Ishitsuka Kantaro, Obara Naoshi, Suyama Takuya, Matsuoka Ryota, Maruyama Yumiko, Sakamoto Tatsuhiro, Kusakabe Manabu, Kato Takayasu, Kurita Naoki, Nishikii Hidekazu, Yokoyama Yasuhisa, Sakata-Yanagimoto Mamiko, Hasegawa Yuichi, Shinagawa Atsushi, Chiba Shigeru
Department of Hematology, University of Tsukuba Hospital.
Department of Hematology, Faculty of Medicine, University of Tsukuba.
Rinsho Ketsueki. 2020;61(5):462-467. doi: 10.11406/rinketsu.61.462.
A 46-year-old man who had previously undergone open surgery for renal cell carcinoma (RCC) developed Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-ALL). After the induction therapy, he achieved complete molecular remission. However, fever and bilateral buttock pain continued during the consolidation therapy. 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) showed FDG accumulation in both iliac bones and in the sacrum; however, no causative diseases, including relapse of Ph-ALL and RCC, were detected. Iliac bone marrow biopsy revealed bone marrow necrosis (BMN), the etiology of which was presumed to be the leukemia itself and the therapeutic response to chemotherapy. Fever resolution and buttock pain alleviation were observed over the next months. We observed diffuse fibrosis in the bone marrow at day 162 and day 364 after cord blood transplantation. Moreover, the FDG accumulation was significantly reduced on PET-CT. BMN is not widely recognized despite its potential association with hematologic malignancies. Additional cases of BMN should be reviewed to clarify BMN etiology and clinical features.
一名46岁男性曾因肾细胞癌（RCC）接受开放手术，后发生费城染色体阳性急性淋巴细胞白血病（Ph-ALL）。诱导治疗后，他实现了完全分子缓解。然而，巩固治疗期间持续发热和双侧臀部疼痛。18F-氟脱氧葡萄糖（FDG）正电子发射断层扫描-计算机断层扫描（PET-CT）显示双侧髂骨和骶骨有FDG积聚；然而，未检测到包括Ph-ALL和RCC复发在内的病因性疾病。髂骨骨髓活检显示骨髓坏死（BMN），其病因推测为白血病本身及化疗的治疗反应。在接下来的几个月里观察到发热消退和臀部疼痛缓解。在脐血移植后第162天和第364天，我们观察到骨髓弥漫性纤维化。此外，PET-CT上的FDG积聚明显减少。尽管BMN可能与血液系统恶性肿瘤有关，但尚未得到广泛认识。应审查更多BMN病例以阐明其病因和临床特征。
