Diagnostic Efficacy of^(18)F-FDG PET/CT in Detecting Bone Marrow Infiltration in Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma

Objective Diffuse large B-cell lymphoma(DLBCL)is often associated with bone marrow infiltration,and 2-deoxy-2-(18F)fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT)has potential diagnostic significance for bone marrow infiltration in DLBCL.Methods A total of 102 patients diagnosed with DLBCL between September 2019 and August 2022 were included.Bone marrow biopsy and^(18)F-FDG PET/CT examinations were performed at the time of initial diagnosis.Kappa tests were used to evaluate the agreement of^(18)F-FDG PET/CT with the gold standard,and the imaging features of DLBCL bone marrow infiltration on PET/CT were described.Results The total detection rate of bone marrow infiltration was not significantly different between PET/CT and primary bone marrow biopsy(P=0.302)or between the two bone marrow biopsies(P=0.826).The sensitivity,specificity,and Youden index of PET/CT for the diagnosis of DLBCL bone marrow infiltration were 0.923(95%CI,0.759-0.979),0.934(95%CI,0.855-0.972),and 0.857,respectively.Conclusion^(18)F-FDG PET/CT has a comparable efficiency in the diagnosis of DLBCL bone marrow infiltration.PET/CT-guided bone marrow biopsy can reduce the misdiagnosis of DLBCL bone marrow infiltration.

THE CHANGES OF BONE VOLUME AND TURNOVER IN POSTMENOPAUSAL WOMEN WITH OSTEOPOROSIS：A REPORT OF 293 BONE BIOPSIES

bone biopsies of ooteoporosis in postmenopausal women were analyzed. The results showed that the mean ttabecular bone volume was(10.6 ± 5. 47)%, which is 29'3% less than the low value of normal range(15%).There were 186 (63. 5%)cases in normal turnover,75(25.6 %)cases in high turnover,and 32 (10.9%)tases in low turnover.In comparison with the normal turnover group ,the osteoid volume and surface,mineralization surface, corrected mineralization rate,osteoclast number, and bone formation rate were elevated (P<0.01), but mineralization lag time was reduced (P< 0' 01) in the high turnover group,and all the above parameters in the low turnover group were opposite (P <0.05 0. 01).In comparison with the 3 agegroups (51￣60, 60￣70,>70),the bone volume and osteoid volume dropped as the age increased. Both high and low turnover situations appeared in the 51￣60 age group,waied had the highest ratio in the 61￣70 age group and the lowest ratio in the >70 age group. All these changes of bone volume and turnover reflect the heterogeneity of etiology and complicacy of pathogenesis in this disease.Bone biopsy is not only to distinguish osteoPOrosis from ostcomalacla, but also to determine the turnover type and direct clinical treatment.

Idiopathic hypereosinophilic syndrome with hepatic sinusoidal obstruction syndrome:A case report and literature review

BACKGROUND Hypereosinophilic syndrome(HES)is classified as primary,secondary or idiopathic.Idiopathic HES(IHES)has a variable clinical presentation and may involve multiple organs causing severe damage.Hepatic sinusoidal obstruction syndrome(HSOS)is characterized by damage to the endothelial cells of the hepatic sinusoids of the hepatic venules,with occlusion of the hepatic venules,and hepatocyte necrosis.We report a case of IHES with HSOS of uncertain etiology.CASE SUMMARY A 70-year-old male patient was admitted to our hospital with pruritus and a rash on the extremities for>5 mo.He had previously undergone antiallergic treatment and herbal therapy in the local hospital,but the symptoms recurred.Relevant examinations were completed after admission.Bone marrow aspiration biopsy showed a significantly higher percentage of eosinophils(23%)with approximately normal morphology.Ultrasound-guided hepatic aspiration biopsy indicated HSOS.Contrast-enhanced computed tomography(CT)of the upper abdomen showed hepatic venule congestion with hydrothorax and ascites.The patient was initially diagnosed with IHES and hepatic venule occlusion.Prednisone,low molecular weight heparin and ursodeoxycholic acid were given for treatment,followed by discontinuation of low molecular weight heparin due to ecchymosis.Routine blood tests,biochemical tests,and imaging such as enhanced CT of the upper abdomen and pelvis were reviewed regularly.CONCLUSION Hypereosinophilia may play a facilitating role in the occurrence and development of HSOS.

