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