Three cases of acute leukemia have been reported. In those cases, the first manifestation was bone and joint pain with abnormal changes on X-ray film, which led to the surgical biopsy.
All of them belonged to non-T, non-B ALL, and no abnormal hematological findings were found in the peripheral blood analysis. 99mTc scintigraphy displayed the invasion as a positive picture. Bone and joint pain subsided with effective induction chemotherapy, and bone changes on the X-ray film disappeared, too. The complete remission has continued from 1 1/2 years to about 7 years. In the case of longest survival, the treatment was discontinued for more than three years.
Judging from our cases, initial bone involvement by roentgenography plays no important role for threatening the prognosis in childhood ALL.
