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Pediatrics
Diagnosis
Musculoskeletal
Focal, Multifocal, and Diffuse Bone Lesions
Leukemia
Leukemia
Christopher G. Anton, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Synonyms

          • Acute lymphocytic (or lymphoblastic) leukemia (ALL), acute myelogenous leukemia (AML), myeloblastoma, chronic myelogenous leukemia (CML), chronic lymphocytic leukemia (CLL), juvenile chronic myeloid leukemia (JCML)

        • Definitions

          • Leukemia: Malignancy of hematopoietic stem cells diffusely infiltrating or replacing normal bone marrow
          • Granulocytic sarcoma or chloroma: Soft tissue mass of leukemic cells typically found with AML
          • Extramedullary sanctuary sites: Sites of leukemia with barriers to systemic therapy (CNS & reproductive organs)

        IMAGING

        • Radiographic Findings

          • CT Findings

            • MR Findings

              • Nuclear Medicine Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Microscopic Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                Selected References

                                1. Inaba H et al: Whole-joint magnetic resonance imaging to assess osteonecrosis in pediatric patients with acute lymphoblastic lymphoma. Pediatr Blood Cancer. 67(8):e28336, 2020
                                2. Smith WT et al: Evaluation of chest radiographs of children with newly diagnosed acute lymphoblastic leukemia. J Pediatr. 223:120-7.e3, 2020
                                3. Chambers G et al: 18F-FDG PET-CT in paediatric oncology: established and emerging applications. Br J Radiol. 92(1094):20180584, 2019
                                4. Pehlivan KC et al: CAR-T cell therapy for acute lymphoblastic leukemia: transforming the treatment of relapsed and refractory disease. Curr Hematol Malig Rep. 13(5):396-406, 2018
                                5. Cunningham I et al: (18) FDG-PET/CT: 21st century approach to leukemic tumors in 124 cases. Am J Hematol. 91(4):379-84, 2016
                                6. Solh M et al: Extramedullary acute myelogenous leukemia. Blood Rev. 30(5):333-9, 2016
                                7. Seth R et al: Leukemias in children. Indian J Pediatr. 82(9):817-24, 2015
                                8. Guillerman RP: Marrow: red, yellow and bad. Pediatr Radiol. 43 Suppl 1:S181-92, 2013
                                9. Yilmaz AF et al: Granulocytic sarcoma: a systematic review. Am J Blood Res. 3(4):265-70, 2013
                                10. Miettunen PM et al: Widespread osteonecrosis in children with leukemia revealed by whole-body MRI. Clin Orthop Relat Res. 470(12):3587-95, 2012
                                11. Seok JH et al: Granulocytic sarcoma of the spine: MRI and clinical review. AJR Am J Roentgenol. 2010 Feb;194(2):485-9. Erratum in: AJR Am J Roentgenol. 194(3):554, 2010
                                12. Aschoff P et al: Integrated FDG-PET/CT for detection, therapy monitoring and follow-up of granulocytic sarcoma. Initial results. Nuklearmedizin. 48(5):185-91, 2009
                                13. Kan JH et al: MRI diagnosis of bone marrow relapse in children with ALL. Pediatr Radiol. 38(1):76-81, 2008
                                14. Merrow AC et al: Leukemia and treatment: imprint on the growing skeleton. Pediatr Radiol. 38(5):594, 2008
                                15. Sinigaglia R et al: Musculoskeletal manifestations in pediatric acute leukemia. J Pediatr Orthop. 28(1):20-8, 2008
                                16. Kato M et al: [Pediatric acute lymphoblastic leukemia initially presenting with bone marrow necrosis.] Rinsho Ketsueki. 48(2):140-3, 2007
                                17. Gassas A et al: A basic classification and a comprehensive examination of pediatric myeloproliferative syndromes. J Pediatr Hematol Oncol. 27(4):192-6, 2005
                                18. Rubnitz JE et al: Death during induction therapy and first remission of acute leukemia in childhood: the St. Jude experience. Cancer. 101(7):1677-84, 2004
                                19. Kuenzle K et al: Detection of extramedullary infiltrates in acute myelogenous leukemia with whole-body positron emission tomography and 2-deoxy-2-[18F]-fluoro-D-glucose. Mol Imaging Biol. 4(2):179-83, 2002
                                20. Gallagher DJ et al: Orthopedic manifestations of acute pediatric leukemia. Orthop Clin North Am. 27(3):635-44, 1996
                                21. Heinrich SD et al: The prognostic significance of the skeletal manifestations of acute lymphoblastic leukemia of childhood. J Pediatr Orthop. 14(1):105-11, 1994
                                22. Meis JM et al: Granulocytic sarcoma in nonleukemic patients. Cancer. 58(12):2697-709, 1986
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Imaging

