1
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Luan C, Zhao H, Ding Y. Bone marrow necrosis: Facts, controversies, and perspective. Int J Lab Hematol 2024. [PMID: 38923828 DOI: 10.1111/ijlh.14335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
Bone marrow necrosis (BMN) is a clinically and pathologically poorly-defined and readily-overlooked entity. The current facts and guidelines pertaining to this entity are scarce, and there exist controversies. Upon reviewing the literature, we present the facts, analyze these controversies, and discourse on future prospects.
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Affiliation(s)
- Chengxin Luan
- Department of Oncology and Hematology, The Fourth Division Hospital of Xinjiang Production and Construction Corps, Yining, China
| | - Hongguo Zhao
- Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yufei Ding
- Department of Pathology, The Fourth Division Hospital of Xinjiang Production and Construction Corps, Yining, China
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2
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Yang R, Jia L, Cui J. Mechanism and clinical progression of solid tumors bone marrow metastasis. Front Pharmacol 2024; 15:1390361. [PMID: 38770000 PMCID: PMC11102981 DOI: 10.3389/fphar.2024.1390361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
The rich blood supply of the bone marrow provides favorable conditions for tumor cell proliferation and growth. In the disease's early stages, circulating tumor cells can escape to the bone marrow and form imperceptible micro metastases. These tumor cells may be reactivated to regain the ability to grow aggressively and eventually develop into visible metastases. Symptomatic bone marrow metastases with abnormal hematopoiesis solid tumor metastases are rare and have poor prognoses. Treatment options are carefully chosen because of the suppression of bone marrow function. In this review, we summarized the mechanisms involved in developing bone marrow metastases from tumor cells and the clinical features, treatment options, and prognosis of patients with symptomatic bone marrow metastases from different solid tumors reported in the literature.
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3
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Le Calvez B, Camuset M, Debord C, Grain A, Eveillard M. Bone marrow necrosis in childhood: The hunt for blasts. Int J Lab Hematol 2023; 45:828-830. [PMID: 37605938 DOI: 10.1111/ijlh.14151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Baptiste Le Calvez
- Pediatric Oncology, Nantes University Hospital, Nantes, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
| | - Margaux Camuset
- Pediatric Oncology, Nantes University Hospital, Nantes, France
| | - Camille Debord
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Audrey Grain
- Pediatric Oncology, Nantes University Hospital, Nantes, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
| | - Marion Eveillard
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
- Hematology Biology, Nantes University Hospital, Nantes, France
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4
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Saito K, Sato T, Notohara K, Nannya Y, Ogawa S, Ueda Y. Complete Bone Marrow Necrosis with Charcot-Leyden Crystals Caused by Myeloid Neoplasm with Mutated NPM1 and TET2. Intern Med 2022; 61:3265-3269. [PMID: 35185048 PMCID: PMC9683816 DOI: 10.2169/internalmedicine.8859-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Bone marrow necrosis (BMN) has various underlying diseases. In hematological malignancies, both lymphoid and myeloid neoplasms have been shown to cause BMN. Charcot-Leyden crystals (CLCs) are bipyramidal crystals that have been found in patients with immune system diseases, tumors, skin diseases, asthma, infections, and intestinal diseases. Because the combination of CLCs and acute myeloid leukemia (AML) is rare, the relationship between BMN, CLCs, and AML remains largely unexplored. We herein report a suspected case of AML that was difficult to diagnose morphologically because of complete BMN with CLCs but achieved complete hematologic remission with treatment similar to that for AML.
