PMC2811304_01
Scanning findings for bones. (A) Disseminated hypermetabolic lesion (maxSUV=9.0, L2 body) at the whole spine by PET. A hypermetabolic lesion suggesting a primary malignant lesion was not detected in the lung, intraabdominal and pelvic organs. (B) No increased bone uptake of hypermetabolic lesions on bone scan, with little osteoblastic effect.
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F1
Although fusion whole body positron emission tomography (PET) showed lesions indicative of multiple bone metastases (Fig. 1A), a bone scan showed little osteoblastic reaction (Fig. 1B).
Diffuse and heterogeneous T1 and T2 showing low SI changes in the lower thoracic and lumbar spine with subtle enhancement.
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F2
Because there was no evidence of malignancy on chest, abdominal and pelvic CT and prostate ultrasonography, we performed lumbar spine magnetic resonance imaging (MRI) (Fig. 2).
Histopathological findings of bone marrow biopsy. (A) Non-cohesive proliferation of large pleomorphic neoplastic cells with large round-to-oval nuclei with vesicular chromatin and abundant foamy cytoplasm (H&E stain, x400). Immunostaining with antibodies to (B) CD99, (C) CD68, (D) CD56, (E) HMB45 (each, x100) and (F) S100 (x200).
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F3
The BM biopsy, however, revealed a diffuse non-cohesive proliferation of pleomorphic neoplastic cells with large round to oval nuclei, vesicular chromatin and abundant foamy eosinophilic cytoplasm (Fig. 3).