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The tumor formation may be the earliest manifestation preceeding other symptoms, signs and bone marrow evidence of systemic malignancy - leukemia/lymphoma. Here we present three cases of systemic malignancy in which bone lesions were the first manifested signs of the disease. All three cases were thought to be orthopedic cases and had been treated...
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... 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 Hypercalcaemia and osteolytic lesions are rare in B-ALL in contrast to their incidence in some other lymphoid malignancies like adult T-cell leukaemia/ lymphoma, myeloma and LCH. [2][3][4] However, in our case, due to the patient's young age, myeloma was ruled out. Owing to lytic bone lesions the most likely diagnosis was LCH (eosinophilic granuloma), but bone marrow aspiration revealed the presence of blasts which on immunophenotyping by flowcytometry indicated B-ALL. ...
... Hypercalcemia in such cases is due to TNF (alpha and beta ), IL-2, IL-6, TGF beta, 1-25(OH)2 and direct invasion by the tumor cells or due to PTHrP and PGE2 secretion by the tumor cells. [4][5][6][7] Our patient presented with multiple osteolytic lesions with hypercalcaemia and a normal total leucocyte count without any blasts in peripheral blood. It is not uncommon to find osteolytic lesions without circulating blasts in peripheral blood in patients of ALL (box 1). ...
A 13-year-old boy presented with fever, skeletal pain, polydipsia, polyuria and multiple osteolytic lesions in pelvic bones and upper femur. There was no organomegaly or lymphadenopathy. His serum calcium levels were raised. Peripheral blood film examination was normal. Bone marrow showed presence of blast cells. Flowcytometry indicated B-acute lymphoblastic leukaemia (B-ALL). Hypercalcaemia and osteolytic lesions are rare presentations of B-ALL. This should be kept as a differential if a child presents with unexplained skeletal pain with lytic lesions.
... [1] Though lytic bone lesions are well documented in acute lymphatic leukemia and lymphomas, they are extremely rare in nonlymphoid malignancies. [2,3] Extramedullary involvement by acute leukemia is a relatively rare but clinically significant phenomenon that often poses diagnostic and therapeutic dilemmas. [4] Extramedullary disease (EMD) in APL is particularly rare, and nowhere in literature multiple extensive osteolytic lesions at initial presentation have been described. ...
Acute promyelocytic leukemia (APL) is an uncommon malignancy in the pediatric population, accounting for only 5-10% of pediatric acute myeloid leukemias, and for this disease to present with bone lesions at diagnosis is extremely unusual. We wish to convey that very rarely, in a pediatric cancer patient presenting with multiple extensive lytic bone lesions, the diagnosis can be APL. The treatment protocol and prognostic implications are vastly different. Histopathology is the gold standard in arriving at a correct diagnosis and delivering proper treatment in such cases. This patient had excellent response to chemotherapy.
... Other common presentations include symptoms involving the appendicular skeleton, including unexplained extremity pain, arthralgias, new-onset limping, or refusal to walk. This presentation of ALL occurs in approximately 1/2 of pediatric patients and generally is attributable to leukemic infiltration of appendicular bone, periosteum, marrow spaces, and/or joints [13,15]. Compressive CNS symptoms or axial skeleton involvement at the time of ALL diagnosis is uncommon in children and adults, with a reported prevalence of 3% to 7% [2,9]. ...
A middle-aged male patient presented with fever, polyarthralgia, polyuria, easy fatigability and weight loss for 1 month. Clinically, there was only significant pallor and a swelling over the right sternoclavicular joint. On investigation, there was anaemia, raised urea, creatinine and pus cells in urine with growth of Escherichia coli. There were also hypercalcaemia and osteolytic lesions over the ribs, scapula, clavicle and skull along with distorted renal corticomedullary differentiation. Although the initial diagnosis was likely to be a case of multiple myeloma, serum protein electrophoresis was negative for the monoclonal band and no Bence-Jones protein was detected in urine. Bone marrow plasma cells were less than 10%, but the serum-free light chain assay revealed altered κ:λ ratio. Later in the course of the disease, a cervical lymph node appeared. The biopsy and immunohistochemistry of this lymph node revealed a CD5 positive diffuse large B-cell lymphoma, but unfortunately the patient succumbed to his illness after receiving the first cycle of Rituximab-Cyclophosphamide-Hydroxydoxorubicin-Oncovin-Prednisolone.
