1995 Volume 9 Issue 6 Pages 446-451
An eleven-year-old boy presented with severe back pain of 3 months' duration. He eventually developed fever and pancytopenia. He had been lying all day long when the diagnosis of acute lymphoblastic leukemia (ALL) was made with bone marrow puncture. Simple X-ray films of vertebral bones showed multiple compression fructures from Th7 to L2. T2-weighted MR imaging exhibited a high signal area in the vertebral bone, compatible with leukemic infiltration. The leukemia responded well to induction therapy of the TCCSG L92-13 PH regimen. In spite of the release of back pain, vertebral low density on X-ray films continued even after 5 months' chemotherapy. MRI, however, showed decreased T2-weighted signal intensity, compatible with a decrease in or the disappearance of leukemic infiltration. According to the literature, the ALL patients presenting with vertebral compression fractures have characteristic features as described below : (1) older age group, (2) long time until the correct diagnosis was made, (3) leukopenia at diagnosis, (4) low percentage of leukemic cells in the peripheral blood, (5) hyperdiploidy in chromosomal analysis, and (6) good prognosis.
