1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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
| | | |
Collapse
|
5
|
Dong P, Tian R, Li L, Su M. Bone marrow necrosis secondary to metastatic adenocarcinoma revealed by 18F-FDG PET/CT: A clinical case report. Medicine (Baltimore) 2017; 96:e9067. [PMID: 29245317 PMCID: PMC5728932 DOI: 10.1097/md.0000000000009067] [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: 02/05/2023] Open
Abstract
RATIONALE Bone marrow necrosis (BMN) is a rare malignancy-associated hematologic disorder characterized by necrosis of myeloid and stromal marrow elements with preservation of cortical bone. PATIENT CONCERNS A 43-year-old female complaining of dizziness and vaginal bleeding for more than 2 months was presented to our department. DIAGNOSIS Due to the laboratory test results, radiographic findings, especially F-fluoro-2-deoxy-D-glucose (F-FDG) positron emission tomography/computed tomography (PET/CT) which revealed that bone marrow was characterized by diffuse F-FDG uptake with extensive central photopenia, and pathologic results, she was diagnosed with metastatic adenocarcinoma accompanied with BMN. And the cancer most likely originated from reproductive system or breast. INTERVENTIONS There was no effective interventions for her before knowing the accurate origin of adenocarcinoma. OUTCOMES Two weeks later, unfortunately, she died. LESSONS F-FDG PET/CT is a useful diagnostic modality in patients with BMN. Malignant tumor should always be considered in patients with extensive BMN, even in young people.
Collapse
|
6
|
Kolesar JM, Morris AK, Kuhn JG. Review : Purine nucleoside analogues: Fludarabine, pentostatin, and cladribine. J Oncol Pharm Pract 2016. [DOI: 10.1177/107815529600200307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose. An introductory template for an extensive discussion of the pharmacology, pharmacokinetics, clinical use and adverse effects of the currently ap proved adenosine analogues: fludarabine, pentostatin, and cladribine is profiled. This is part one of a three-part series. Data Sources. We reviewed the literature through a MEDLINE search from 1986 to 1996. Relevant articles cited in literature obtained by MEDLINE searching were also considered. We searched the following terms: fludarabine, cladribine, pentostatin, apoptosis and adenosine ana logues. The search was restricted to the English language. We have incorporated pricing information from our prac tice sites as well as the average wholesale price for the purpose of cost comparison. Data Extraction. We have reviewed the current literature with regard to the chemistry, mechanisms of action and pharmacology, pharmacokinetics, clinical use, adverse effects, drug interactions, indications, formulation, dosage, administration, pharmaceutical issues and a cost comparison of the currently approved adenosine ana logues, fludarabine, pentostatin, and cladribine. Data Synthesis. The adenosine analogues are struc turally similar agents used in the management of hemato logical malignancies. Fludarabine and cladribine exhibit significant activity in CLL (chronic lymphocytic leukemia) and NHL (non-Hodgkin's lymphoma) and pentostatin and cladribine are both active in the treatment of hairy cell leukemia. There are no comparative clinical trials between the agents and we have provided comparisons based on pharmacology, clinical experience, adverse effects and cost as well as reviewing the clinical use of these agents. Conclusion. The adenosine analogues, fludarabine, pentostatin, and cladribine, represent an important ad vance in the treatment of indolent lymphoid malignancies. Although response rates for fludarabine and cladribine in chronic lymphocytic leukemia and for pentostatin and cladribine in hairy cell leuemia are improved over standard therapy, the true clinical impact of these agents has not yet been realized. Additional studies in larger populations of both previously treated and untreated patients, as well as comparative trials between the deoxyadenosine analogues themselves need to be carried out. Moreover, combination chemotherapy trials with deoxyadenosine analogues and other cytotoxic agents need to be performed to determine the efficacy and toxicity of these combinations in various lymphoid malignancies.
Collapse
Affiliation(s)
- Jill M. Kolesar
- University of Texas Health Science Center in San Antonio, Clinical Pharmacy Programs, San Antonio, Texas
| | - Ashley K. Morris
- University of Texas Health Science Center in San Antonio, Clinical Pharmacy Programs, San Antonio, Texas, The Audie Murphy Veterans Affairs Hospital, San Antonio, Texas
| | - John G. Kuhn
- University of Texas Health Science Center in San Antonio, Clinical Pharmacy Programs, San Antonio, Texas
| |
Collapse
|
7
|
Noureldine MHA, Khamashta MA, Merashli M, Sabbouh T, Hughes GRV, Uthman I. Musculoskeletal manifestations of the antiphospholipid syndrome. Lupus 2016; 25:451-62. [DOI: 10.1177/0961203316636467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/01/2016] [Indexed: 11/17/2022]
Abstract
The scope of clinical and laboratory manifestations of the antiphospholipid syndrome (APS) has increased dramatically since its discovery in 1983, where any organ system can be involved. Musculoskeletal complications are consistently reported in APS patients, not only causing morbidity and mortality, but also affecting their quality of life. We reviewed all English papers on APS involvement in the musculoskeletal system using Google Scholar and Pubmed; all reports are summarized in a table in this review. The spectrum of manifestations includes arthralgia/arthritis, avascular necrosis of bone, bone marrow necrosis, complex regional pain syndrome type-1, muscle infarction, non-traumatic fractures, and osteoporosis. Some of these manifestations were reported in good quality studies, some of which showed an association between aPL-positivity and the occurrence of these manifestations, while others were merely described in case reports.