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Affiliation(s)
- Kenki Saito
- Department of Hematology/Oncology, Kurashiki Central Hospital, Japan
| | - Takayuki Sato
- Department of Hematology/Oncology, Kurashiki Central Hospital, Japan
| | - Kenji Notohara
- Department of Anatomic Pathology, Kurashiki Central Hospital, Japan
| | - Yasuhito Nannya
- Department of Pathology and Tumor Biology, Kyoto University, Japan
- Division of Hematopoietic Disease Control, Institute of Medical Science, The University of Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Kyoto University, Japan
| | - Yasunori Ueda
- Department of Hematology/Oncology, Kurashiki Central Hospital, Japan
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5
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Miyazawa Y, Takei H, Kobayashi N, Akashi N, Sairenji Y, Sugisaki M, Naito C, Ishikawa T, Shimizu H, Ishizaki T, Yokohama A, Tsukamoto N, Yoshida Y, Matsumura N, Takayama Y, Handa H. Two cases of follicular lymphoma with MYC gene abnormalities that presented with bone marrow necrosis. J Clin Exp Hematop 2022; 62:208-216. [PMID: 36261333 PMCID: PMC9898713 DOI: 10.3960/jslrt.22004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Bone marrow necrosis (BMN) occurs most frequently in hematological malignancies and sometimes in non-hematological disorders. Lymphoid diseases causing necrosis are regarded as high-grade disease. B-lymphoblastic leukemia/lymphoma is the most common malignant cause of BMN. Here, we present two patients with follicular lymphoma (FL) and MYC gene abnormalities who developed BMN. In one case of BMN, the necrosis disappeared in response to chemotherapy, and the patient survived with complete remission. In the other case, BMN remained even after chemotherapy, and effective chemotherapy could not be administered due to suppressed hematopoiesis, which led to the lymphoma worsening and the patient's death. Indolent lymphomas, such as FL, as in these cases, have the potential to develop BMN. It is important to detect the development of BMN and administer chemotherapy early to improve patient prognosis, since severe BMN prevents patients from receiving effective treatment.
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Affiliation(s)
- Yuri Miyazawa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hisashi Takei
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Nobuhiko Kobayashi
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Naoki Akashi
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yukiko Sairenji
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Manato Sugisaki
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Chiaki Naito
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tetsuya Ishikawa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroaki Shimizu
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takuma Ishizaki
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Akihiko Yokohama
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Norifumi Tsukamoto
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yuka Yoshida
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Nozomi Matsumura
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yoshiyasu Takayama
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Handa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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6
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Mishra S, Padhi S, Mohapatra S, Panigrahi A, Das PK, Adhya AK, Patra S, Mishra P, Bhuyan B. Bone marrow trephine immunohistochemistry is useful in characterizing malignancy-associated myelonecrosis: A retrospective observational study. Int J Lab Hematol 2021; 43:1516-1523. [PMID: 34342935 DOI: 10.1111/ijlh.13671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/22/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aim to describe the utility of immunohistochemistry (IHC) in characterizing malignancy-associated myelonecrosis (MN) on bone marrow trephine biopsies (BMBx) as a part of initial workup. MATERIALS AND METHODS Patten and intensity of antigenic immunoexpression in necrotic tumor cells on BMBx were evaluated in a series of cases using standardized avidin-biotin-complex immunoperoxidase technique after heat-induced epitope retrieval and compared the same with viable tumor cells wherever available. RESULTS Fifteen out of 2494 (0.6%) cases (median age: 28 years; range: 4 to 66 years) had evidence of MN (extensive in eight, moderate in five, and focal in two) secondary to hematological (N = 9) and solid (N = 6) malignancies. Five (33.3%) had pancytopenia, and eight (53.3%) had difficult and/or hemodiluted aspirate. Antigenic expression for CD10, CD79a, CD3, CD7, and CD20 was retained by necrotic leukemic blasts or lymphoma cells; CD34, TdT, and PAX5 showed heterogeneous expression; and a weak Golgi zone (dot like) CD30 positivity was noted in Reed-Sternberg (RS) or RS-like giant cells. Necrotic epithelial metastases retained pancytokeratin in all and showed variable positivity for prostate-specific antigen, carcinoembryonic antigen, CK20, ER, PR, and GATA3. Necrotic neuroblastomas (N = 2) retained positivity for synaptophysin and chromogranin, whereas retained nuclear positivity for NKX2.2 in necrotic Ewing family of tumor (N = 1) aided in early diagnosis. CONCLUSION Myelonecrosis may retain tumor antigenicity, and immunohistochemistry using selected panel of antibodies should be tried in such challenging cases for an early presumptive diagnosis and further decision making.
