51
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Reversible bone marrow necrosis after all-trans retinoic acid induction therapy for acute promyelocytic leukaemia. Pathology 2011; 43:515-7. [PMID: 21753723 DOI: 10.1097/pat.0b013e3283489087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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52
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Shin SY, Park H, Chae SW, Woo HY. Microangiopathic hemolytic anemia as the first manifestation of metastatic signet ring cell carcinoma of unknown origin: a case report and review of literature. Korean J Lab Med 2011; 31:157-61. [PMID: 21779188 PMCID: PMC3129345 DOI: 10.3343/kjlm.2011.31.3.157] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 04/04/2011] [Accepted: 04/20/2011] [Indexed: 01/27/2023] Open
Abstract
Microangiopathic hemolytic anemia (MAHA) occurs occasionally as a paraneoplastic syndrome in some solid tumors, but MAHA accompanied by signet ring cell carcinoma of an unknown origin is very rare. In this study, we present the case of an 80-yr-old man who was admitted to the hospital because of a 1-month history of lower back pain and dyspnea. He was diagnosed with MAHA on the basis of the laboratory findings that revealed anemia with schistocytes, decreased haptoglobin levels, and a negative direct Coombs' test. Bone marrow examination, which was performed because of the progression of anemia, revealed bone marrow metastases of signet ring cell carcinoma with extensive bone marrow necrosis. However, the primary origin of this signet ring cell carcinoma was not found. When the cause of progressive MAHA is unknown, the possibility of cancer-associated MAHA must be excluded by performing additional tumor workup, including the detection of tumor markers, gastric and colorectal endoscopic examinations, bone marrow examinations, and positron emission tomography-computed tomography or bone scans.
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Affiliation(s)
- Sang-Yong Shin
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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53
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Rossi P, Curiel M, Demoux AL, Bagneres D, Costello R, Chaumoitre K, Bernard F, Frances Y, Granel B. Bone marrow necrosis and sickle cell crisis associated with double heterozygosity for HbS and HbOARAB. Am J Hematol 2011; 86:309-10. [PMID: 20954261 DOI: 10.1002/ajh.21868] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 08/25/2010] [Accepted: 08/26/2010] [Indexed: 11/10/2022]
Affiliation(s)
- Pascal Rossi
- Department of Internal Medicine, Public Hospitals of Marseilles, North Hospital, Chemin des Bourrely, France.
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54
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Lee YH, Hong YC, Yang CF, Wu HT, Huang LJ, Tzeng CH, Liu CY. Severe extensive bone marrow necrosis from miliary tuberculosis without granulomas and pulmonary presentations. J Chin Med Assoc 2010; 73:208-11. [PMID: 20457443 DOI: 10.1016/s1726-4901(10)70043-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 01/28/2010] [Indexed: 11/22/2022] Open
Abstract
Bone marrow necrosis (BMN) is a rare clinicopathologic entity caused by hypoxemia after failure of the microcirculation, which frequently manifests with bone pain, fever, and peripheral cytopenia. In most reported cases of BMN resulting from miliary tuberculosis (TB), the presence of marrow granulomas, pulmonary infiltrates and/or extrapulmonary involvement is common. We report a female patient with extensive BMN from miliary TB, whose initial presentation was only severe peripheral cytopenia with extensive marrow necrosis, with neither evident pulmonary manifestations nor granulomas in the marrow biopsy. Serial Ziehl-Neelsen stains and Mycobacterium tuberculosis cultures were negative. The diagnosis of suspected miliary TB was made by consecutive positive results from polymerase chain reaction analysis for TB of marrow samples at 2 separate examination time points and a good treatment response to anti-TB therapy. Magnetic resonance imaging showed a geographic pattern of multiple signal abnormalities, indicating bone infarcts over the bilateral iliac bones and T-L-spine vertebral bodies, compatible with extensive BMN. The unusual presentation of extensive BMN with severe peripheral cytopenia in the absence of granulomas or pulmonary presentations should alert clinical physicians in epidemic areas. We discuss the use of polymerase chain reaction analysis for TB and magnetic resonance imaging for diagnosis of these patients.
