1
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Singh A, Rawat S, Kushwaha R, Jain M, Verma SP, Verma N, Singh US. Bone marrow metastasis in nonhematological malignancies: A study from tertiary care center. Ann Afr Med 2024; 23:91-99. [PMID: 38358178 PMCID: PMC10922175 DOI: 10.4103/aam.aam_55_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/16/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction Metastatic cancer presents a treatment challenge to clinicians, particularly for patients with bone marrow infiltration. For tumor staging, therapy selection, and prognosis risk stratification, the status of the bone marrow should be known for the presence or absence of metastasis. The study aimed to evaluate the hematological findings and comprehensive analysis of bone marrow in cases of nonhematological malignancies with bone marrow metastasis. Materials and Methods This retrospective study comprised a record retrieval of the departmental archives for the past 6 years. A total of 331 patients with nonhematological malignancies were found, of whom 31.42% (104/331) showed bone marrow metastasis. An integrated clinical approach with bone marrow examination findings and immunohistochemistry whenever necessary was used to achieve a definitive diagnosis of bone marrow metastasis. Results Among the study population, 31.42% (104/331) of patients had nonhematological malignancies that metastasized to the bone marrow. Most of the patients with bone marrow metastasis had anemia, which was found in 77.88% (81/104) of the cases. Leukoerythroblastic reaction was noted in 31.73% (33/104) of the cases, and thrombocytopenia was found in 25% (26/104) of the cases. The most common malignancy with bone marrow metastasis in adults was prostatic adenocarcinoma (28.1%) (9/32) and in pediatric cases, neuroblastoma (53.9%) (52/98). Conclusions It is essential to diagnose nonhematological malignancies that have metastasized to the bone marrow since this necessitates tumor staging, therapy selection, and prognosis risk stratification. To conclude, not a single hematological parameter is predictive of bone marrow metastasis; however, unexplained anemia, a leukoerythroblastic blood picture, and thrombocytopenia in peripheral blood should raise suspicion for bone marrow metastasis in cases of nonhematological malignancies.
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Affiliation(s)
- Anurag Singh
- Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Shalini Rawat
- Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Rashmi Kushwaha
- Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Mili Jain
- Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Shailendra Prasad Verma
- Department of Clinical Hematology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Nishant Verma
- Department of Pediatrics, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Uma Shankar Singh
- Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India
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2
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Nozaki K, Matsushima H, Obikane H, Nishimoto R, Tanaka R, Morishige T, Masuda T, Kume H. Two cases of prostate cancer with disseminated carcinomatosis of the bone marrow treated with novel hormonal agents. IJU Case Rep 2023; 6:329-333. [PMID: 37928277 PMCID: PMC10622209 DOI: 10.1002/iju5.12611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/11/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Disseminated carcinomatosis of the bone marrow in prostate cancer is rare and has a poor prognosis. Although strong evidence suggests that novel hormonal agents improve the prognosis of metastatic prostate cancer, their effectiveness in cases of disseminated carcinomatosis of the bone marrow remains unclear. Case presentation We encountered two cases of prostate cancer with disseminated carcinomatosis of the bone marrow at the time of initial diagnosis. One patient was treated with enzalutamide, abiraterone, docetaxel, cabazitaxel, denosumab, and radium-223 and died 38 months after the initial diagnosis. The other patient was treated with apalutamide and denosumab, and had progression-free survival for 17 months after the initial diagnosis. Conclusion These results suggest that novel hormonal agents may improve the prognosis of prostate cancer even in patients with disseminated carcinomatosis of the bone marrow.
