Pathology (1990); 22, pp. 124-125

LETTER TO THE EDITOR

OSTEOLYTIC SKELETAL LESIONS IN CHRONIC MYELOID LEUKEMIA Skeletal lesions are uncommonly described in the chronic phase of chronic myeloid leukemia (CML). In a recent autopsy study of 204 cases of CML, no skeletal lesions were found.’ However, osteolytic lesions have been described during blastic transformation.’ A 22 year old male patient with Philadelphia chromosome positive CML in chronic phase treated with hydroxyurea for 4 years was seen with right hip and shoulder pain. A blood count showed normal white cell count without blasts. A skeletal survey showed osteolytic lesions in both hips, right shoulder and 1Ith and 12th thoracic vertebrae. Bone marrow biopsy showed hypocellular marrow with increase in reticulin fibres but no increase in blasts. He subsequently developed severe gastrointestinal bleeding from a duodenal ulcer. Endoscopic laser therapy failed to control his bleeding and he died despite vigorous transfusion and resuscitation. At post-mortem examination, with reference to the bony lesions, the lower thoracic, the whole lumbar vertebrae and the right femur were examined. The right femur showed multiple osteolytic lesions in the head, greater trochanter and metaphysis (Fig. 1). Osteosclerotic areas were present adjacent to the lytic ones. The other skeletal lesions showed similar findings. Microscopic examination of the lesions revealed focal loss of bony trabeculae and myelofibrosis with dense collagen and reticulin fibres. Eosinophils were prominent among the residual hemopoietic tissue, with numerous macrophages having engulfed abundant CharcotLeyden crystals seen (Fig. 2). No myeloid hyperplasia or increase in blasts were found.

Fig. 1 The right femoral head showing multiple osteolytic lesions partly bordered by osteosclerotic areas ( x 1).

Fig. In the osteolytic areas, many macrophages packed full of Charcot-Leyden crystals are noted (H & E~ 750).

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Pathology (1990).22, April

Our patient showed several interesting findings. The osteolytic lesions were areas of myelofibrosis instead of excessive myeloid proliferation as previously reported. Another interesting finding is the presence of macrophages with multiple Charcot-Leyden crystals, which were probably derived from rapid turnover of eosinophils in the bone marrow, a phenomenon akin to “Gaucher-like” cells found in the marrow of CML due to abnormal accumulation of membrane lipids in macrophages as a result of rapid turnover of granulocytes. In the differential diagnosis of osteolytic lesions in CML, acceleration or blastic transformation are usually considered. We have shown that myelofibrosis can be another possibility. Presence of CharcotLeyden crystal-laden macrophages in such lesions is described for the first time.

Y.L. Kwong Irene O.L. Ng S.Y. Leung Department of Pathology, University of Hong Kong, Queen Mary Hospital, Hong Kong

References

1. Barcos M, Lane W, Gomez GA, et al. An autopsy study of 1206

acute and chronic leukemias (1958-1982). Cancer 1987; 60: 827-37.

2. Valimaki M, Vuopio P, Liewendahl K . Bone lesions in chronic myelogenous leukemia. Acta Med Scand 1981; 210: 403-8.

Osteolytic skeletal lesions in chronic myeloid leukemia.

Pathology (1990); 22, pp. 124-125 LETTER TO THE EDITOR OSTEOLYTIC SKELETAL LESIONS IN CHRONIC MYELOID LEUKEMIA Skeletal lesions are uncommonly descr...
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