Histologic and radiologic studies at the time of leukemic transformation. (A) BM biopsy showing immature myeloid proliferation without segmentation (blasts >20%) and dysplastic megakaryocytes. With silver staining (right panel), marked reticulin fibrosis associated with osteoesclerosis was also shown. (B) Chest CT scan showing an increase in bone density of the vertebral bodies and a right lung nodule of 2 × 2 cm in size with speculated edges. (C) Positron-emission tomography with CT showing a markedly increased of 18 F-FDG uptake in the BM of the vertebral bodies; sacrum; extremity bones (specially left humerus); and focal in the spleen.