Bone lesions in chronic granulocytic leukaemia

Area of Science:

• Oncology
• Radiology
• Pathology

Background:

• Chronic granulocytic leukaemia (CGL) typically shows minimal radiographic bone abnormalities during its stable phase.
• Skeletal involvement in CGL is uncommon, making significant bone lesions a rare presentation.

Observation:

• A patient with CGL presented with simultaneous, diverse skeletal lesions in the fibulae, tibiae, pubic bones, femora, and humeri.
• Radiographic findings included symmetrical punched-out and permeative lytic lesions, periosteal reactions, and extensive cloaking of fibulae.
• Multiple osteosclerotic lesions were observed in the pelvic and proximal limb bones, alongside fluctuant, culture-negative soft tissue swellings.

Findings:

• Histological examination revealed fibrosis with hematopoietic tissue, including megakaryocytes, in subcutaneous and lytic lesions.
• Bone marrow biopsy confirmed myelofibrosis with hematopoietic islands, characteristic of CGL without blastic transformation.

Implications:

• This case underscores the potential for varied and severe skeletal manifestations in chronic granulocytic leukaemia, even in stable phases.
• Highlights the importance of considering CGL in the differential diagnosis of complex bone lesions and soft tissue masses.
• Suggests further investigation into the mechanisms underlying CGL-associated skeletal pathology is warranted.