Intramuscular Leukemic Relapse: Clinical Signs and Imaging Findings. A Multicentric Analysis

Overview

Journal Skeletal Radiol

Specialties Orthopedics
Radiology

Date 2014 Sep 27

PMID 25256752

Citations 1

Authors

Alexey Surov

Hayyam Kiratli

Soo Ah Im

Yasuhiro Manabe

Alibhe ONeill

Atul B Shinagare

Rolf Peter Spielmann

Affiliations

Soon will be listed here.

Abstract

Objective: Leukemia is a group of malignant diseases involving peripheral blood and bone marrow. Extramedullary tumor manifestation in leukemia can also occur. They more often involve lymph nodes, skin, and bones. Intramuscular leukemic relapse (ILR) is very unusual. The aim of this analysis was to summarize the reported data regarding clinical signs and radiological features of ILR.

Material And Methods: The PubMed database was searched for publications related to ILR. After an analysis of all identified articles, 20 publications matched the inclusion criteria. The authors of the 20 publications were contacted and provided imaging of their cases for review. The following were recorded: age, gender, primary diagnosis, clinical signs, pattern, localization and size of the intramuscular leukemic relapse. Images of 16 patients were provided [8 computer tomographic (CT) images and 15 magnetic resonance images, MRI]. Furthermore, one patient with ILR was identified in our institutional database. Therefore, images of 17 patients were available for further analysis.

Results: Overall, 32 cases with ILR were included in the analysis. In most cases acute myeloid leukemia was diagnosed. Most ILRs were localized in the extremities (44 %) and in the extraocular muscles (44 %). Clinically, ILR manifested as local pain, swelling and muscle weakness. Radiologically, ILR presented most frequently with diffuse muscle infiltration. On postcontrast CT/MRI, most lesions demonstrated homogeneous enhancement. ILRs were hypo-/isointense on T1w and hyperintense on T2w images.

Conclusion: ILR manifests commonly as focal pain, swelling and muscle weakness. ILR predominantly involved the extraocular musculature and the extremities. Radiologically, diffuse muscle infiltration was the most common imaging finding.

Citing Articles

Infiltrative pattern of carcinomatosis in extremity muscles on MRI.

Soliman F, Hwang S, Landa J, Lefkowitz R, Panicek D Clin Imaging. 2016; 40(3):451-5.

PMID: 27133685 PMC: 4853653. DOI: 10.1016/j.clinimag.2015.12.012.

References

Ahn J, Cho S, Kim Y, Yang D, Bae W, Shim H . Polymyositis and myocarditis after donor lymphocyte infusion. Int J Hematol. 2009; 90(1):113-116. DOI: 10.1007/s12185-009-0332-3. View

Okamoto K, Hirai S, Honma M . Extensive leukemic cell infiltration into skeletal muscles. Muscle Nerve. 1996; 19(8):1052-4. DOI: 10.1002/(SICI)1097-4598(199608)19:8<1052::AID-MUS15>3.0.CO;2-Z. View

Chen E, Morrison D, Donahue S . Acute myeloid leukemia presenting as bilateral proptosis from diffuse extraocular muscle infiltration. Am J Ophthalmol. 2004; 137(5):948-50. DOI: 10.1016/j.ajo.2003.10.050. View

Talbert R, Laor T, Yin H . Proliferative myositis: expanding the differential diagnosis of a soft tissue mass in infancy. Skeletal Radiol. 2011; 40(12):1623-7. DOI: 10.1007/s00256-011-1274-4. View

Nugent R, BELKIN R, Neigel J, Rootman J, Robertson W, Spinelli J . Graves orbitopathy: correlation of CT and clinical findings. Radiology. 1990; 177(3):675-82. DOI: 10.1148/radiology.177.3.2243967. View

Fritz J, Vogel W, Claussen C, Wehrmann M, Pereira P, Horger M . Generalized intramuscular granulocytic sarcoma mimicking polymyositis. Skeletal Radiol. 2007; 36(10):985-9. DOI: 10.1007/s00256-007-0314-6. View

