PMC3961366_01
May-Grunwald Giemsa stain of BM aspirates. (A) BM aspiration from the left ilium showing lymphoid hyperplasia with 52.2% blasts. (B) BM aspiration from the anterior left ilium revealing no monoclonal blasts on the basis of morphology and cell surface markers. (C) Subsequent BM aspiration from the posterior left ilium showing infiltration of monotonous blast cells. BM, bone marrow.
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BM aspiration of the anterior left ilium revealed lymphoid hyperplasia with 52.2% blast-like cells (Fig. 1A). Therefore, a second BM aspiration from the posterior left ilium was performed, but no monoclonal blasts were evident on the basis of morphological and cell surface marker analyses (Fig. 1B). Subsequent BM aspiration from the anterior and posterior left ilium revealed infiltration of monotonous blast cells (anterior, 71.6%; posterior, 99.6%) (Fig. 1C).
Radiographic images at the time of relapse. (A) T2-weighted magnetic resonance image of the abdomen and vertebrae. Infiltrative process in the ilium, adjacent soft tissue and multiple vertebral bodies are indicated. (B) 18F-fluorodeoxyglucose positron emission tomography showing hypermetabolic foci in the left ilium, the epiphysis of the left humerus, the proximal end of the right tibia and multiple vertebral bodies corresponding to areas of marrow infiltration.
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Magnetic resonance imaging (MRI) revealed infiltrative processes in the ilium, the adjacent soft tissue and multiple vertebral bodies (Fig. 2A). Whole-body positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) revealed hypermetabolic foci in the left ilium, the epiphysis of the left humerus, the proximal end of the right tibia and multiple vertebral bodies corresponding to the areas of marrow infiltration visualized on MRI (Fig. 2B).