Gastrointestinal amyloidosis in a patient with smoldering multiple myeloma:A case report

BACKGROUND Smoldering multiple myeloma(SMM)is an asymptomatic plasma cell proliferative disorder that can progress to multiple myeloma(MM).Amyloidosis(light chain)(AL)is the most common form of systemic amyloidosis.There are few reports of SMM coexisting with AL involving the digestive tract.CASE SUMMARY A 63-year-old woman presented with lower limb edema,abdominal distension,abdominal pain,and hematochezia.Gastroscopy showed gastric retention,gastric angler mucosal coarseness,hyperemia,and mild oozing of blood.Colonoscopy showed hyperemic and edematous mucosa of the distal ascending colon and sigmoid colon with the presence of multiple round and irregular ulcers,submucosal ecchymosis,and hematoma.Gastric and colonic tissue biopsy confirmed the diagnosis of AL by positive Congo red staining.MM was confirmed by bone marrow biopsy and immunohistochemistry.The patient had no hypercalcemia,renal dysfunction,anemia,bone lesions or biomarkers of malignancy defined as plasma cells>60%in bone marrow.Additionally,no elevated serum free light chain ratio,or presence of bone marrow lesions by magnetic resonance imaging(SLiM criteria)were detected.The patient was finally diagnosed with SMM coexisting with AL.She received chemotherapy and was discharged when the symptoms were relieved.She is doing well at nearly five years of follow up.CONCLUSION This case highlights that high index of suspicion is required to diagnose gastrointestinal AL.It should be suspected in elderly patients with endoscopic findings of granular-appearing mucosa,ecchymosis,and submucosal hematoma.Timely diagnosis and appropriate therapy can help to improve the prognosis of these patients.

Anemia in ESKD Patient (End-Stage Kidney Disease): The Rare Cause Is in the Forefront

We reported a case of severe anemia in a patient with end-stage kidney disease (ESKD) on dialysis. The anemia developed when the patient is switched from hemodialysis (HD) to peritoneal dialysis (PD) when the intra-venous erythropoietin stimulating agent (ESA, Epogen) was changed into subcutaneous injection of darbepoetin. The patient’s hemoglobin dropped 2 grams in about two months during this period. Extensive work-up including, bleeding disorders, hemolysis, iron deficiency, infections including CMV, Epstein-Bar virus, parvo-19 virus infection were unrevealing The anti-Epogen neutralizing antibodies were not measured due to unavailability. Bone marrow biopsy and aspirate were negative for infiltrations or myelodysplastic syndrome (MDS). The leukocyte and platelet counts were normal. Even though anti-ESA antibodies were not measured in this case, all tentative causes of his anemia were excluded by laboratory investigations. The patient’s anemia was treated symptomatically with blood transfusion and discontinuation of the ESA treatment. He made a remarkable recovery.

Magnetic resonance imaging guided bone biopsies in the iPath-200 system

Objective To study the clinical value of a new MRI compatible percutaneous bone biopsy system.Methods Twenty-six patients with bone lesions MRI-guided biopsies underwent using a 0. 23-T open MR system combined with an iPath-200 optical leading system.Results Of the 26 biopsies, 23 samples were sufficient for histological examination and the histopathologic diagnoses were confirmed. In the high-risk areas like spine, the biopsies were successfully done in 11 patients. No procedural complications occurred.Conclusion Percutaneous biopsy of bone lesions performed under MRI-guidance in an iPath system was proved to be accurate and safe.

Hemophagocytic syndrome： a rare but fatal complication after liver transplantation

Hemophagocytic syndrome （HPS） is recognized as a disorder characterized by a variety of symptomsincluding fever, jaundice, skin rash, lymphadenopathy, and hepatosplenomegaly related to uncontrolled systemic T-cell activation. Two forms of HPS have been characterized： primary/familial hemophagocytic lymphohistiocytosis and secondary/reactive HPS. Reactive HPS was first described in 1979 by Risdall et al.2 Although most patients with HPS are immunocompromised, only a small number of patients with HPS have been reported following liver transplantation （LT）, suggesting a low level of awareness for this hematological disorder after transplantation. We herein report one patient who underwent LT and in whom HPS subsequently developed. The patient had an aggressive clinical course and fatal outcome. The observation of one case of HPS in a cohort of 741 patients who underwent LT in our center raised the possibility that the case of HPS in these immunocompromised patients might be increasing in the future. Because of this,