Acrophyseal growth arrest in a long-term survivor of acute lymphoblastic leukemia
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CASE REPORT
Acrophyseal growth arrest in a long-term survivor of acute lymphoblastic leukemia Jacky de Rooy 1 & Stan Buckens 1 & Paul M. Brons 2 & Ingrid van der Geest 3 & Filip Vanhoenacker 4 Received: 20 April 2020 / Revised: 7 June 2020 / Accepted: 9 June 2020 # The Author(s) 2020
Abstract Growth arrest at the secondary growth plate, also known as the acrophysis, is a rare phenomenon with only very few known published case reports. We report on a case of formation of ghost secondary ossification centers at the acrophyses of the knee joint in a 14-year-old female, who survived early childhood acute lymphoblastic leukemia. The patient suffered from severe side effects from both disease and subsequent treatment strategies with a 10-month immobilization period as a consequence at the age of 3 years. The ghost secondary ossification centers were encountered on radiographs and MRI 10 years later, when she presented for evaluation of chronic pain in her left knee related to sports activities, due to a meniscal cyst. Awareness of this phenomenon is nevertheless important, because it seems that endochondral bone growth recovery at the acrophyses might be different from recovery in physes, because we found no concomitant sequelae of growth arrest in the metaphyses. Keywords Acrophysis . Growth arrest lines . Endochondral ossification . Secondary ossification center
Introduction Over the years, the curability of acute lymphoblastic leukemia (ALL) in children has improved to ~ 90% due to intensive therapy strategies [1]. These treatment strategies, consisting of multi-agent osteotoxic chemotherapy including also high doses of glucocorticosteroids, as well as low vitamin D levels, poor nutrition and low muscle mass, and the ALL itself, however, may all contribute to secondary, multifactorial impairment or even arrest of bone growth and significant bone morbidity [2]. Both acute and chronic skeletal abnormalities such as osteoporosis, insufficiency fractures, and osteonecrosis are
* Jacky de Rooy [email protected] 1
Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
2
Department of Pediatric Oncology, Amalia Childrens Hospital of the Radboud University Medical Centre, Nijmegen, Netherlands
3
Department of Orthopedic Oncologic Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
4
Department of Radiology, General Hospital Sint-Maarten, Mechelen, Universities of Antwerp and Ghent, Antwerp, Belgium
among the most prevalent adverse sequelae, occurring during or shortly after finishing ALL treatment [3, 4]. Normally, altered temporal impairment of bone growth, whether caused by general illness, treatment, or local trauma, becomes evident as Harris growth arrest lines on radiographs, paralleling the epiphyseal growth plate in the proximal and distal metaphyses and diaphyses of rapid growing long bones [5]. These lines reflect a slowdown in normal endochondral ossification resulting in dense, more transversely oriented bony trabeculae [6, 7]. E
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