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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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Milosevic I, Vlaisavljevic N, Ilic Sabo J. A rare case of embryonal rhabdomyosarcoma with tumor cells in peripheral blood mimicking acute leukemia. J Hematop 2023; 16:241-242. [PMID: 38175428 DOI: 10.1007/s12308-023-00558-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/10/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Ivana Milosevic
- Faculty of Medicine, University of Novi Sad, University Clinical Centre of Vojvodina, Novi Sad, Serbia.
| | | | - Jelena Ilic Sabo
- Faculty of Medicine, University of Novi Sad, University Clinical Centre of Vojvodina, Novi Sad, Serbia
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Cheng JJ, Mott RT, Savage PD, Paluri RK. Metastatic Alveolar Rhabdomyosarcoma with Extensive Bone Marrow Replacement in an Older Adult. Case Rep Oncol 2021; 14:1505-1510. [PMID: 34899243 PMCID: PMC8613543 DOI: 10.1159/000519595] [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] [Received: 07/22/2021] [Accepted: 09/11/2021] [Indexed: 11/19/2022] Open
Abstract
Rhabdomyosarcoma is extremely rare in adults. Metastatic rhabdomyosarcoma can resemble other malignancies, which can delay diagnosis and prompt treatment. This case illustrates an example of metastatic alveolar rhabdomyosarcoma with concurrent bone marrow infiltration. A 67-year-old woman presented with epistaxis and diffuse bone pain. She developed progressive thrombocytopenia requiring platelet transfusions. The patient was initially thought to have leukemia. She was found to have a large sinonasal mass with extensive metastatic disease and bone marrow infiltration. The patient was ultimately diagnosed with metastatic alveolar rhabdomyosarcoma. She was started on chemotherapy with vincristine, actinomycin, and cyclophosphamide. Unfortunately, she died prior to discharge home. Alveolar rhabdomyosarcoma can resemble a primary bone marrow malignancy when it infiltrates the bone marrow. Further investigation is needed to clarify its clinical behavior and expedite diagnosis and treatment.
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Affiliation(s)
- Justin J Cheng
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ryan T Mott
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Paul D Savage
- Section of Hematology and Oncology, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ravi K Paluri
- Section of Hematology and Oncology, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Jagdale RV, Pol JN. Alveolar rhabdomyosarcoma of urinary bladder presenting as acute leukemia: A diagnostic trap. INDIAN J PATHOL MICR 2021; 63:623-626. [PMID: 33154320 DOI: 10.4103/ijpm.ijpm_850_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rhabdomyosarcoma (RMS) masquerading as acute leukemia (AL) is very rare. We report a case which presented as acute leukemia subsequently diagnosed to be Alveolar RMS of Urinary Bladder. Although cases of RMS with leukemic presentation have been reported, to our knowledge this is the first case of Alveolar RMS of Urinary Bladder with leukemic picture at initial presentation. We would like to emphasize that this critical error can have serious consequences on the treatment and outcome of these patients.
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Affiliation(s)
- Rakhi V Jagdale
- Department of Pathology, Shri Siddhivinayak Ganapati Cancer Hospital, Miraj, Maharashtra, India
| | - Jaydeep N Pol
- The Oncopathology Centre, Mahatma Gandhi Cancer Hospital, Miraj, Maharashtra, India
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De Miguel Sánchez C, Robles de Castro D, Córdoba Alonso AI, Guinea de Castro JM. Diffuse bone marrow metastases of small cell carcinoma with associated erythrophagocytosis mimicking acute leukaemia. Hematol Transfus Cell Ther 2021; 44:459-461. [PMID: 34266809 PMCID: PMC9477751 DOI: 10.1016/j.htct.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/30/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
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Pasvolsky O, Heiman L, Popovtzer A, Zimra Y, Rabizadeh E, Barshack I, Mardoukh C, Raanani P, Rozovski U. Genomic analysis of metastatic rhabdomyosarcoma masquerading as acute leukemia. Pathol Res Pract 2019; 216:152779. [PMID: 31813602 DOI: 10.1016/j.prp.2019.152779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/01/2019] [Accepted: 12/01/2019] [Indexed: 10/25/2022]
Abstract
Blast appearing cells in the peripheral blood and bone marrow may occasionally arise from non-hematopoietic tissues. We present a 58 year old female who presented at our emergency room with symptomatic pancytopenia. Several months earlier she was diagnosed and treated for rhabdomyosracoma of the nasopharynx and entered remission. When we examined the bone-marrow aspirate we estimated the number of blasts at 25 %. Based on this evaluation, a provisional diagnosis of acute leukemia was made. However, immunohistochemistry and flow cytometry analysis revealed that the cells presumed to be blasts were in fact rhabdomyosarcoma cells masquerading as leukemia. The mutational landscapes of the primary tumor and the bone marrow metastasis had similar yet distinct profiles. Annotation analysis suggested that the primary and metastatic tumors use alternate mutations to activate the RAS/AKT signaling pathways. In this case, looking beyond the mutational profiling revealed an additional layer of similarity between both the original and metastatic samples, exposing a common and possibly targetable pathway. Application of annotation tools in clinical practice could enable extraction of valuable information from somatic mutational gene panels.
