July, 2024
July 2024
Nico Gagelmann: Spotter in hematology. A short thread with some snapshots and diagnosis
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.

  1. 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


5. Massive splenomegaly 

  • 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