Bone marrow necrosis secondary to imatinib usage, mimicking spinal metastasis on magnetic resonance imaging and FDG-PET/CT.
Imatinib mesylate has become the treatment of choice for gastrointestinal stromal tumors (GISTs) and has made a revolutionary impact on survival rates. Bone marrow necrosis is a very rare adverse event in malignant GIST. Bone metastases are also rarely encountered in the setting of this disease. The authors report on a patient with malignant GIST who developed a bone lesion, mimicking spinal metastasis on both MR imaging and FDG-PET/CT. Corpectomy and anterior fusion was performed, but the pathology report was consistent with bone marrow necrosis. Radiological and clinical similarities made the distinction between metastasis and bone marrow necrosis challenging for the treating physicians. Instead of radical surgical excision, more conservative methods such as percutaneous or endoscopic bone biopsies may be more useful for pathological confirmation, even though investigations such as MR imaging and FDG-PET/CT indicate metastatic disease.
Departments of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Yavuz
Y
Aras
Mehmet Osman
MO
Akcakaya
Seher N
SN
Unal
Bilge
B
Bilgic
Omer Faruk
OF
Unal
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001549:Benzamides; D001853:Bone Marrow / Q000473:pathology*; D001855:Bone Marrow Diseases / Q000139:chemically induced* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy; D006801:Humans; D000068877:Imatinib Mesylate; D008279:Magnetic Resonance Imaging; D064847:Multimodal Imaging; D009336:Necrosis / Q000139:chemically induced* / Q000473:pathology; D010879:Piperazines / Q000009:adverse effects* / Q000627:therapeutic use; D049268:Positron-Emission Tomography; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D013125:Spinal Neoplasms / Q000556:secondary*; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate