case_images: PMC11794277_01
case_images: The PET/CT scan of the patient showed areas of uneven density in several vertebrae. Slightly increased FDG uptake was observed in the vertebral bodies and appendages, with active FDG metabolism also detected in the spinal cord cavity between the T12 and L2 segments.
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case_images: PMC11794277_01_fmed-11-1507716-g001.jpg
case_images: F1
case_images: There was slightly increased FDG uptake in the vertebral bodies and appendages, and active FDG metabolism was also noted in the spinal cord cavity from the T12-L2 segment (Figure 1).
case_images: (A) Bone marrow cytomorphology by bone marrow aspirate smear. (B) Karyotype of bone marrow. (C) FISH probe detection of myeloid sarcoma biopsies. (D) FISH probe detection of bone marrow aspirate.
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case_images: PMC11794277_01_fmed-11-1507716-g002.jpg
case_images: F2
case_images: A bone marrow smear revealed significantly active marrow hyperplasia, but no blasts or abnormal promyelocytes were detected (Figure 2A). Chromosomal analysis revealed 46,XY,t(15;17)(q24;q21)[2]/46,XY[18] (Figure 2B). FISH analysis of the MS tissues revealed a 94% positivity rate for PML::RARA fusion signals (Figure 2C), while bone marrow FISH showed a 8% positivity rate for PML::RARA fusion at the 17q21/15q22-24 site, including 4% atypical signals (Figure 2D).
case_images: (A) PET/CT scan at the L2 level before surgery. (B) CT scan at the L2 level after surgery. (C) CT scan at the L2 level after one cycle of retinoic acid combined with arsenic trioxide induction therapy.
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case_images: F3
case_images: CR, and the PML::RARA fusion gene was no longer detectable. CT scans of the lumbar spine showed no mass (Figure 3).
case_images: Quantitative changes in expression of PML::RARA fusion gene monitored by real-time PCR. PML::RARA fusion gene levels in peripheral blood of patients were dynamically monitored by real-time PCR. The detected value of PML::RARA level (PML::RARA/ABL) = PML::RARA copy number/ABL copy number x 100%. When the detected value showed negative, it indicated that there was no fusion gene expression or the fusion gene expression level in the submitted samples was lower than the lower limit of detection (100 copies/ml) of this method. The PML::RARA fusion gene decreased after chemotherapy and remained negative during maintenance therapy.
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case_images: F4
case_images: One year after treatment, the patient remained in remission, with molecular analyses of bone marrow and peripheral blood showing no evidence of PML::RARA fusion transcripts (Figure 4).