Seymour P C, Line B R
Department of Radiology, Albany Medical Center, New York 12208, USA.
Clin Nucl Med. 1996 Nov;21(11):844-6. doi: 10.1097/00003072-199611000-00004.
A 69-year-old man with polycythemia vera and myelofibrosis was seen with a 2-week history of increasing arm pain. A bone scan showed diffuse prominence of the long bones, especially in the metaphyseal and epiphyseal regions of the lower extremities. There was relative prominence of the proximal right humerus that suggested the presence of a malignant process in addition to marrow space expansion secondary to myelofibrosis. An MRI of the right upper extremity showed a permeated lesion in the proximal right humerus extending into the adjacent soft tissue with a large soft tissue component. At surgery, a biopsy was followed by placement of a humeral rod. The morphologic features of the tumor together with CD34 positivity were consistent with a granulocytic sarcoma. This is the first reported case of bone scintigraphic findings in advanced p. vera with myelofibrosis and malignant transformation. The case illustrates the scintigraphic appearance of extensive expansion of the marrow and suggests the importance of vigilance for relatively subtle changes of complicating malignancies.
一名69岁患有真性红细胞增多症和骨髓纤维化的男性患者，因手臂疼痛加重两周前来就诊。骨扫描显示长骨弥漫性突出，尤其是下肢的干骺端和骨骺区域。右肱骨近端相对突出，提示除骨髓纤维化继发的骨髓腔扩张外，还存在恶性病变。右上肢MRI显示右肱骨近端有一个浸润性病变，延伸至相邻软组织，伴有较大的软组织成分。手术时，活检后植入了肱骨棒。肿瘤的形态学特征及CD34阳性结果与粒细胞肉瘤一致。这是首例报道的晚期真性红细胞增多症合并骨髓纤维化及恶性转化的骨闪烁显像表现。该病例说明了骨髓广泛扩张的闪烁显像表现，并提示警惕复杂恶性肿瘤相对细微变化的重要性。