                                    • Clinical Issues

                                      TERMINOLOGY

                                      • Synonyms

                                        • Acute lymphocytic (or lymphoblastic) leukemia (ALL), acute myelogenous leukemia (AML), myeloblastoma, chronic myelogenous leukemia (CML), chronic lymphocytic leukemia (CLL), juvenile chronic myeloid leukemia (JCML)

                                      • Definitions

                                        • Leukemia: Malignancy of hematopoietic stem cells diffusely infiltrating or replacing normal bone marrow
                                        • Granulocytic sarcoma or chloroma: Soft tissue mass of leukemic cells typically found with AML
                                        • Extramedullary sanctuary sites: Sites of leukemia with barriers to systemic therapy (CNS & reproductive organs)

                                      IMAGING

                                      • Radiographic Findings

                                        • CT Findings

                                          • MR Findings

                                            • Nuclear Medicine Findings

                                              • Imaging Recommendations

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • General Features

                                                    • Microscopic Features

                                                      CLINICAL ISSUES

                                                      • Presentation

                                                        • Demographics

                                                          • Natural History & Prognosis

                                                            • Treatment

                                                              Selected References

                                                              1. Inaba H et al: Whole-joint magnetic resonance imaging to assess osteonecrosis in pediatric patients with acute lymphoblastic lymphoma. Pediatr Blood Cancer. 67(8):e28336, 2020
                                                              2. Smith WT et al: Evaluation of chest radiographs of children with newly diagnosed acute lymphoblastic leukemia. J Pediatr. 223:120-7.e3, 2020
                                                              3. Chambers G et al: 18F-FDG PET-CT in paediatric oncology: established and emerging applications. Br J Radiol. 92(1094):20180584, 2019
                                                              4. Pehlivan KC et al: CAR-T cell therapy for acute lymphoblastic leukemia: transforming the treatment of relapsed and refractory disease. Curr Hematol Malig Rep. 13(5):396-406, 2018
                                                              5. Cunningham I et al: (18) FDG-PET/CT: 21st century approach to leukemic tumors in 124 cases. Am J Hematol. 91(4):379-84, 2016
                                                              6. Solh M et al: Extramedullary acute myelogenous leukemia. Blood Rev. 30(5):333-9, 2016
                                                              7. Seth R et al: Leukemias in children. Indian J Pediatr. 82(9):817-24, 2015
                                                              8. Guillerman RP: Marrow: red, yellow and bad. Pediatr Radiol. 43 Suppl 1:S181-92, 2013
                                                              9. Yilmaz AF et al: Granulocytic sarcoma: a systematic review. Am J Blood Res. 3(4):265-70, 2013
                                                              10. Miettunen PM et al: Widespread osteonecrosis in children with leukemia revealed by whole-body MRI. Clin Orthop Relat Res. 470(12):3587-95, 2012
                                                              11. Seok JH et al: Granulocytic sarcoma of the spine: MRI and clinical review. AJR Am J Roentgenol. 2010 Feb;194(2):485-9. Erratum in: AJR Am J Roentgenol. 194(3):554, 2010
                                                              12. Aschoff P et al: Integrated FDG-PET/CT for detection, therapy monitoring and follow-up of granulocytic sarcoma. Initial results. Nuklearmedizin. 48(5):185-91, 2009
                                                              13. Kan JH et al: MRI diagnosis of bone marrow relapse in children with ALL. Pediatr Radiol. 38(1):76-81, 2008
                                                              14. Merrow AC et al: Leukemia and treatment: imprint on the growing skeleton. Pediatr Radiol. 38(5):594, 2008
                                                              15. Sinigaglia R et al: Musculoskeletal manifestations in pediatric acute leukemia. J Pediatr Orthop. 28(1):20-8, 2008
                                                              16. Kato M et al: [Pediatric acute lymphoblastic leukemia initially presenting with bone marrow necrosis.] Rinsho Ketsueki. 48(2):140-3, 2007
                                                              17. Gassas A et al: A basic classification and a comprehensive examination of pediatric myeloproliferative syndromes. J Pediatr Hematol Oncol. 27(4):192-6, 2005
                                                              18. Rubnitz JE et al: Death during induction therapy and first remission of acute leukemia in childhood: the St. Jude experience. Cancer. 101(7):1677-84, 2004
                                                              19. Kuenzle K et al: Detection of extramedullary infiltrates in acute myelogenous leukemia with whole-body positron emission tomography and 2-deoxy-2-[18F]-fluoro-D-glucose. Mol Imaging Biol. 4(2):179-83, 2002
                                                              20. Gallagher DJ et al: Orthopedic manifestations of acute pediatric leukemia. Orthop Clin North Am. 27(3):635-44, 1996
                                                              21. Heinrich SD et al: The prognostic significance of the skeletal manifestations of acute lymphoblastic leukemia of childhood. J Pediatr Orthop. 14(1):105-11, 1994
                                                              22. Meis JM et al: Granulocytic sarcoma in nonleukemic patients. Cancer. 58(12):2697-709, 1986