Download PDF
CC BY 4.0 · World J Nucl Med
DOI: 10.1055/s-0044-1800837
Case Report

A Case Report of Neuroleukemiosis Detected on FDG PET Scan in a Patient of Mixed Phenotype Acute Leukemia Post Bone Marrow Transplantation in Remission

Ramya Soundararajan
1   Department of Nuclear Medicine, Army Hosp Research and Referral, New Delhi, India
,
Archana Yadav
1   Department of Nuclear Medicine, Army Hosp Research and Referral, New Delhi, India
,
Anil Kumar AVS
1   Department of Nuclear Medicine, Army Hosp Research and Referral, New Delhi, India
,
Hemlata Jangir
2   Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Neuroleukemiosis, an exceedingly rare manifestation of leukemia, is defined as peripheral nerve infiltration by leukemic cells. The typical clinical presentation is with peripheral neuropathy and/or chloromatous masses. The diagnosis of this condition is quite challenging, as symptoms usually appear in patients during remission and there are no other signs of relapse. The diagnosis is supported with electrophysiologic testing and imaging and finally established with histopathology and immunophenotyping. We present a case of multineuritis in a patient with mixed phenotype acute leukemia during remission post allogeneic hematopoietic stem cell transplant, where inflamed thickened nerves were detected on positron emission tomography/computed tomography imaging with fluorine-18 fluorodeoxyglucose. A diagnosis of neuroleukemiosis was established via biopsy and immunophenotyping. The literature is reviewed regarding this interesting and rare clinical condition.

Keywords

18F-FDG PET/CT - peripheral nerve - acute leukemia - extramedullary - neuroleukemiosis

Authors' Contributions

R.S. contributed to the preparation of the report. A.Y. contributed to the preparation of the case report and diagnosing. A.K.A.V.S. contributed to diagnosing the case, conceiving the idea, and preparation of the report. H.J. contributed to the biopsy and preparation of the case report.




Publication History

Article published online:
05 December 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/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Aregawi DG, Sherman JH, Douvas MG, Burns TM, Schiff D. Neuroleukemiosis: case report of leukemic nerve infiltration in acute lymphoblastic leukemia. Muscle Nerve 2008; 38 (03) 1196-1200
    CrossrefPubMedSearch in Google Scholar
  • 2 van den Ancker W, Terwijn M, Westers TM. et al. Acute leukemias of ambiguous lineage: diagnostic consequences of the WHO2008 classification. Leukemia 2010; 24 (07) 1392-1396
    CrossrefPubMedSearch in Google Scholar
  • 3 Mau C, Ghali MGZ, Styler M, Malysz J, Specht CS, Rizk E. Neuroleukemiosis: diagnosis and management. Clin Neurol Neurosurg 2019; 184: 105340
    CrossrefPubMedSearch in Google Scholar
  • 4 Esteller Gauxax D, Doncel-Moriano Cubero A, Claro Brandner M. et al. Neuropatía múltiple como manifestación clínica de una recidiva de leucemia. Rev Neurol 2022; 75 (04) 93
    CrossrefPubMedSearch in Google Scholar
  • 5 Reddy CG, Mauermann ML, Solomon BM. et al. Neuroleukemiosis: an unusual cause of peripheral neuropathy. Leuk Lymphoma 2012; 53 (12) 2405-2411
    CrossrefPubMedSearch in Google Scholar
  • 6 Poikayil RJ, Narayanan G, Sugathan H, Soman LV. Mixed Phenotypic Acute Leukemia with Leukemia Cutis and Neuroleukemiosis. Baylor University Medical Center Proceedings 2017; 30 (3) 334-335
    CrossrefPubMedSearch in Google Scholar
  • 7 Harris AC, Kitko CL, Couriel DR. et al. Extramedullary relapse of acute myeloid leukemia following allogeneic hematopoietic stem cell transplantation: incidence, risk factors and outcomes. Haematologica 2013; 98 (02) 179-184
    CrossrefPubMedSearch in Google Scholar
  • 8 Voin V, Khalid S, Shrager S. et al. Neuroleukemiosis: two case reports. Cureus 2017; 9 (07) e1529
    PubMedSearch in Google Scholar
  • 9 Wang T, Miao Y, Meng Y, Li A. Isolated leukemic infiltration of peripheral nervous system. Muscle Nerve 2015; 51 (02) 290-293
    CrossrefPubMedSearch in Google Scholar
  • 10 Kraus PD, Wolff D, Grauer O. et al. Muscle cramps and neuropathies in patients with allogeneic hematopoietic stem cell transplantation and graft-versus-host disease. PLoS One 2012; 7 (09) e44922
    CrossrefPubMedSearch in Google Scholar
  • 11 Sabaté-Llobera A, Cortés-Romera M, Gamundí-Grimalt E, Sánchez-Fernández JJ, Rodríguez-Bel L, Gámez-Cenzano C. Diagnosing neuroleukemiosis: is there a role for 18F-FDG-PET/CT?. Rev Esp Med Nucl Imagen Mol 2017; 36 (06) 396-398
    PubMedSearch in Google Scholar
  • 12 Beaulieu S, Rubin B, Djang D, Conrad E, Turcotte E, Eary JF. Positron emission tomography of schwannomas: emphasizing its potential in preoperative planning. AJR Am J Roentgenol 2004; 182 (04) 971-974
    CrossrefPubMedSearch in Google Scholar
  • 13 Ng KS, Leung JMS. Vincristine-induced polyneuropathy at FDG PET/CT. Radiology 2019; 293 (01) 36-36
    CrossrefPubMedSearch in Google Scholar
  • 14 Yoon D, Xu Y, Cipriano PW. et al. Neurovascular, muscle, and skin changes on [18F]FDG PET/MRI in complex regional pain syndrome of the foot: a prospective clinical study. Pain Med 2022; 23 (02) 339-346
    CrossrefPubMedSearch in Google Scholar
  • 15 Xie X, Cheng B, Han X, Liu B. Findings of multiple neuritis on FDG PET/CT imaging. Clin Nucl Med 2013; 38 (01) 67-69
    CrossrefPubMedSearch in Google Scholar
  • 16 Bertagna F, Giubbini R, Biasiotto G, Rosenbaum J, Alavi A. Incidental inflammatory findings in nerves and in patients with neoplastic diseases evaluated by 18F-FDG-PET/CT. Hell J Nucl Med 2009; 12 (03) 279-280
    PubMedSearch in Google Scholar
  • 17 Cipriano PW, Yoon D, Gandhi H. et al. 18F-FDG PET/MRI in chronic sciatica: early results revealing spinal and nonspinal abnormalities. J Nucl Med 2018; 59 (06) 967-972
    CrossrefPubMedSearch in Google Scholar
  • 18 Cheng G, Chamroonrat W, Bing Z, Huang S, Zhuang H. Elevated FDG activity in the spinal cord and the sciatic nerves due to neuropathy. Clin Nucl Med 2009; 34 (12) 950-951
    CrossrefPubMedSearch in Google Scholar
  • 19 Kiyoki Y, Matsuoka R, Kaneta T, Nishikii H. 18FDG-PET imaging and histopathology in neuroleukemiosis with acute myeloid leukemia. Int J Hematol 2020; 112 (04) 433-434
    CrossrefPubMedSearch in Google Scholar