Tohoku J. Exp. Med., 2015 May, 236(1)

Hand Osteolysis in Patients with Adult T-Cell Leukemia-Lymphoma: Radiographic Characteristics

SHIGERU EHARA,¹ KEI TAKAHASHI,² JUN NISHIDA,³ MASATAKA UETANI,⁴ KENJIROU OHASHI⁵ and TAKATOSHI AOKI⁶

¹Department of Radiology, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
²Iwate Medical University School of Liberal Arts, Morioka, Iwate, Japan
³Department of Orthopedic Surgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
⁴Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Nagasaki, Japan
⁵Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
⁶Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Fukuoka, Japan

Adult T-cell leukemia-lymphoma (ATLL) is caused by human T-cell lymphotrophic virus I (HTLV-I) infection. Among ATLL cases, 70% of patients present with leukemia and the remaining patients present with lymphoma. Hand osteolysis in the patients with ATLL is considered as paraneoplastic syndrome and caused by parathyroid hormone-related peptide (PTHrP) released from tumor cells. Radiographic features are similar to hyperparathyroidism, but the distribution of osteolysis in hands appears to be slightly different with the authors' experiences. The objective of this study was to identify radiographic characteristics of hand osteolysis associated with ATLL. We included six ATLL patients (5 men and 1 woman; age range, 45-71 years). All the patients presented with acute leukemia, and three were associated with hypercalcemia and pain in various locations including hands. Patterns of osteolysis on hand radiographs were evaluated and recorded independently by three musculoskeletal radiologists. We analyzed the distribution of the bone resorption in the ray distribution of the hand, finger predilection, and the difference between the ulnar and radial sides. The bone resorption was characterized by frequent involvement of the distal and proximal phalanges, predilection of ring fingers and prominent involvement on the ulnar side, compared with frequent involvement of proximal and middle phalanges, index and middle fingers, and on the radial side in the bone resorption of typical hyperparathyroidism. Such distribution may be a characteristic feature of hand osteolysis in patients with ATLL. The present findings are helpful for physicians to differentiate PTHrP-mediated osteolysis in ATLL from parathyroid hormone-mediated hyperparathyroidism.

keywords —— adult T-cell leukemia-lymphoma; hyperparathyroidism; osteolysis; parathyroid hormone-related peptide; radiography

© 2015 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2015, 236, 63-69

Correspondence: Shigeru Ehara, M.D., Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan.

e-mail: ehara@iwate-med.ac.jp