14-year-old female, who survived early childhood acute lymphoblastic leukemia. The patient suffered from severe side effects from both disease and subsequent treatment strategies with a 10-month immobilization period as a consequence at the age of 3 years. The ghost secondary ossification centers were encountered on radiographs and MRI 10 years later, when she presented for evaluation of chronic pain in her left knee related to sports activities, due to a meniscal cyst. Awareness of this phenomenon is nevertheless important, because it seems that endochondral bone growth recovery at the acrophyses might be different from recovery in physes, because we found no concomitant sequelae of growth arrest in the metaphyses.
Highlights
Over the years, the curability of acute lymphoblastic leukemia (ALL) in children has improved to ~ 90% due to intensive therapy strategies [1]
To the best of our knowledge, we report the first case of persistent ghosts of the acrophysis of the distal femur, proximal tibia, and patella in a long-term survivor of acute lymphoblastic leukemia (ALL) probably caused by underlying multifactorial causes of bone morbidity
Cartilage is gradually replaced by bone at places where cartilaginous growth plates have been formed. [9]
Summary
The curability of acute lymphoblastic leukemia (ALL) in children has improved to ~ 90% due to intensive therapy strategies [1] These treatment strategies, consisting of multi-agent osteotoxic chemotherapy including high doses of glucocorticosteroids, as well as low vitamin D levels, poor nutrition and low muscle mass, and the ALL itself, may all contribute to secondary, multifactorial impairment or even arrest of bone growth and significant bone morbidity [2]. At the age of 3, she suffered from pre-B-ALL, non-high-risk, treated with a standard multi-agent Dutch Child Oncology GroupALL10 protocol, including vincristine, L-asparaginase, and high doses of dexamethasone with additional intrathecal triple therapy resulting in complete remission at day 40 She developed a syndrome of inappropriate antidiuretic hormone secretion (SIADH) as a side effect of vincristine and treatment was further complicated by pneumonias and therapy-resistant candidiasis of the liver resulting in a long stay at the intensive care unit as a result. Formal oral and written permission to publish this case was obtained from the patient and her parents
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