Photo from Nico Gagelmann/X
May 22, 2024, 12:03
Nico Gagelmann: Spotter in hematology. A short thread with some snapshots and diagnosis
Nico Gagelmann, , shared a post on X:
“Spotter in hematology.
A short thread with some snapshots and diagnosis.
- Osteolysis in multiple myeloma.
- myeloma activity sometimes appears as ‘lytic lesions’ (with local disappearance of normal bone due to resorption) or as ‘punched-out lesions’ on the skull X-ray (‘raindrop skull’)
- lesions may also be sclerotic, which is seen as radiodense
2. Mee’s lines coinciding with chemotherapy cycles (R-CHOP for lymphoma)
- also called leukonychia striata
- white lines of discoloration across the nails of the fingers and toes (leukonychia)
- can also occur after poisoning or kidney failure
3. Immune thrombocytopenic purpura
– lesions categorized as:
- Petechiae (small up to 2mm across)
- Ecchymoses or bruises
- Palpable purpura (eg in vasculitis)
- Pigmented (haemorrhages, capillaritis)
– spotted also in DIC, HIT, warfarin-induced necrosis, or vascular disorders
4. Sweet syndrome associated with acute myeloid leukemia
- characterized by the sudden onset of fever, elevated white blood cell count, and papules and plaques
- with dense infiltrates by neutrophil granulocytes on histologic examination
- first described 1964 by Robert D Sweet
- associated with MPNs, chronic myeloid leukemia, hairy cell leukemia, β-thalassaemia major and more
- also in infectious diseases (visceral leishmaniasis, malaria)
- infiltrative conditions (Gaucher disease)
- treat disease, surgery is massive and risky
6. Mediastinal lymphoma
- Hodgkin, aggressive lymphoma incl primary mediastinal B cell lymphoma
- also thymoma, teratoma and thyroid tumors as differential
7. Chronic graft-versus-host disease
- can involve not only epithelial targets as in classic acute GVHD (GI, liver, skin, lungs) but also any other organ system
- incl oral, esophageal, musculoskeletal, joint, fascial, ocular, lymphohematopoietic systems
- hair, nails, genitals
8. Medication-related osteonecrosis of the jaw
- uncommon but severe complication of treatment with osteoclast inhibitors, such as denosumab and bisphosphonates
- be aware in myeloma, bone metastases of other tumors, osteoporosis
9. Hairy kidney in Erdheim-Chester disease
- non–Langerhans-cell histiocytosis
- typically manifested by sclerotic lesions in the long bones
- also with extraosseous findings
- treatment with vemurafenib, inhibitor of mutated BRAF V600E kinase, in patients with mutation
10. Lymphadenopathy
- associated with various hematological malignancies including SLL/CLL, lymphoma and others
- in extensive cases external radiotherapy can be given, treat underlying disease!
11. Hepatic candidiasis
- typically in patients with neutropenia
- multiple hypoattenuating microabscesses
- tiny foci of increased attenuation in some abscesses, helps distinguish from benign liver cysts
- splenic involvement possible
- treat with amphotericin B or echinocandin
12. Gingival hyperplasia in acute leukemia
- extramedullary involvement of leukemia can occur in up to 40%
- only 5% or less of all patients with AML present with gum infiltration
- most often associated with acute (myelo)monocytic leukemia.”
Find images here.
Source: Nico Gagelmann/X
acute leukemia
cancer
Chronic graft-versus-host disease
EBMT
Erdheim Chester disease
European Society for Blood and Marrow Transplantation
Hepatic candidiasis
Immune thrombocytopenic purpura
Lymphadenopathy
Massive splenomegaly
Mediastinal lymphoma
mee's lines
multiple myeloma
Nico Gagelmann
OncoDaily
Oncology
sweet syndrome
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