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Affiliation(s)
- Yun-Hsuan Lee
- Department of Medicine, Taipei Veterans General Hospital, Taiwan, ROC
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55
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Yamamoto M, Belmont HM, Utsunomiya M, Hidaka Y, Kishimoto M. Gelatinous transformation of the bone marrow in systemic lupus erythematosus. Lupus 2009; 18:1108-11. [DOI: 10.1177/0961203309106344] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gelatinous transformation of the bone marrow is a rare disease characterised by a focal marrow hypoplasia, fat atrophy and accumulation of extracellular mucopolysaccharides abundant in hyaluronic acid, which is often associated with extreme malnutrition and weight loss. There are only two reports describing its association with systemic lupus erythematosus (SLE). One described underlying diseases in 155 cases of gelatinous transformation of the bone marrow and found one case with clinical diagnosis of SLE, but no clinical details were provided. The other described three SLE patients with gelatinous transformation of the bone marrow; however, two of these were cachectic and one was diagnosed with concomitant tuberculosis. We describe one active SLE patient without other comorbidities whose pancytopaenia was histologically confirmed as gelatinous transformation. The combination of high-dose steroid, intravenous immunoglobulin and mycophenolate mofetil improved the peripheral blood cytopaenia and reversed the bone marrow abnormalities.
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Affiliation(s)
- M Yamamoto
- Division of Rheumatology, Kameda Medical Center, Chiba, Japan
| | - HM Belmont
- Division of Rheumatology, NYU-Hospital for Joint Diseases, New York, USA
| | - M Utsunomiya
- Division of Rheumatology, Kameda Medical Center, Chiba, Japan
| | - Y Hidaka
- Division of Rheumatology, Kameda Medical Center, Chiba, Japan
| | - M Kishimoto
- Division of Rheumatology, Kameda Medical Center, Chiba, Japan
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56
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Wang YC, Chang PY, Yao NS. Bone Marrow Necrosis Caused by Metastatic Colon Cancer. J Clin Oncol 2009; 27:e48. [DOI: 10.1200/jco.2008.21.3140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yung-Chih Wang
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ping-Ying Chang
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Nai-Shun Yao
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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57
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58
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Ioannou S, Vlahadami I, Voulgarelis M. Bone marrow necrosis and fat embolism syndrome presented as conus medullaris syndrome in a patient with primary mediastinal large B-cell lymphoma. Leuk Res 2009; 34:116-8. [PMID: 19540591 DOI: 10.1016/j.leukres.2009.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Revised: 05/01/2009] [Accepted: 05/26/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Savvas Ioannou
- Department of Pathophysiology, Medical School, National University of Athens, Athens, Greece
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59
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Resende LSR, Mendes RP, Bacchi MM, Marques SA, Barraviera B, Souza LR, Meira DA, Niéro-Melo L. Bone marrow necrosis related to paracoccidioidomycosis: the first eight cases identified at autopsy. Histopathology 2009; 54:486-9. [PMID: 19309401 PMCID: PMC2680265 DOI: 10.1111/j.1365-2559.2009.03245.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To report the first eight bone marrow necrosis (BMN) cases related to paracoccidioidomycosis (PCM) from patient autopsies with well-documented bone marrow (BM) histology and cytology. METHODS AND RESULTS A retrospective evaluation was performed on BM specimens from eight autopsied patients from Botucatu University Hospital with PCM-related BMN. Relevant BMN literature was searched and analysed. CONCLUSIONS All eight patients had acute PCM. Six had histological only (biopsies) and two cytological only (smears) specimens. Five biopsy specimens revealed severe and one mild coagulation patterned necrotic areas. Five had osteonecrosis. The cytological specimens also showed typical BMN patterns. Paracoccidioides brasiliensis yeast forms were visible within necrotic areas in all cases.
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Affiliation(s)
- Lucilene S R Resende
- Haematology Service of Clinical Department, Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil.
