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CC BY 4.0 · World J Nucl Med 2024; 23(01): 049-053
DOI: 10.1055/s-0044-1779280
Case Report

Role of 18F-FDG-PET/CT in an AML-M5a Subtype Patient with Rare Constellation of Hemophagocytic Lymphohistiocytosis & Bilateral Multiple Breast Chloromas

Yuvan Shrinivas
1   Amrita School of Medicine, Amrita Vishwa Vidyapeetham University, Cochin, Kerala, India
2   Department of Radiodiagnosis, GITAM Institute of Medical Sciences And Research (deemed to be university), Visakhapatnam, Andhra Pradesh, India
,
Shanmuga Sundaram Palaniswamy
3   Department of Nuclear Medicine & Molecular Imaging, Amrita Institute of Medical Sciences & Research Centre, Cochin, Kerala, India
,
Padma Subramanyam 
3   Department of Nuclear Medicine & Molecular Imaging, Amrita Institute of Medical Sciences & Research Centre, Cochin, Kerala, India
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Abstract

We report a treated case of acute myeloid leukemia (AML-M5a subtype) with monocytic differentiation (AMoL) presenting with fever and body pains. Initial 18F-FDG-PET/CT (18F-flurodeoxyglucose positron emission tomography/computed tomography) identified multiple lymph nodal, and marrow lesions. Biopsy confirmed hemophagocytic lymphohistiocytosis (HLH). Post HLH treatment, follow-up PET/CT demonstrated unsuspected FDG avid bilateral breast lesions (n = 5), which proved to be chloromas, that is, extranodal manifestation of AML. 18F-FDG-PET/CT has helped not only in identifying the various sites of disease involvement but also in guiding the sites for biopsy. Finally, 18F-FDG-PET/CT was useful in monitoring therapy response for both these coexisting pathologies, which are said to be resistant to treatment based on FLT3-ITD tyrosine kinase-3 internal tandem duplication mutation positivity and high-grade AML status. This case represents a rare constellation of different etiologies that needed to be differentiated. It also emphasizes the challenges in interpreting PET/CT findings, especially in difficult clinical scenarios. Disease distribution in HLH/presence of chloromas, etc., can mimic stage IV lymphoma in a known case of AML. So the nuclear medicine physician should be aware of the different complications in the background of AML, especially in patients with poor prognostic factors.

Keywords

AML - hemophagocytic lymphohistiocytosis - fever - whole-body 18F-FDG-PET/CT - chloromas - breast


Publication History

Article published online:
13 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Schnittger S, Schoch C, Kern W, Hiddemann W, Haferlach T. FLT3 length mutations as marker for follow-up studies in acute myeloid leukaemia. Acta Haematol 2004; 112 (1–2): 68-78
    CrossrefPubMedGoogle Scholar
  • 2 Scott RB, Robb-Smith AHT. Histiocytic medullary reticulosis. The Lancet 1939; 194
    CrossrefGoogle Scholar
  • 3 Ramos-Casals M, Brito-Zerón P, López-Guillermo A, Khamashta MA, Bosch X. Adult haemophagocytic syndrome. Lancet 2014; 383 (9927) 1503-1516
    CrossrefPubMedGoogle Scholar
  • 4 Salvati L, Di Renzo A, Moscardelli S, Natali L, Claudio F, Viscido A. Secondary hemophagocytic lymphohistiocytosis: a case report. Acta Biomed 2021; 92 (S1): e2021060
    PubMedGoogle Scholar
  • 5 Neiman RS, Barcos M, Berard C. et al. Granulocytic sarcoma: a clinicopathologic study of 61 biopsied cases. Cancer 1981; 48 (06) 1426-1437
    CrossrefPubMedGoogle Scholar
  • 6 Burns A. Observations of Surgical Anatomy in Head and Neck. Edinburg: Thomas Royce; 1811: 364-366
    Google Scholar
  • 7 Huang XE, Li YJ, Zhou XD. Granulocytic sarcoma of the breast: a case report. Oncol Lett 2015; 10 (04) 2447-2449
    CrossrefPubMedGoogle Scholar
  • 8 Valbuena JR, Admirand JH, Gualco G, Medeiros LJ. Myeloid sarcoma involving the breast. Arch Pathol Lab Med 2005; 129 (01) 32-38
    CrossrefPubMedGoogle Scholar
  • 9 Paydas S, Zorludemir S, Ergin M. Granulocytic sarcoma: 32 cases and review of the literature. Leuk Lymphoma 2006; 47 (12) 2527-2541
    CrossrefPubMedGoogle Scholar