18 FDG-PET imaging and histopathology in neuroleukemiosis with acute myeloid leukemia
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IMAGES IN HEMATOLOGY
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FDG‑PET imaging and histopathology in neuroleukemiosis with acute myeloid leukemia
Yusuke Kiyoki1 · Ryota Matsuoka2 · Tomohiro Kaneta3 · Hidekazu Nishikii1 Received: 27 April 2020 / Revised: 24 July 2020 / Accepted: 20 August 2020 © Japanese Society of Hematology 2020
A 30-year old man demonstrated myeloblastosis in the peripheral blood and massive infiltration of leukemic blasts in the bone marrow. The myeloblasts showed C D7− CD11b+ − + − + CD14 CD33 CD34 CD56 by flow cytometry, and positive peroxidase and negative esterase stainings. Cytogenetic analysis revealed a complex karyotype. He was diagnosed as acute myeloid leukemia, without maturation (FAB classification: AML-M1). Remission induction chemotherapy with idarubicin and cytarabine resulted in hematologic complete remission. However, meningeal infiltration of leukemic cells developed after 2 cycles of consolidation chemotherapy. Salvage chemotherapy together with intrathecal chemotherapy was administered, and leukemic cells in cerebrospinal fluid disappeared. Nonetheless, the patient complained severe peripheral neuralgia. No leukemic cells were detected in
the bone marrow. An electrophysiologic test revealed the delayed nerve conduction in the peripheral nerves. There were no significant abnormalities in brain MRI. Notably, 18 FDG-PET images demonstrated accumulations of 18FDG in multiple peripheral nerves (Fig. 1a). He eventually died due to disease progression. Autopsy revealed apparent infiltration of leukemic cells into the peripheral nerve roots, in which 18FDG accumulation was evident (Fig. 1b–d). Neuroleukemiosis is a rare complication of myeloid malignancies, in that tumor cells infiltrate into the peripheral nervous system. While there is no consensus on the usefulness of 18FDG-PET for the diagnosis of neuroleukemiosis, the peculiar pattern of 18FDG accumulation was helpful for the diagnosis in the current case.
* Hidekazu Nishikii [email protected] 1
Department of Hematology, Faculty of Medicine, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki 305‑8575, Japan
2
Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
3
Department of Advanced Molecular Imaging, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Fig. 1 a The images of 18FDG-PET (left) and PET-CT (right). Arrow, abnormal accumulation of FDG in peripheral nerves. b–d Hematoxylin–Eosin (b), CD56 (c), and S100 (d) staining of femoral nerve with
an autopsy specimen [original magnification, × 40 (left) and × 200 (right)]. Massive infiltration of CD56 positive leukemic cells into S100 positive neural structure was observed
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Conflict of interest The authors declare that they have no conflict of interest. Informed consent The authors collected the patient’s informed co
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