Collapse
Affiliation(s)
- M H A Noureldine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - M A Khamashta
- Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, King’s College University, London, UK
| | - M Merashli
- Division of Rheumatology, The Royal London Hospital, London, UK
| | - T Sabbouh
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - G R V Hughes
- London Lupus Center, London Bridge Hospital, London, UK
| | - I Uthman
- Division of Rheumatology, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
8
|
Pan Y, Wang X, Wang C, Zhang Q, Xi R, Bai J, Bai H. Extensive bone marrow necrosis resolved by allogeneic umbilical cord blood mesenchymal stem cell transplantation in a chronic myeloid leukemia patient. Bone Marrow Transplant 2015; 50:1265-8. [PMID: 25961769 DOI: 10.1038/bmt.2015.60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Y Pan
- Department of Hematology, Lanzhou General Hospital, Lanzhou, China
| | - X Wang
- Department of Hematology, Lanzhou General Hospital, Lanzhou, China
| | - C Wang
- Department of Hematology, Lanzhou General Hospital, Lanzhou, China
| | - Q Zhang
- Department of Hematology, Lanzhou General Hospital, Lanzhou, China
| | - R Xi
- Department of Hematology, Lanzhou General Hospital, Lanzhou, China
| | - J Bai
- Department of Hematology, Lanzhou General Hospital, Lanzhou, China
| | - H Bai
- Department of Hematology, Lanzhou General Hospital, Lanzhou, China
| |
Collapse
|
9
|
Wool GD, Deucher A. Bone marrow necrosis: ten-year retrospective review of bone marrow biopsy specimens. Am J Clin Pathol 2015; 143:201-13; quiz 306. [PMID: 25596246 DOI: 10.1309/ajcp0tn1mcmolmpk] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Bone marrow can undergo necrosis for many different causes; malignant causes are reported to be more frequent. METHODS We undertook a 10-year retrospective review of all bone marrow biopsy specimens with bone marrow necrosis at our institution. RESULTS Identified cases represented approximately 0.3% of our bone marrow cases. Most identified bone marrow cases with necrosis were involved by metastatic tumor or hematolymphoid malignancy (90% of total) in relatively equal proportions. In those cases of bone marrow necrosis with hematolymphoid malignancy, lymphoid disease predominated and the necrosis was often seen in the setting of chemotherapy. In metastatic tumor cases, necrosis seemed to enrich in prostate adenocarcinoma and Ewing sarcoma/primitive neuroectodermal tumor; neuroblastoma showed much less necrosis. Ten percent of patients with bone marrow necrosis had no underlying malignancy, and the associated causes varied. CONCLUSIONS The causes of bone marrow necrosis are diverse but should always prompt careful assessment for malignancy and infectious etiology.
Collapse
Affiliation(s)
- Geoffrey D. Wool
- Department of Pathology, University of Chicago, Chicago, IL
- Department of Laboratory Medicine, University of California, San Francisco
| | - Anne Deucher
- Department of Laboratory Medicine, University of California, San Francisco
| |
Collapse
|
10
|
Khoshnaw NSH, Al-Rawi HA, Nore BF. Precursor T-cell acute lymphoblastic leukemia presenting with bone marrow necrosis: a case report. J Med Case Rep 2012; 6:349. [PMID: 23057758 PMCID: PMC3492084 DOI: 10.1186/1752-1947-6-349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 08/29/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED INTRODUCTION Bone marrow necrosis is a clinicopathological condition diagnosed most often at postmortem examination, but it is also seen during the course of malignancy and is not always associated with a poor prognosis. The morphological features of bone marrow necrosis are disruption of the normal marrow architecture and necrosis of myeloid tissue and medullary stroma. Non-malignant conditions associated with bone marrow necrosis are sickle cell anemia, infections, drugs (sulfasalazine, interferon α, all-trans retinoic acid, granulocyte colony-stimulating factor and fludarabine), disseminated intravascular coagulation, antiphospholipid antibody syndrome and acute graft versus host diseases. The malignant causes are leukemia, lymphoma and metastatic carcinomas. Herein we report the case of a patient with precursor T-cell acute lymphoblastic leukemia and bone marrow necrosis at initial presentation. CASE PRESENTATION A 10-year-old Kurdish boy was presented with generalized bone pain and fever of 1 month's duration which was associated with sweating, easy fatigability, nose bleeding, breathlessness and severe weight loss. On examination, we observed pallor, tachypnea, tachycardia, low blood pressure, fever, petechial hemorrhage, ecchymoses, tortuous dilated veins over the chest and upper part of abdomen, multiple small cervical lymph node enlargements, mildly enlarged spleen, palpable liver and gross abdominal distention. Blood analysis revealed pancytopenia and elevated lactate dehydrogenase and erythrocyte sedimentation rate. Imaging results showed mediastinal widening on a planar chest X-ray and diffuse focal infiltration of the axial bone marrow on magnetic resonance imaging of the lumbosacral vertebrae. Bone marrow aspiration and biopsy examination showed extensive bone marrow necrosis. Immunophenotyping analysis of the bone marrow biopsy confirmed T-cell acute lymphoblastic leukemia, as CD3 and terminal deoxynucleotidyl transferase markers were positive and CD10, CD20 and CD79a markers were negative. CONCLUSION The aggressive initial clinical presentation of our patient with huge mediastinal widening, development of superior vein cava syndrome and extensive bone marrow necrosis as initial signs made the diagnosis of the case difficult. The necrotic hematopoietic cells gave inconclusive results on the initial immunohistochemistry tests. The prognosis of bone marrow necrosis is better secondary to acute lymphoblastic leukemia in the pediatric age group compared with adults and those with underlying solid tumors. Despite the aggressive behavior at initial presentation, the patient responded to chemotherapy and necrosis disappeared at day 28 after the start of the therapeutic regimen.