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60
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Riley RS, Williams D, Ross M, Zhao S, Chesney A, Clark BD, Ben-Ezra JM. Bone marrow aspirate and biopsy: a pathologist's perspective. II. interpretation of the bone marrow aspirate and biopsy. J Clin Lab Anal 2009; 23:259-307. [PMID: 19774631 PMCID: PMC6648980 DOI: 10.1002/jcla.20305] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Accepted: 02/19/2009] [Indexed: 12/11/2022] Open
Abstract
Bone marrow examination has become increasingly important for the diagnosis and treatment of hematologic and other illnesses. Morphologic evaluation of the bone marrow aspirate and biopsy has recently been supplemented by increasingly sophisticated ancillary assays, including immunocytochemistry, cytogenetic analysis, flow cytometry, and molecular assays. With our rapidly expanding knowledge of the clinical and biologic diversity of leukemia and other hematologic neoplasms, and an increasing variety of therapeutic options, the bone marrow examination has became more critical for therapeutic monitoring and planning optimal therapy. Sensitive molecular techniques, in vitro drug sensitivity testing, and a number of other special assays are available to provide valuable data to assist these endeavors. Fortunately, improvements in bone marrow aspirate and needle technology has made the procurement of adequate specimens more reliable and efficient, while the use of conscious sedation has improved patient comfort. The procurement of bone marrow specimens was reviewed in the first part of this series. This paper specifically addresses the diagnostic interpretation of bone marrow specimens and the use of ancillary techniques.
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Affiliation(s)
- Roger S Riley
- Medical College of Virginia Hospitals of Virginia Commonwealth University, Richmond, Virginia, USA.
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61
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Shim K, MacKenzie MJ, Winquist E. Chemotherapy-associated osteonecrosis in cancer patients with solid tumours: a systematic review. Drug Saf 2008; 31:359-71. [PMID: 18422377 DOI: 10.2165/00002018-200831050-00001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Non-traumatic osteonecrosis of bone is recognized as a potential complication in solid-tumour cancer patients receiving treatment with cytotoxic chemotherapy. This review summarizes recent reports of osteonecrosis associated with chemotherapy in cancer patients, and describes the possible underlying pathophysiology and options available for its diagnosis, prevention and treatment. Fifty-four reported cases of non-traumatic osteonecrosis in adult patients with solid tumours receiving chemotherapy were identified by searching for reports in the medical literature. Osteonecrosis was observed most commonly in men receiving chemotherapy for testicular cancer. Osteonecrosis was also seen in patients receiving chemotherapy for breast, ovarian, small-cell lung cancer and osteosarcoma. Most patients had received corticosteroids, had femoral head involvement and had delayed onset of osteonecrosis. It appears that patients at higher risk for osteonecrosis with chemotherapy are identifiable. As the long-term survival of patients with solid tumours receiving chemotherapy increases, the prevalence of treatment-related osteonecrosis may also increase. Patients should be informed that osteonecrosis is a potential complication of cancer treatment. Measures to reduce risk should be taken, and patients should be monitored for early symptoms. Routine screening for chemotherapy-associated osteonecrosis is not recommended; however, a high index of clinical suspicion in patients at risk may allow for early intervention and preservation of the joints.
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Affiliation(s)
- Katharine Shim
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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62
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Campiotti L, Codari R, Appio L, Ultori C, Solbiati F, Maria Grandi A, Venco A. Bone marrow necrosis related to imatinib mesylate therapy for cml bilineal blast crisis. Leuk Res 2007; 31:1768-70. [PMID: 17403537 DOI: 10.1016/j.leukres.2007.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 02/17/2007] [Accepted: 02/19/2007] [Indexed: 11/23/2022]
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63
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Rossi D, Ramponi A, Franceschetti S, Stratta P, Gaidano G. Bone marrow necrosis complicating post-transplant lymphoproliferative disorder: resolution with rituximab. Leuk Res 2007; 32:829-34. [PMID: 18036657 DOI: 10.1016/j.leukres.2007.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 10/02/2007] [Accepted: 10/04/2007] [Indexed: 10/22/2022]
Abstract
Bone marrow necrosis is a rare cause of bone marrow failure. Malignancy is the most frequent cause of bone marrow necrosis. Among malignancies, non-Hodgkin lymphoma (NHL) accounts for 10% of cases of bone marrow necrosis. Virtually all reported cases of NHL-associated bone marrow necrosis have developed in immunocompetent hosts. We report on a case of bone marrow necrosis complicating post-transplant lymphoproliferative disorder (PTLD) and resolving after rituximab monotherapy. This case report provides the first evidence of (i) bone marrow necrosis as a complication of PTLD; (ii) rapid resolution of NHL-associated bone marrow necrosis after rituximab treatment.
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Affiliation(s)
- Davide Rossi
- Division of Hematology, Department of Clinical and Experimental Medicine & IRCAD, Amedeo Avogadro University of Eastern Piedmont and Ospedale Maggiore della Carità, Via Solaroli 17, 28100 Novara, Italy.