Vardiman J, Thiele J, Arber D, Brunning R, Borowitz M, Porwit A . The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood. 2009; 114(5):937-51. DOI: 10.1182/blood-2009-03-209262. View

Shinagare A, Krajewski K, Hornick J, Zukotynski K, Kurra V, Jagannathan J . MRI for evaluation of myeloid sarcoma in adults: a single-institution 10-year experience. AJR Am J Roentgenol. 2012; 199(6):1193-8. DOI: 10.2214/AJR.12.9057. View

Yun D, Im S, Cho B, Park G . Necrotic intramuscular chloroma with infection: magnetic resonance imaging features. Jpn J Radiol. 2011; 29(10):735-8. DOI: 10.1007/s11604-011-0623-5. View

10.

Jost E, Lorenzen J, Haage P, Bos G, Beelen D, Galm O . Heart and muscle involvement by extra-medullary myeloid leukemia: a case report and review of the literature. Leuk Lymphoma. 2005; 46(12):1819-24. DOI: 10.1080/10428190500233830. View

11.

Surov A, Kohler J, Wienke A, Gufler H, Bach A, Schramm D . Muscle metastases: comparison of features in different primary tumours. Cancer Imaging. 2015; 14:21. PMC: 4331826. DOI: 10.1186/1470-7330-14-21. View

12.

Manabe Y, Hamakawa Y, Sunami K, Ohta Y, Omori N, Abe K . Granulocytic sarcoma with orbit, cauda equina, muscle and peripheral nerve extension but without bone marrow involvement. Intern Med. 2007; 46(9):633-5. DOI: 10.2169/internalmedicine.46.6127. View

13.

Papageorgiou A, Tzioufas A, Voulgarelis M . B-cell chronic lymphocytic leukaemia presenting as lower motor neuron disease and SS. Rheumatology (Oxford). 2012; 51(7):1338-40. DOI: 10.1093/rheumatology/kes017. View

14.

Bassichis B, McClay J, Wiatrak B . Chloroma of the masseteric muscle. Int J Pediatr Otorhinolaryngol. 2000; 53(1):57-61. DOI: 10.1016/s0165-5876(00)00301-3. View

15.

Hinkle A, Dinndorf P, Bulas D, Kapur S . Relapse of acute lymphoblastic leukemia in the inferior rectus muscle of the eye. Cancer. 1994; 73(6):1757-60. DOI: 10.1002/1097-0142(19940315)73:6<1757::aid-cncr2820730634>3.0.co;2-m. View

16.

Taverna C, Vogt P, Pestalozzi B . Uncommon sites of presentation of hematologic malignancies. Case 2: diffuse muscle infiltration by granulocytic sarcoma seven years after acute myelomonocytic leukemia. J Clin Oncol. 1999; 17(5):1642-3. View

17.

Chun C, Jee W, Park H, Kim Y, Park J, Lee S . MRI features of skeletal muscle lymphoma. AJR Am J Roentgenol. 2010; 195(6):1355-60. DOI: 10.2214/AJR.09.3904. View

18.

van der Vliet H, Roberson A, Hogan M, Morales C, Crader S, Letendre L . All-trans-retinoic acid-induced myositis: a description of two patients. Am J Hematol. 2000; 63(2):94-8. DOI: 10.1002/(sici)1096-8652(200002)63:2<94::aid-ajh7>3.0.co;2-h. View

19.

Ple-Plakon P, Demirci H, Cheng J, Elner V . Orbital myeloid sarcoma in an adult with acute myeloid leukemia, FAB M1, and 12p-deletion. Ophthalmic Plast Reconstr Surg. 2013; 29(3):e73-5. DOI: 10.1097/IOP.0b013e318272d497. View

20.

Chen M, Yang S, Yao T, Chong P, Chen S . Bilateral hip pain caused by adductor pyomyositis as the initial presentation of chronic myeloid leukemia in a 17-year-old child. Pediatr Neonatol. 2011; 52(6):353-7. DOI: 10.1016/j.pedneo.2011.08.010. View