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Affiliation(s)
- Shruti Mishra
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Somanath Padhi
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sonali Mohapatra
- Department of Medical Oncology/Hematology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Ashutosh Panigrahi
- Department of Medical Oncology/Hematology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Prabodha Kumar Das
- Department of Medical Oncology/Hematology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Amit Kumar Adhya
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Susama Patra
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pritinanda Mishra
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Biswajit Bhuyan
- Department of Medical Oncology/Hematology, All India Institute of Medical Sciences, Bhubaneswar, India
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7
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Lozano-Chinga M, Draper L, George TI, Agarwal AM, Dansie DM, Maese L. Bone marrow necrosis in pediatric malignancies: 10-Year retrospective review and review of literature. Pediatr Blood Cancer 2021; 68:e28806. [PMID: 33314722 DOI: 10.1002/pbc.28806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022]
Abstract
Bone marrow necrosis (BMN) is a rare pathologic finding, but when encountered is most often associated with malignancy. In adults, its presence correlates with an inferior prognosis, however in children the prognostic implication is unclear. We performed a retrospective review of 3,760 bone marrow specimens in patients ≤18 years over a 10-year period. BMN was identified in less than 1% of specimens and only in patients with leukemia, lymphoma, or neuroblastoma. BMN contributed to a delay in diagnosis; however, advanced medical imaging may serve as a tool to localize nonnecrotic areas for bone marrow sampling, facilitating an expedited diagnosis.
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Affiliation(s)
- Michell Lozano-Chinga
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| | - Lauren Draper
- Division of Hematology/Oncology, Saint Louis University, St. Louis, Missouri
| | - Tracy I George
- Division of Hematopathology, Department of Pathology, University of Utah, Salt Lake City, Utah.,ARUP Laboratories, Salt Lake City, Utah
| | - Archana M Agarwal
- Division of Hematopathology, Department of Pathology, University of Utah, Salt Lake City, Utah.,ARUP Laboratories, Salt Lake City, Utah
| | - David M Dansie
- Department of Medical Imaging, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Luke Maese
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
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Chen R, Wu J, Yang J, Wei C, Liang D, Du J, Li Y, Liu Q, Zhang Y, Deng L. Analysis and Clinical Characteristics of 23 Cases of Bone Marrow Necrosis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:e356-e364. [PMID: 33541793 DOI: 10.1016/j.clml.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bone marrow necrosis (BMN) is a rare secondary disorder of many discrepant neoplastic processes. The etiology is diverse, and malignancy is the most common background disease. PATIENTS AND METHODS Between 2005 and 2019, a total of 23 cases of BMN were detected and analyzed at Zhujiang Hospital and Nanfang Hospital. RESULTS In our study, the 40-60-year-old age group was the one with the highest incidence of BMN (n = 12, 52.2%). The background diseases of patients with BMN varied. Eighteen (78.3%) of 23 patients were diagnosed with hematologic diseases at the same time, most of which were acute B lymphocytic leukemia (n = 8, 34.8%). The complete blood count of these 23 patients noted a decrease in hemoglobin (100%), a decrease or increase in white blood cells and neutrophils, and thrombocytopenia (78.3%). The levels of lactate dehydrogenase (> 300 U/L) and serum ferritin (> 500 μg/L) were elevated in all patients, and 16 (94.1%) of 17 patients presented with increased d-dimer levels. The 2-week cumulative survival and 2-year cumulative survival of patients with BMN were 56.5% and 47.4%, respectively. The mortality probability within 2 weeks was 43.5%, and the adjusted mortality probability was 26.7% within 2 weeks to 2 years, indicating that patients with BMN had the greatest risk of death within 2 weeks. CONCLUSION BMN patients with B lymphocytic leukemia as the background disease had a better prognosis than those with other background diseases. BMN of unknown etiology may have an extremely poor prognosis. Therefore, diagnosing the background disease plays an important role in the treatment of BMN.