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64
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Hwang S, Panicek DM. Magnetic resonance imaging of bone marrow in oncology, Part 2. Skeletal Radiol 2007; 36:1017-27. [PMID: 17492444 DOI: 10.1007/s00256-007-0308-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 03/05/2007] [Accepted: 03/07/2007] [Indexed: 02/02/2023]
Abstract
Magnetic resonance imaging plays an integral role in the detection and characterization of marrow lesions, planning for biopsy or surgery, and post-treatment follow-up. To evaluate findings in bone marrow on MR imaging, it is essential to understand the normal composition and distribution of bone marrow and the changes in marrow that occur with age, as well as the basis for the MR signals from marrow and the factors that affect those signals; these points have been reviewed and illustrated in part 1 of this two-part article. Part 2 will emphasize the practical application of MR imaging to facilitate differentiation of normal marrow, tumor, and treatment-related marrow changes in oncology patients, and will review complementary MR techniques under development.
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Affiliation(s)
- Sinchun Hwang
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY 10021, USA
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65
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Noguchi M, Oshimi K. Extensive bone marrow necrosis and symptomatic hypercalcemia in B cell blastic transformation of chronic myeloid leukemia: report of a case and review of the literature. Acta Haematol 2007; 118:111-6. [PMID: 17641550 DOI: 10.1159/000106100] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 05/09/2007] [Indexed: 11/19/2022]
Abstract
Extensive bone marrow necrosis and symptomatic hypercalcemia have been described independently as rare complications of chronic myeloid leukemia. Here we report a 66-year-old man who developed B cell blastic transformation 10 years after diagnosis of CML in the chronic phase. Extensive bone marrow necrosis and symptomatic hypercalcemia concurrently developed after transformation, with development of disseminated intravascular coagulation and multifocal osteolysis. Most necrotic cells were readily identifiable as blasts. Mediators related to hypercalcemia, including prostaglandin E2, transforming growth factor-alpha and transforming growth factor-beta, were significantly elevated in the serum. As far as we know, this is the first case report of chronic myeloid leukemia concurrently developing bone marrow necrosis and hypercalcemia; this association was not reported in other types of leukemia or bone marrow malignancies.
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Affiliation(s)
- Masaaki Noguchi
- Department of Hematology, Juntendo Urayasu Hospital, Urayasu-shi, Chiba, Japan.
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66
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Otrock ZK, Taher AT, Makarem JA, Kattar MM, Nsouli G, Shamseddine AI. Thrombotic thrombocytopenic purpura and bone marrow necrosis associated with disseminated gastric cancer. Dig Dis Sci 2007; 52:1589-91. [PMID: 17436106 DOI: 10.1007/s10620-006-9407-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Accepted: 04/28/2006] [Indexed: 12/09/2022]
Affiliation(s)
- Zaher K Otrock
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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67
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Tang YM, Jeavons S, Stuckey S, Middleton H, Gill D. MRI features of bone marrow necrosis. AJR Am J Roentgenol 2007; 188:509-14. [PMID: 17242262 DOI: 10.2214/ajr.05.0656] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to illustrate and review the MRI appearance of histologically proven cases of bone marrow necrosis (BMN) and to review the literature on this clinicopathologic entity with emphasis on its distinction from avascular necrosis (AVN) of bone. CONCLUSION BMN is a rare clinicopathologic entity separate from AVN and has a distinctive MRI appearance. As MRI comes to play an increasingly important role in the evaluation of bone marrow disease, BMN is likely to be more frequently encountered. Awareness of BMN and its MRI appearance and appreciation of the frequent association between BMN and underlying malignancy may assist in the early diagnosis of BMN and initiate an intensive search for occult malignancy.
