Solitary lytic bone lesion in an adult with chronic myelogenous leukemia.

Abstract

In the available American and European literature, mention has been found of the protean forms of bone involvement encountered in myelogenous leukemia. Descriptions of solitary lytic bone lesions, however, are rare. Such a case is presented here. This patient caused no diagnostic problem, although roentgenograms revealed a lesion compatible with bone sarcoma or metastatic neoplasm. Only one account of a similar entity was found in the more recent literature (1). This concerned a solitary lytic lesion in the mid-femoral diaphysis of a fifty-four-year-old Italian female. Clinical and laboratory evaluation of the patient led to the firm conclusion that the bone lesion was due to leukemic infiltration and was not a metastatic growth with an associated leukemoid reaction. No biopsy was obtained, however. In general, it is agreed that leukemic bone lesions in the adult are rare, or at least uncommon. Schinz et al. (2) state that in adult life roentgenographically demonstrable bone changes are relatively rare in myeloid leukemia. Pugh (3) also notes that osseous changes in the adult are not often seen, and similar comments are made by Coley (4) and Shanks and Kerley (5). A 42-year-old white male was admitted to the Veterans Administration Hospital for the first time in September 1952, being referred from another institution for radioactive gold therapy. A diagnosis of chronic myelogenous leukemia had been established on discharge from the Army in 1949, and since that time the patient had been admitted to hospitals five times for external irradiation of an enlarged spleen and multiple blood transfusions to correct anemia. The pertinent clinical findings on the first admission to the Veterans Hospital were: a moderately enlarged liver, splenic enlargement to six fingerbreadths below the costal margin, and generalized lymphadenopathy. The laboratory findings were as follows: white cell count 128,000, with stab forms 27, myelocytes 24, metamyelocytes 21, segmented forms 19, promyelocytes 5, basophils 2, lymphocytes 1, myeloblasts 1; hemoglobin, 11 gm.; packed cell volume, 34 per cent; sedimentation rate, 13 mm.; platelets, 481,000; Bromsulfalein test, 6.6 per cent; albumin-globulin ratio, 4.3/2.3. Bone marrow aspiration confirmed the diagnosis of myeloid leukemia. The only roentgenogram obtained showed a normal chest. Treatment consisted of a total of 84 mc. of radioactive gold divided into two doses, one month apart, and 2,500 c.c. of whole blood. The patient's general condition showed both subjective and objective improvement, with a regression of the splenomegaly and a reduction in the white blood count to 25,000–30,000. On Sept. 30, 1953, the patient was again seen, via another institution, because of pain in the left knee, of two months duration. The knee was swollen, tender, and erythematous on the anterolateral aspect. The spleen was not palpable. The temperature was 101.4°.