The Risk of Misdiagnosing the Primary Site Responsible for Bone Metastases in Patients With Chronic Lymphocytic Leukemia and a Second Primary Carcinoma

Abstract

Chronic lymphocytic leukemia (CLL) is a common malignancy which may coexist with other primary cancers. CLL is rarely the cause of solitary bone lesions; such lesions in the context of CLL are believed to result from either Richter’s transformation or metastasis from another primary malignancy. Renal cell carcinoma (RCC), on the other hand, is a malignancy which frequently metastasizes to bone and may cause an osteolytic solitary bone lesion. The origin of a solitary bone lesion in a patient with multiple potential primary malignancies has prognostic implications and affects treatment protocol, and as such must be diagnosed accurately. We describe a patient with CLL and a history of RCC who is found to have an incidental solitary bone lesion of the T11 vertebra. After two separate CT-guided biopsies revealed various lymphoid cell predominance and no evidence of RCC, treatment with low dose external beam radiation therapy (EBRT) was employed. Post-therapy MRI showed further propagation of the lesion. Surgical corpectomy was subsequently performed and postoperative pathology of the lesion was consistent with RCC. The patient was treated with bisphosphonates and a higher dose of EBRT. Our case illustrates the importance of surgical excisional biopsy for accurately diagnosing the primary source metastatic to the bone in a patient with CLL and another potential primary cancer.

A case of bone lesion in a patient with relapsed chronic lymphocytic leukemia and review of the literature

“…In 11 on 22 cases of the literature, patients had the axial skeleton or proximal long bones involved, 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 and in rare cases, fractures were localized to the skull or facial bones. 17 , 22 , 23 Multiple fractures were reported in 8 cases.…”

“…[7][8][9] Some cases in literature have already described the presence of lytic lesions in patients affected by CLL, and one of them was previously described by our group. 10 In 11 on 22 cases of the literature, patients had the axial skeleton or proximal long bones involved, [10][11][12][13][14][15][16][17][18][19][20][21] and in rare cases, fractures were localized to the skull or facial bones. 17,22,23 Multiple fractures were reported in 8 cases.…”

A case of bone lesion in a patient with relapsed chronic lymphocytic leukemia and review of the literature

“…[7][8][9] Some cases in literature have already described the presence of lytic lesions in patients affected by CLL, and one of them was previously described by our group. 10 In 11 on 22 cases of the literature, patients had the axial skeleton or proximal long bones involved [10][11][12][13][14][15][16][17][18][19][20][21] and in rare cases fractures were localized to the skull or facial bones. 17,22,23 Multiple fractures were reported in 8 cases.…”

Epileptic Seizure Provoked by Bone Metastasis of Chronic Lymphoid Leukemia and Merkel Cell Carcinoma

“…In addition to patient history, clinical presentation and radiological findings enabled the suspected diagnosis of skull metastasis of MCC compressing the brain, causing symptomatic epileptic seizures. Bone metastasis from CLL was unlikely, as solitary bone lesions in the context of CLL are believed to result from either Richter's transformation or metastasis from another primary malignancy [ 5 ], in this case, from MCC. Therefore, previous oncological diagnoses and imaging are of key importance in clarifying the origins of solitary bone lesions of the skull.…”