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Affiliation(s)
- Ruge Chen
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jun Wu
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jilong Yang
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Cong Wei
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Dan Liang
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jingwen Du
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuhua Li
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qifa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yu Zhang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - Lan Deng
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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9
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Chan AS, Marvania NV, Burley NB, Martinez R. Unexpected and Deadly: Three Cases of Bone Marrow Necrosis. Cureus 2020; 12:e9565. [PMID: 32905546 PMCID: PMC7473607 DOI: 10.7759/cureus.9565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Bone marrow necrosis (BMN) is a rare pathological diagnosis, with an incidence of 0.3% to 2%. It is most often associated with hematological malignancies and less commonly due to solid tumors, infections, medications, sickle cell disease, chemotherapy, radiotherapy, or idiopathic causes. We reviewed bone marrow biopsies performed in our institution from 2009 to 2019 and found three cases of BMN. Two cases were secondary to neoplastic causes, while the third one was possibly from alcohol abuse.
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Affiliation(s)
- Abigail S Chan
- Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA
| | | | | | - Roberto Martinez
- Hematology and Oncology, Sinai Hospital of Baltimore, Baltimore, USA
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10
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Yarali N, Isik M, Arman-Bilir O, Guzelkucuk Z, Oguz-Erdogan AS. Bone Marrow Necrosis in a Patient Following Blinatumomab Therapy. J Pediatr Hematol Oncol 2020; 42:e167-e169. [PMID: 31219910 DOI: 10.1097/mph.0000000000001532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Bone marrow necrosis (BMN) is an extremely rare condition characterized by necrosis of the myeloid tissue and medullary stroma leaving an amorphous eosinophilic background and ill-defined necrotic cells in the hematopoietic bone marrow. Several conditions are associated with BMN, including sickle cell disease, metastatic carcinoma, and hematologic malignancies. It is also associated with the use of antineoplastic drugs, such as fludarabine, interferon alpha, and imatinib. Blinatumomab is a CD19/CD3 bispecific T-cell engager antibody which redirects autologous CD3-positive T cells to CD19-positive lymphoblasts creating a cytolytic synapse leading to blastic cells. Cytokine release syndrome, cerebral nervous system toxicities, and febrile neutropenia are the most frequent adverse effects of blinatumomab. Here, we report an adolescent boy with relapse/resistant acute lymphoblastic leukemia developing BMN following blinatumomab therapy. To our knowledge, this is the first case report on BMN following blinatumomab treatment.
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Affiliation(s)
- Nese Yarali
- Departments of Pediatric Hematology/Oncology
| | - Melek Isik
- Departments of Pediatric Hematology/Oncology
| | | | | | - Ayse Selcen Oguz-Erdogan
- Pathology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
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11
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Deucher A, Wool GD. How I investigate bone marrow necrosis. Int J Lab Hematol 2019; 41:585-592. [DOI: 10.1111/ijlh.13091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/15/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Anne Deucher
- Department of Laboratory Medicine University of California San Francisco California
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12
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Hilal T, Bansal P, Kelemen K, Slack J. Nivolumab-associated bone marrow necrosis. Ann Oncol 2019; 29:513-514. [PMID: 29351576 DOI: 10.1093/annonc/mdx643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- T Hilal
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, USA.
| | - P Bansal
- Division of Hematology/Oncology, University of New Mexico, Albuquerque, USA
| | - K Kelemen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, USA
| | - J Slack
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, USA
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13
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Diamantidis MD, Gogou V, Koletsa T, Metallidis S, Papaioannou M. Massive bone marrow necrosis revealing an HIV-related primary bone marrow lymphoma: a diagnostic challenge. Int J Hematol 2018; 109:125-129. [PMID: 30293217 DOI: 10.1007/s12185-018-2542-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 11/24/2022]
Abstract
Bone marrow necrosis (BMN) is a condition that can be difficult to diagnose, requiring a hematologist experienced in bone marrow morphology. This diagnostic challenge should alert the clinician of a severe disease or a possible underlying malignancy, either hematological or a solid tumor. We describe the concomitant presence of a primary bone marrow lymphoma (diffuse large B-cell lymphoma-DLBCL), along with an extensive BMN in an HIV patient for the first time in a living individual. HIV infection, BMN and DLBCL presented a multifactorial crossword of molecular events underlying the complex pathophysiology. The exact precipitating pathophysiological events resulting in BMN remain obscure and provide their clear impact for future research. The present report is instructive and also contains a critical review of the literature related to the case presented.