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Affiliation(s)
- Keina Nozaki
- Department of UrologyTokyo Metropolitan Police HospitalTokyoJapan
| | | | - Hiyo Obikane
- Department of Diagnostic PathologyTokyo Metropolitan Police HospitalTokyoJapan
| | - Ryohei Nishimoto
- Department of UrologyTokyo Metropolitan Police HospitalTokyoJapan
| | - Ryo Tanaka
- Department of UrologyTokyo Metropolitan Police HospitalTokyoJapan
| | - Takeru Morishige
- Department of UrologyTokyo Metropolitan Police HospitalTokyoJapan
| | - Tomoko Masuda
- Department of UrologyTokyo Metropolitan Police HospitalTokyoJapan
| | - Haruki Kume
- Department of UrologyThe University of Tokyo Graduate School of MedicineTokyoJapan
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3
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Suto H, Inui Y, Okamura A. Slowly Progressive Bone Marrow Metastasis of Gastric Cancer Followed-up Without Treatment. In Vivo 2023; 37:1389-1393. [PMID: 37103098 DOI: 10.21873/invivo.13222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND/AIM Bone marrow metastasis (BMM) of gastric cancer (GC) is complicated by disseminated intravascular coagulation syndrome (DIC), which is more prominent in poorly differentiated carcinoma. This is one of the first case reports of a slowly progressing BMM of GC after approximately 1 year of follow-up without treatment. CASE REPORT A 72-year-old woman underwent total gastrectomy and splenectomy for GC in February 2012. The pathological diagnosis was that of a moderately differentiated adenocarcinoma. Five years later in December 2017, she developed anemia; however, its cause remained unknown. Due to worsening of the anemia, the patient visited the Kakogawa Central City Hospital in October 2018. Bone marrow biopsy revealed an infiltration of caudal type homeobox 2-positive cancer cells, and our diagnosis was BMM of GC. There was no DIC. The incidence of BMM is high in well- or moderately differentiated breast cancer but rarely causes DIC. CONCLUSION As with breast cancer, in moderately differentiated cancer cells, BMM of GC may progress slowly after the appearance of symptoms without causing DIC.
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Affiliation(s)
- Hirotaka Suto
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan;
- Department of Medical Oncology/Hematology, Kakogawa Central City Hospital, Hyogo, Japan
| | - Yumiko Inui
- Department of Medical Oncology/Hematology, Kakogawa Central City Hospital, Hyogo, Japan
| | - Atsuo Okamura
- Department of Medical Oncology/Hematology, Kakogawa Central City Hospital, Hyogo, Japan
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4
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Sharma A, Dwivedi A. Is Further Evaluation of Areas with Faint MDP Uptake Needed in Individuals with Oligo-Metastatic Prostatic Adenocarcinoma? World J Nucl Med 2023; 22:40-42. [PMID: 36923982 PMCID: PMC10010852 DOI: 10.1055/s-0042-1757281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 42-year-old male patient with high-risk prostate adenocarcinoma underwent baseline 99m Tc-methylene diphosphonate skeletal scintigraphy, which revealed two skeletal metastases and an area of faint radiotracer uptake in the left femoral shaft. In view of oligo-metastatic nature of the disease in the bone scan and the young age of the patient, he was a candidate for metastases-directed treatment. Single photon emission computed tomography (SPECT)/CT was performed to further characterize this lesion. It was revealed to be a small soft tissue density lesion within the fatty bone marrow density, suggesting bone marrow involvement. A more sensitive evaluation of such areas with faint radiotracer uptake may be needed in high-risk prostate cancer patients where access to advanced modalities is limited. Their significance will also need reassessment as their detection will improve with technological advancements.
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Affiliation(s)
- Anshul Sharma
- Department of Nuclear Medicine, Homi Bhabha Cancer Hospital and Research Centre, Punjab, India
| | - Ankur Dwivedi
- Department of Radiodiagnosis, Homi Bhabha Cancer Hospital and Research Centre, Punjab, India
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5
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Lu G, Jia L, Yang R, Lv Z, Cui J. Acquired hyperfibrinolysis as the presenting sign of metastatic breast cancer: A case report. Oncol Lett 2023; 25:106. [PMID: 36817045 PMCID: PMC9933151 DOI: 10.3892/ol.2023.13692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
Fibrinolysis is a bleeding disorder characterized by hypofibrinogenemia caused by abnormal activation of fibrinolytic system function. Patients with cancer are prone to hypercoagulable and should be vigilant for the risk of venous thrombosis. However, patients with tumors in which bleeding is the first manifestation are relatively rare. The present study reports the case of a 52-year-old woman with metastatic breast cancer with acquired hyperfibrinolysis as the first manifestation. Hyperfibrinolysis is an important sign and manifestation of disease progression. In this case, fibrinogen was used as a sensitive biomarker of tumor burden to specifically predict the efficacy of the antitumor therapy. Effective antitumor therapy can improve the hyperfibrinolysis of patients, and so the fibrinogen levels gradually increased. In conclusion, the present case showed acquired hyperfibrinolysis with bleeding symptoms, which is an uncommon paraneoplastic phenomenon in breast cancer, especially when combined with bone marrow metastasis, as in the present case. Timely diagnosis and treatment of the primary disease is the fundamental way to improve hyperfibrinolysis. As an effective biomarker, fibrinogen level predicts the changes in a patient's illness and guides the clinical diagnosis and treatment process.