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Affiliation(s)
- Oren Pasvolsky
- Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lucille Heiman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pathology, Rabin Medical Center, Petah Tikva, Israel
| | - Aron Popovtzer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Head and Neck Tumor Unit, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Yael Zimra
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Hemato-Oncology Laboratory, Felsenstein Medical Research Center, Rabin Medical Center, Petah Tikva, Israel
| | - Esther Rabizadeh
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Hemato-Oncology Laboratory, Felsenstein Medical Research Center, Rabin Medical Center, Petah Tikva, Israel
| | - Iris Barshack
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pathology, Sheba Medical Center, Israel
| | - Corine Mardoukh
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pathology, Sheba Medical Center, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Rozovski
- Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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López‐Andrade B, Duran MA, Torres L, García‐Recio M, Lo Riso L, Formica A, Ramos RF, Cerda N, Sampol A. Rhabdomyosarcoma debut masquerading as acute lymphoblastic leukemia: A case report and review of the literature. Clin Case Rep 2019; 7:1545-1548. [PMID: 31428386 PMCID: PMC6693075 DOI: 10.1002/ccr3.2284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/18/2019] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
Bone marrow infiltration by alveolar rhabdomyosarcoma is uncommon, some cases can mimicry acute leukemia at presentation and mislead the diagnosis. The integration of diagnostics tests and techniques in uncommon malignancies is important to suspect and reach the diagnosis and avoid delay on treatment. We report a case of alveolar rhabdomyosarcoma bone marrow infiltration associated with hemophagocytosis and cell cannibalism, mimicking acute leukemia at presentation.
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Affiliation(s)
| | - Maria Antonia Duran
- Servicio Hematología y HemoterapiaHospital Universitario Son EspasesPalma MallorcaSpain
| | - Lourdes Torres
- Servicio Hematología y HemoterapiaHospital Can MisesIbizaSpain
| | - Marta García‐Recio
- Servicio Hematología y HemoterapiaHospital Universitario Son EspasesPalma MallorcaSpain
| | - Laura Lo Riso
- Servicio Hematología y HemoterapiaHospital Universitario Son EspasesPalma MallorcaSpain
| | - Alejandro Formica
- Servicio Hematología y HemoterapiaHospital Universitario Son EspasesPalma MallorcaSpain
| | - Rafael F. Ramos
- Servicio Anatomía patológicaHospital Universitario Son EspasesPalma MallorcaSpain
| | - Niurka Cerda
- Servicio Anatomía patológicaHospital Can MisesIbizaSpain
| | - Antonia Sampol
- Servicio Hematología y HemoterapiaHospital Universitario Son EspasesPalma MallorcaSpain
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Pushpam D, Raj A, Batra A, Bakhshi S. Occam's Razor versus Hickam's Dictum: An Unusual Cause of Acute Renal Failure in Pediatric Solid Malignancy. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_54_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Deepam Pushpam
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Raj
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Batra
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Su Y, Wang X, Yang J, Zhao W, Duan C, Jin M, Ma X. Alveolar rhabdomyosarcoma with bone marrow metastasis causes disseminated intravascular coagulation. Pediatr Investig 2018; 2:263-266. [PMID: 32851277 PMCID: PMC7331434 DOI: 10.1002/ped4.12102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yan Su
- Beijing Key Laboratory of Pediatric Hematology OncologyNational Discipline of PediatricsMinistry of EducationMOE Key Laboratory of Major Diseases in ChildrenHematology Oncology CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Xisi Wang
- Beijing Key Laboratory of Pediatric Hematology OncologyNational Discipline of PediatricsMinistry of EducationMOE Key Laboratory of Major Diseases in ChildrenHematology Oncology CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Jing Yang
- Beijing Key Laboratory of Pediatric Hematology OncologyNational Discipline of PediatricsMinistry of EducationMOE Key Laboratory of Major Diseases in ChildrenHematology Oncology CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Wen Zhao
- Beijing Key Laboratory of Pediatric Hematology OncologyNational Discipline of PediatricsMinistry of EducationMOE Key Laboratory of Major Diseases in ChildrenHematology Oncology CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Chao Duan
