Advances in Radiation Oncology A rare case of appendicular skeleton localization in a patient with Chronic Lymphocytic Leukemia (CLL) successfully treated with salvage radiotherapy  Carmelo Tuscano, MD, Iolanda Donatella Vincelli, MD, Demetrio Arico’, MD, Anna Maria Marchione, MD, Paolo Versace, MD, Caterina Stelitano, MD, Giuseppe Sceni, PhD, Francesca Ronco, MD, Elvio Grazioso Russi, MD, Said Al Sayyad, MD  Advances in Radiation Oncology  DOI: 10.1016/j.adro.2017.01.007 Copyright © 2017 The Authors on behalf of the American Society for Radiation Oncology Terms and Conditions

Figure 1 Distal tibial swelling (1a). Bone scan with Technetium-99m-MDP demonstrating early intense uptake in the distal third of right tibia (1b, white arrow). Advances in Radiation Oncology DOI: (10.1016/j.adro.2017.01.007) Copyright © 2017 The Authors on behalf of the American Society for Radiation Oncology Terms and Conditions

Figure 2 Right distal tibia bone biopsy (yellow arrows) with Hematoxylin and Eosin staining showing monomorphic and diffuse paratrabecular proliferation of small lymphocitic elements, apparently with a normal maturation pattern. Immunophentypic analysis determining positivity for CD20, CD3 (less than 1 %), CD5, CD23 and with a Ki-67 about 5 %. Advances in Radiation Oncology DOI: (10.1016/j.adro.2017.01.007) Copyright © 2017 The Authors on behalf of the American Society for Radiation Oncology Terms and Conditions

Figure 3 PET-CT scan with 18F-FDG showing , at time of diagnostic workup, an hypermetabolic glucose activity (SUVmax 2.2) at level of endomedullary compartment of right distal tibia (fig.3a, blue arrows). Complete metabolic answer following salvage radiotherapy with an indolent lymphoma dose range of 24 Gy (fig3b, blue arrows) at 3 months and at 17 months (fig3c, blue arrows). Advances in Radiation Oncology DOI: (10.1016/j.adro.2017.01.007) Copyright © 2017 The Authors on behalf of the American Society for Radiation Oncology Terms and Conditions