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Affiliation(s)
- Michael D Diamantidis
- Department of Haematology, First Department of Internal Medicine, Faculty of Medicine, AHEPA General Hospital, Aristotle University of Thessaloniki (AUTH), S. Kiriakidi St. 1, 54 636, Thessaloniki, Greece
| | - Vasiliki Gogou
- Department of Haematology, First Department of Internal Medicine, Faculty of Medicine, AHEPA General Hospital, Aristotle University of Thessaloniki (AUTH), S. Kiriakidi St. 1, 54 636, Thessaloniki, Greece
| | - Triantafyllia Koletsa
- Department of Pathology, Faculty of Medicine, AHEPA General Hospital, Aristotle University of Thessaloniki (AUTH), S. Kiriakidi St. 1, 54 636, Thessaloniki, Greece
| | - Simeon Metallidis
- Department of Haematology, First Department of Internal Medicine, Faculty of Medicine, AHEPA General Hospital, Aristotle University of Thessaloniki (AUTH), S. Kiriakidi St. 1, 54 636, Thessaloniki, Greece
| | - Maria Papaioannou
- Department of Haematology, First Department of Internal Medicine, Faculty of Medicine, AHEPA General Hospital, Aristotle University of Thessaloniki (AUTH), S. Kiriakidi St. 1, 54 636, Thessaloniki, Greece.
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14
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Ducourneau B, Hemar C. Bone marrow necrosis in neuroendocrine tumor of the thymus. Clin Case Rep 2018; 6:1970-1971. [PMID: 30349709 PMCID: PMC6186880 DOI: 10.1002/ccr3.1728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 06/19/2018] [Accepted: 06/27/2018] [Indexed: 01/18/2023] Open
Abstract
The prognosis of patients with marrow necrosis secondary to neoplastic disease (often gastric adenocarcinoma) was found to be extremely poor with a median overall survival (OS) of few months. This case confirms the very poor prognosis and shows an association with a neural endocrine adenocarcinoma of the thymus.
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Affiliation(s)
- Benoît Ducourneau
- Laboratory of HematologyHospital center of ValenciennesValenciennesFrance
- Laboratory of HematologyBiology and Pathology CenterLilleFrance
| | - Claire Hemar
- Laboratory of HematologyHospital center of ValenciennesValenciennesFrance
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15
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Sui J, Zhang Y, Yang L, Wang H, Xu J, Wei R, Hao Y, Wang X, Peng J, Ma J. Successful treatment with rivaroxaban of cerebral venous thrombosis and bone marrow necrosis induced by pegaspargase: A case report and literature review. Medicine (Baltimore) 2017; 96:e8715. [PMID: 29145310 PMCID: PMC5704855 DOI: 10.1097/md.0000000000008715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
RATIONALE Pegaspargase has been used in the treatment of acute lymphoblastic leukemia with promising results. However, it has also been associated with several potentially serious complications, including thrombosis. Pegaspargase-induced cerebral venous thrombosis and bone marrow necrosis are very rare. PATIENT CONCERNS A 50-year-old female developed headache, weakness of the right lower extremity, fever, and bone pain after chemotherapy including pegaspargase for the treatment of acute lymphoblastic leukemia. DIAGNOSES Her imaging studies and bone marrow examinations were compatible with cerebral venous thrombosis and bone marrow necrosis. INTERVENTIONS The patient received anticoagulation therapy with rivaroxaban. OUTCOMES After treatment with rivaroxaban, she had a good outcome without major or minor bleeding. LESSONS Clinicians should be aware of the very rare but possible induction of bone marrow necrosis during pegaspargase treatment when there is necrosis in other organs. Because of its greater safety and convenience, rivaroxaban gains popularity over traditional anticoagulant drugs.