- Beijing Key Laboratory of Pediatric Hematology OncologyNational Discipline of PediatricsMinistry of EducationMOE Key Laboratory of Major Diseases in ChildrenHematology Oncology CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Mei Jin
- Beijing Key Laboratory of Pediatric Hematology OncologyNational Discipline of PediatricsMinistry of EducationMOE Key Laboratory of Major Diseases in ChildrenHematology Oncology CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Xiaoli Ma
- Beijing Key Laboratory of Pediatric Hematology OncologyNational Discipline of PediatricsMinistry of EducationMOE Key Laboratory of Major Diseases in ChildrenHematology Oncology CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
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Nazco Deroy Á, Martín Batista S, Álvarez-Argüelles Cabrera H, García Hernández S, Raya Sánchez JM. Nasal embryonal rhabdomyosarcoma with bone marrow metastasis simulating acute leukemia: A case report and review of the literature. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2018; 52:87-91. [PMID: 30902383 DOI: 10.1016/j.patol.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/05/2018] [Accepted: 08/15/2018] [Indexed: 11/29/2022]
Abstract
We present a case of a nasal rhabdomyosarcoma (RMS) in a 27-year-old male with epistaxis and nasal obstruction due to a mass, which was subjected to prophylactic tumor embolization. However, histopathological study on the nasal biopsy was impossible due to necrotic changes. As blast cells were present in peripheral blood samples, a bone marrow biopsy was recommended in order to reach a definitive diagnosis. The possibility of an RMS in cases of bone marrow infiltration by a diffuse tumor constituted by small, round, blast-like cells mimicking acute leukemia should be assessed. Immunohistochemical staining in bone marrow biopsy and flow cytometry in aspirate samples may help to establish the diagnosis (CD45 negativity and CD56 positivity) and cytogenetic studies can be useful in identifying a RMS subtype. When clinically possible, it is desirable to await the results of the tumor immunophenotype and those of the primary mass or bone marrow biopsy to avoid possible errors of diagnosis and treatment.
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Affiliation(s)
- Ángel Nazco Deroy
- Department of Pathology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain.
| | - Silvia Martín Batista
- Department of Haematology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | | | - Sonia García Hernández
- Department of Pathology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - José María Raya Sánchez
- Department of Haematology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
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Li X, Li W, Mo W, Yang Z. Acute lymphoblastic leukemia arising after treatment of Ewing sarcoma was misdiagnosed as bone marrow metastasis of Ewing sarcoma: A case report. Medicine (Baltimore) 2018; 97:e9644. [PMID: 29505001 PMCID: PMC5779770 DOI: 10.1097/md.0000000000009644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Both acute lymphoblastic leukemia (ALL) and Ewing sarcoma (ES) are small round cell tumors, and it is difficult to differential diagnose them because of overlapping clinical, radiographic, histologic, and immunophenotypic features. PATIENT'S CONCERNS A 5-year-old boy was admitted to our hospital because of pains in his left leg without obvious inducement and lameness worsening with walking over a two 2-month period. DIAGNOSES Based on the comprehensive analysis of radiography, magnetic resonance imaging (MRI), pathology biopsy and immunohistochemistry, the lesion was confirmed to be ES. INTERVENTIONS The patient received neoadjuvant chemotherapy with 2 cycles of VAC (vincristine 1 mg/m, adriamycin 50 mg/m, cyclophosphamide 800 mg/m) and 2 cycles of IE (ifosfamide 1.2 g/m, etoposide 70 mg/m, mesna 1.2 g/m) regimens. OUTCOMES After 16 months, the results of routine blood tests showed reduced hemoglobin levels and decreased platelet counts. In addition, blast-like cells were found in a peripheral blood smear. All of the results suggested that the patient should undergo bone marrow aspiration and biopsy, which showed blast-like cells similar to that observed in cases of ES. Thus, a diagnosis of bone marrow metastasis of ES was established. However, when combined with immunohistochemistry data and medical history, the patient was eventually diagnosed as ALL arising after treatment of ES. LESSONS When there was an abnormality in peripheral blood, it was easily misdiagnosed as bone marrow metastasis of ES after ES patient received neoadjuvant chemotherapy. We should jointly analyze bone marrow aspiration smear, bone marrow biopsy, immunohistochemistry, analysis of the medical history, even cytogenetic and molecular analysis for differential diagnosis.
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