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Affiliation(s)
- Yu Ming Tang
- Department of Radiology, Princess Alexandra Hospital, Ipswich Rd., Woolloongabba, Brisbane, Queensland 4102, Australia
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68
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Ozkan A, Ozkalemkas F, Ali R, Ozkocaman V, Ozcelik T. Severe bone marrow necrosis without suggestive features. Am J Hematol 2006; 81:386-7. [PMID: 16628718 DOI: 10.1002/ajh.20591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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69
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Aydogdu I, Erkurt MA, Ozhan O, Kaya E, Kuku I, Yitmen E, Aydin NE. Reversible bone marrow necrosis in a patient due to overdosage of diclofenac sodium. Am J Hematol 2006; 81:298. [PMID: 16550525 DOI: 10.1002/ajh.20536] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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70
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Matsue K, Takeuchi M, Koseki M, Uryu H. Bone marrow necrosis associated with the use of imatinib mesylate in a patient with Philadelphia chromosome-positive acute lymphoblastic leukemia. Ann Hematol 2006; 85:542-4. [PMID: 16570152 DOI: 10.1007/s00277-005-0071-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Accepted: 12/15/2005] [Indexed: 11/29/2022]
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71
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Resende LSR, Mendes RP, Bacchi MM, Marques SA, Barraviera B, Souza LR, Meira DA, Niéro-Melo L. Infiltrative myelopathy by paracoccidioidomycosis. A review and report of nine cases with emphasis on bone marrow morphology. Histopathology 2006; 48:377-86. [PMID: 16487359 DOI: 10.1111/j.1365-2559.2006.02354.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To report nine additional well-defined cases with infiltrative myelopathy by paracoccidioidomycosis (PCM), to describe the specific lesions and infection-related stromal abnormalities, to review the literature on this type of involvement and to introduce a new cause of granulomatous lesions of bone marrow. METHODS AND RESULTS Different bone marrow specimens were studied (aspirated smears, aspirated clots, biopsy imprints and biopsies) from nine patients with acute or subacute forms of PCM known to have PCM infiltrative myelopathy. CONCLUSIONS The biopsy specimens were the best for demonstrating bone marrow involvement by PCM. The lesions varied from compact and focal granulomas with few fungal cells to numerous disseminated fungal cells within a loose granulomatous inflammatory reaction, with a continuum between these extremes suggesting a spectrum of immune response to the fungi. Other findings such as bone marrow fibrosis, parenchymal coagulative necrosis and bone necrosis were also observed in the affected areas.
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Affiliation(s)
- L S R Resende
- Clinical Deparmtent, Botucatu Medical School, São Paulo State University, Botucatu, Brazil.
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72
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Affiliation(s)
- Ersoy Kekilli
- Department of Nuclear Medicine, Inonu University, Medical Faculty, Malatya, Turkey.
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73
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Zell JA, Chang JC. Neoplastic fever: a neglected paraneoplastic syndrome. Support Care Cancer 2005; 13:870-7. [PMID: 15864658 DOI: 10.1007/s00520-005-0825-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2005] [Accepted: 04/13/2005] [Indexed: 11/24/2022]
Abstract
Neoplastic fever, a paraneoplastic syndrome caused by cancer itself, represents a diagnostic challenge for the clinician and is an important issue in supportive oncology. Timely recognition of this febrile condition by differentiating it from other cancer-associated fevers, such as infection and drug reaction, is essential for effective patient management. Although the pathophysiology of neoplastic fever is not well understood, it is suspected to be cytokine mediated. In clinical practice, when a patient with cancer presents with unexplained fever, extensive diagnostic studies are needed to differentiate neoplastic fever from nonneoplastic fever. Only after excluding identifiable etiologies of fever can the diagnosis of neoplastic fever be suspected. According to our experience, the naproxen test is a safe and useful test in differentiating neoplastic fever from infectious fever in patients with cancer. In addition, naproxen and other nonsteroidal anti-inflammatory drugs have been effective in the management of neoplastic fever and offer a significant palliative benefit for the patient.
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Affiliation(s)
- Jason A Zell
- Division of Hematology/Oncology, Chao Family Comprehensive Cancer Center, University of California-Irvine Medical Center, Orange, CA 92868, USA.
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74
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Santana ANC, Ramos RG, Zanandrea EF, Brandão-Neto RA. Bone marrow necrosis successfully treated with corticosteroid. Eur J Haematol 2004; 74:75-6. [PMID: 15613112 DOI: 10.1111/j.1600-0609.2004.00323.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 60-yr-old white woman with CREST syndrome (calcinosis cutis, Raynaud's phenomenon, esophageal involvement, sclerodactyly, telangectasia), idiophatic portal hypertension and esophageal varices presented with a 2-month history of bone pain and severe anemia, requiring erythrocyte transfusion every 5-7 d. Initial laboratory findings were hemoglobin (Hb) 4.4 g/dL, platelets 15 x 10(9)/L, white blood cell count (WBC) 2.7 x 10(9)/L. Bone marrow biopsy showed large areas of BMN, and cultures of bone marrow aspirate were negative. The patient was started on intravenous pulse methylprednisolone (1000 mg/d for 3 d) followed by oral prednisone (1 mg/kg/d), and did not require erythrocyte transfusion thereafter. On the 40th day, our patient had Hb 11.6 g/dL, platelets 120 x 10(9)/L, WBC 6.2 x 10(9)/L. Here, we describe the first report of BMN in a patient with CREST syndrome, the first description of successful treatment with intravenous pulse corticosteroid and discuss the possible immune mechanisms involved in the present case.