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Affiliation(s)
- Jingrui Sui
- Department of Hematology, Qilu Hospital, Shandong University, Jinan
- Department of Hematology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai
| | - Yongming Zhang
- Department of Hepatobiliary Surgery, Yantaishan Hospital, Yantai
| | - Liqing Yang
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai
| | - Hui Wang
- Department of Hematology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai
| | - Junqing Xu
- Department of Hematology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai
| | - Rongxia Wei
- Department of Hematology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai
| | - Yaping Hao
- Department of Endocrinology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China
| | - Xiaolei Wang
- Department of Hematology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai
| | - Jun Peng
- Department of Hematology, Qilu Hospital, Shandong University, Jinan
| | - Junjie Ma
- Department of Hematology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai
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Morton JM, George JN. Microangiopathic Hemolytic Anemia and Thrombocytopenia in Patients With Cancer. J Oncol Pract 2017; 12:523-30. [PMID: 27288467 DOI: 10.1200/jop.2016.012096] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The unexpected occurrence of thrombotic microangiopathy (TMA), characterized by microangiopathic hemolytic anemia and thrombocytopenia, in a patient with cancer requires urgent diagnosis and appropriate management. TMA is a term used to describe multiple syndromes caused by microvascular thrombosis, including thrombotic thrombocytopenic purpura (TTP), Shiga toxin-mediated hemolytic uremic syndrome, and complement-mediated TMA. In patients with cancer, systemic microvascular metastases and bone marrow involvement can cause microangiopathic hemolytic anemia and thrombocytopenia. This occurs most often in patients with known metastatic cancer, but microangiopathic hemolytic anemia and thrombocytopenia may occur unexpectedly in patients without known metastatic disease or be the presenting features of undiagnosed cancer. TMA may also be caused by commonly used chemotherapy agents, either through dose-dependent toxicity or an acute immune-mediated reaction. These causes of TMA must be distinguished from TTP, which results from a severe deficiency of ADAMTS13 and is the most common cause of TMA among adults without cancer. The importance of this distinction is to avoid inappropriate use of plasma exchange, which is associated with major complications. Plasma exchange is the essential treatment for TTP, but it has no known benefit for patients with cancer-induced or drug-induced TMA. We will describe cancer-induced and drug-induced TMA using the experience of the Oklahoma TTP-Hemolytic Uremic Syndrome Registry and data from a systematic review of all published reports of drug-induced TMA. We will illustrate the principles of evaluation and management of these disorders with patients' stories.
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Affiliation(s)
- Jordan M Morton
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - James N George
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
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17
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Affiliation(s)
- M H A Noureldine
- 1 Department of Neurosurgery, Lebanese American University Medical Center, Beirut, Lebanon
| | - I Uthman
- 2 Division of Rheumatology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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18
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Karafin MS, Singavi A, Johnson ST, Field JJ. A Fatal Case of Immune Hyperhemolysis with Bone Marrow Necrosis in a Patient with Sickle Cell Disease. Hematol Rep 2017; 9:6934. [PMID: 28286630 PMCID: PMC5337824 DOI: 10.4081/hr.2017.6934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/19/2016] [Accepted: 11/21/2016] [Indexed: 11/28/2022] Open
Abstract
In patients with sickle cell disease, hyperhemolysis is a rare but life-threatening complication of transfusion. In this case report, we describe a 61 year-old woman with hemoglobin sickle cell (SC) disease and history of alloimmunization who developed hyperhemolysis associated with a transfusion. She was found to have a warm and a clinically-significant cold autoantibody. Severe anemia (Hb 2.7 g/dL) with reticulocytopenia and thrombocytopenia prompted a bone marrow biopsy, which demonstrated extensive bone marrow necrosis. Despite treatment, the bone marrow failure did not improve and the patient died on hospital day 38. This case illustrates the potential risks of transfusion in a patient with sickle cell disease, especially one with previous hemolytic reactions. While uncommon, hyperhemolysis can cause death, in this case by extensive bone marrow necrosis. In patients with sickle cell disease, judicious use of red cell transfusions with phenotypically-matched units can diminish, but never completely abrogate, the risks associated with transfusion.
