Bone

Bone lesions are uncommon in CML, having been reported in only six patients (3 percent of a series of 205 patients at the NCI).76 In one half of cases, bone involvement occurred during the blastic phase of CML. The bone lesions of CML are painful, tend to occur at the end of long bones, and display osteolytic features on radiographic examinations. In rare cases, symptomatic lytic bone lesions have preceded the diagnosis of CML and/or simulated a primary bone tumor.77,78 Multiple lytic bone lesions that have suggested multiple myeloma may also occur and even be associated with hypercalcemia.79 Hypercal-cemia without apparent bone destruction has been reported in association with the accelerated phase of CML.80 If a patient does have a bone lesion, it generally is a myeloblastoma, recognizable with the use of appropriate histochemical stains, cyto-genetic studies, or ultrastructural analysis.

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