Collapse
Affiliation(s)
- Najmaddin S H Khoshnaw
- Department of Hematology, Hiwa Hematology-Oncology Center, Kurdistan Regional Government, Sulaimaniyah, Iraq.
| | | | | |
Collapse
|
11
|
|
12
|
Ferreira RA, Vastert SJ, Abinun M, Foster HE, Modesto C, Olivé T, Kuis W, Wulffraat NM. Hemophagocytosis during fludarabine-based SCT for systemic juvenile idiopathic arthritis. Bone Marrow Transplant 2006; 38:249-51. [PMID: 16770315 DOI: 10.1038/sj.bmt.1705415] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
13
|
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.
Collapse
Affiliation(s)
- Semra Paydas
- Department of Oncology, Cukurova University Faculty of Medicine, Balcal, Adana, Turkey.
| | | | | | | | | | | | | |
Collapse
|
14
|
Diebold J, Molina T, Camilleri-Broët S, Le Tourneau A, Audouin J. Bone marrow manifestations of infections and systemic diseases observed in bone marrow trephine biopsy review. Histopathology 2000; 37:199-211. [PMID: 10971695 DOI: 10.1046/j.1365-2559.2000.00965.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Bone marrow modifications resulting from infections and systemic diseases can be studied by analysis of morphology and aetiology. Two types of lesions or modifications can be observed, those occurring in the connective tissue comprising inflammatory processes, acute and chronic, as well as immune reactions, and those involving the normal haematopoietic cell lines, with possible hyperplastic or aplastic changes in one or more cell lines. The main lesions are described (oedema, haemorrhage, necrosis, suppuration, granulomas, lymphoid nodules and hyperplasia, immunoblastic or plasmacytic hyperplasia), as well as the main aetiologies. In association, the three main haematopoietic cell lines show hyperplasia, hypoplasia, aplasia of one or all of the cell lines, sometimes with dysmyelopoiesis. The stroma and vessel reactions comprise myelofibrosis, gelatinous transformation or amyloid deposits. The methods for identifying aetiological agents are emphasized. It should also be stressed that malignant neoplasias of different types involving the bone marrow can be responsible for such inflammatory or immune reactions.
Collapse
Affiliation(s)
- J Diebold
- Service Central 'Jacques-Delarue' d'Anatomie et de Cytologie Pathologiques, Hôtel-Dieu, Paris, France
| | | | | | | | | |
Collapse
|
15
|
|
16
|
Bashawri L, Satti MB. Bone marrow necrosis: report of five cases and review of the literature. Ann Saudi Med 2000; 20:78-82. [PMID: 17322755 DOI: 10.5144/0256-4947.2000.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- L Bashawri
- Department of Pathology, College of Medicine, King Faisal University, Dammam, Saudi Arabia
| | | |
Collapse
|
17
|
Abstract
Bone marrow necrosis is a rare clinical condition often associated with hematological malignancy. The mechanism by which malignant disease causes marrow necrosis is unknown. We present a case of a patient with newly diagnosed pancytopenia with bone marrow biopsy evidence of extensive marrow necrosis. Upon further work-up utilizing Tc bone scan directed bone marrow biopsy, a massive CD8+ T cell marrow infiltrate was discovered engulfing AML-M2 blasts. The role of Tc bone scans in the work-up of bone marrow necrosis as well as the potential mechanism of AML-M2 induced marrow necrosis in the setting of reactive CD8+ T cell infiltration is discussed.
Collapse
Affiliation(s)
- S N Markovic
- Division of Hematology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | | | | |
Collapse
|