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Affiliation(s)
- Matthew S Karafin
- Medical Sciences Institute, Blood Center of Wisconsin, Milwaukee, WI; Medical College of Wisconsin, Milwaukee, WI, USA
| | - Arun Singavi
- Medical College of Wisconsin , Milwaukee, WI, USA
| | - Susan T Johnson
- Medical Sciences Institute , Blood Center of Wisconsin, Milwaukee, WI
| | - Joshua J Field
- Medical Sciences Institute, Blood Center of Wisconsin, Milwaukee, WI; Medical College of Wisconsin, Milwaukee, WI, USA
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19
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Bone Marrow Necrosis in Newly Diagnosed Acute Leukemia: Two Case Reports and Review of the Literature. Oncol Ther 2017; 5:111-118. [PMID: 28680961 PMCID: PMC5488115 DOI: 10.1007/s40487-017-0041-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Indexed: 12/21/2022] Open
Abstract
Bone marrow necrosis (BMN) in acute leukemia is a rare histopathological entity at the time of initial diagnosis. However, it represents an important diagnostic and prognostic challenge. Two cases of BMN are reported: a 44-year-old patient with B cell precursor (BCP) acute lymphoblastic leukemia (ALL) and a 27-year-old man with FAB-M5 acute myeloid leukemia (AML) who both presented with bone marrow failure and extensive necrosis. From these clinical cases, we conducted a brief review of the literature.
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May J, Sullivan JC, LaVie D, LaVie K, Marques MB. Inside Out: Bone Marrow Necrosis and Fat Embolism Complicating Sickle-β+ Thalassemia. Am J Med 2016; 129:e321-e324. [PMID: 27296331 DOI: 10.1016/j.amjmed.2016.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Jori May
- Department of Medicine at the University of Alabama at Birmingham.
| | | | - Daniel LaVie
- Department of Medicine at the University of Alabama at Birmingham
| | - Katherine LaVie
- Department of Medicine at the University of Alabama at Birmingham
| | - Marisa B Marques
- Department of Pathology at the University of Alabama at Birmingham
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21
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Sharma R, Gajendra S, Jain S, Gupta SK, Sachdev R. Multiple Myeloma: An Unusual Cause of Extensive Bone Marrow Necrosis. J Clin Diagn Res 2016; 10:XL01-XL02. [PMID: 27504393 DOI: 10.7860/jcdr/2016/18035.7914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 03/24/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Rashi Sharma
- Senior Resident, Department of Pathology and Laboratory Medicine, Medanta-The Medicity , Sector - 38, Gurgaon, Haryana, India
| | - Smeeta Gajendra
- Associate Consultant, Department of Pathology and Laboratory Medicine, Medanta-The Medicity , Sector - 38, Gurgaon, Haryana, India
| | - Swachi Jain
- Junior Resident, Department of Pathology and Laboratory Medicine, Medanta-The Medicity , Sector - 38, Gurgaon, Haryana, India
| | - Sunil Kumar Gupta
- Consultant, Department of Hematology and Medical Oncology, Medanta-The Medicity , Sector - 38, Gurgaon, Haryana, India
| | - Ritesh Sachdev
- Senior Consultant, Department of Pathology and Laboratory Medicine, Medanta-The Medicity , Sector - 38, Gurgaon, Haryana, India
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22
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High frequency of infection with tuberculosis as the most common cause of bone marrow necrosis: a study from tertiary care centre in northern India and their clinico-pathologic analysis. J Hematop 2015. [DOI: 10.1007/s12308-015-0244-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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