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Affiliation(s)
- Alfredo N C Santana
- Pulmonary Division, University of São Paulo Medical School, São Paulo, Brazil.
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75
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Cadi P, Claessens YE, Cariou A, Safran D. Nécrose médullaire osseuse sévère associée à un choc septique en réanimation. ACTA ACUST UNITED AC 2004; 23:501-4. [PMID: 15158242 DOI: 10.1016/j.annfar.2004.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2003] [Accepted: 01/24/2004] [Indexed: 11/30/2022]
Abstract
Unexplained cytopenias can be related to bone marrow necrosis (BMN) in critically ill patients as it can be encountered in several diseases or life-threatening conditions. We present the case of a 39-year-old woman with pancytopenia revealing a BMN in the setting of an acute pyelonephritis with septic shock, multiple organ failure and sickle cell trait. After a short review on the subject, we suggest that various haematological abnormalities occurring in critically ill patients may be related to a mild to severe marrow necrosis.
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Affiliation(s)
- P Cadi
- Service d'anesthésie-réanimation, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris cedex 15, France.
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76
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Paydas S, Ergin M, Baslamisli F, Yavuz S, Zorludemir S, Sahin B, Bolat FA. Bone marrow necrosis: clinicopathologic analysis of 20 cases and review of the literature. Am J Hematol 2002; 70:300-5. [PMID: 12210811 DOI: 10.1002/ajh.10114] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Bone marrow necrosis (BMN) is a relatively uncommon clinicopathologic entity. The etiology is diverse, and malignancy, especially hematopoietic in origin, is the most common underlying disease of BMN. In this retrospective analysis, cases with BMN were re-evaluated for etiology, histopathologic details, and clinical manifestations. In the last 8 years, 23 cases of BMN were detected among the 1,083 bone marrow (BM) biopsies, and the prevalence was found to be 2.2%. Three of these 23 cases with BMN were children, and 20 cases were in adults. Sixteen of these cases (80%) had underlying malignant disease, and four (20%) had nonmalignant disease. Among the malignant cases, three cases had acute myeloblastic leukemia (AML), four had relapsed Hodgkin's disease (R-HD), one had acute lymphoblastic leukemia (ALL), two had chronic myelocytic leukemia (CML), two had non-Hodgkin's lymphoma (NHL), three had disseminated intravascular coagulation (DIC) associated with metastatic solid tumor, and one had myelodysplastic syndrome/myeloproliferative syndrome (MDS/MPS). Among the nonmalignant cases, two had tuberculosis infection, one had anti-phospholipid syndrome (APS), and one had a history of drug ingestion. The most common symptoms were bone pain, fever, fatigue, and jaundice. The most common laboratory findings were variable and associated with underlying disease, but anemia, leukopenia, thrombocytopenia, and high LDH and alkaline phosphatase levels were detected in the majority of the cases, as was also seen in other series. BMN was graded according to the extent of necrosis in the BM biopsy, and necrosis was extensive in 12 cases, moderate in five cases, and mild in three cases. Increased reticulin was found in 16 cases; four cases had severe, eight had moderate, and four had mild fibrosis, and this was found to be an interesting accompanying finding in BMN. In conclusion malignancy is the most common cause of BMN but some nonmalignant conditions such as tuberculosis and APS may be the underlying cause of BMN.
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Affiliation(s)
- Semra Paydas
- Department of Oncology, Cukurova University Faculty of Medicine, Balcal, Adana, Turkey.
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Venkateswaran L, Duerst R, Haut P, Kletzel M, Chou P. Bone marrow necrosis associated with relapse of acute myelogenous leukemia following unrelated hematopoeitic stem cell transplantation using an immunoablative regimen. MEDICAL AND PEDIATRIC ONCOLOGY 2002; 38:148-9. [PMID: 11813193 DOI: 10.1002/mpo.1299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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