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Affiliation(s)
- Guanyu Lu
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Lin Jia
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ruohan Yang
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zheng Lv
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China,Correspondence to: Professor Jiuwei Cui or Professor Zheng Lv, Cancer Center, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, Jilin 130021, P.R. China, E-mail:
| | - Jiuwei Cui
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China,Correspondence to: Professor Jiuwei Cui or Professor Zheng Lv, Cancer Center, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, Jilin 130021, P.R. China, E-mail:
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6
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Fan X, Li F, Xiao C, Cai Y, You F. Long-term stable disease with mFOLFOX6 chemotherapy plus cetuximab for bone marrow metastasis from rectal cancer: A case report. Front Oncol 2023; 13:1117530. [PMID: 36776321 PMCID: PMC9909532 DOI: 10.3389/fonc.2023.1117530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
Bone marrow metastasis from rectal cancer is a rare but severe disease associated with a poor prognosis due to limited treatment options. There is no consensus on therapeutic strategies, and better-tolerated and more effective treatment options are urgently needed. We report a case that one patient with rectal cancer developed pancytopenia 15 months after completion of radical surgery and chemotherapy and was diagnosed with bone marrow metastasis. The patient was treated with mFOLFOX6 chemotherapy plus cetuximab, considering both his poor bone marrow function and a genetic test showing a wild-type of KRAS/NRAS/PIK3CA/BRAF. Twelve cycles were successfully completed with dose modifications and supportive measures. The patient's condition improved markedly based on a comprehensive assessment that included computed tomography images, blood cell counts, tumor markers, and clinical symptoms. The patient remains alive for 11 months at the last follow up. The patient treated with mFOLFOX6 chemotherapy plus cetuximab attained long-term stable disease, suggesting its promising efficacy and safety for bone marrow metastasis from rectal cancer and may hold promise as a treatment strategy for this specific patient population. Consideration can be given to the inclusion of mFOLFOX6 chemotherapy plus cetuximab in first-line treatment regimen for bone marrow metastasis from rectal cancer.
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Affiliation(s)
- Xiumei Fan
- Oncology Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Fang Li
- Oncology Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chong Xiao
- Oncology Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China,TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yi Cai
- Oncology Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China,*Correspondence: Yi Cai, ; Fengming You,
| | - Fengming You
- Oncology Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China,TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China,*Correspondence: Yi Cai, ; Fengming You,
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7
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Otsubo R, Yano H, Itonaga H, Iwasaki K, Segawa K, Nagayasu T. Severe thrombocytopenia and anemia as an initial presentation of breast cancer: A case report. Clin Case Rep 2022; 10:e6762. [PMID: 36545558 PMCID: PMC9764036 DOI: 10.1002/ccr3.6762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Breast cancer patients with bone marrow metastasis (BMM) having profound thrombocytopenia and anemia are rare and there is no definitive treatment guideline. We present a case of successful initial treatment with anti-disseminated intravascular coagulation therapy and endocrine therapy, followed by chemotherapy to avoid deterioration of severe thrombocytopenia and anemia.
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Affiliation(s)
- Ryota Otsubo
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan,Department of Breast Surgery, Sasebo City General HospitalNagasakiJapan
| | - Hiroshi Yano
- Department of Breast Surgery, Sasebo City General HospitalNagasakiJapan
| | - Hidehiro Itonaga
- Department of Hematology, Sasebo City General HospitalNagasakiJapan
| | - Keisuke Iwasaki
- Department of Pathology, Sasebo City General HospitalNagasakiJapan
| | - Keiko Segawa
- Department of RadiologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Takeshi Nagayasu
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
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8
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Yang R, Jia L, Lu G, Lv Z, Cui J. Symptomatic bone marrow metastases in breast cancer: A retrospective cohort study. Front Oncol 2022; 12:1042773. [PMID: 36605432 PMCID: PMC9808780 DOI: 10.3389/fonc.2022.1042773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Breast cancer symptomatic bone marrow metastasis (BMM) is rare and has a poor prognosis. Chemotherapy is usually the primary treatment, but it has limited efficacy, resulting in dose reduction and a decrease in quality of life due to the adverse effects of the agent. Other than chemotherapy, there are no other treatment studies for BMM. This study aimed to explore the clinicopathological characteristics of BMM patients with breast cancer, the prognosis using different treatment modalities, and the risk factors that affect the prognosis. Methods This retrospective study included patients diagnosed with breast cancer BMM from January 2018 to January 2022 in the Cancer Center of the First Hospital of Jilin University. The analysis focused on the characteristics of the patients, the treatment regimen, and the prognosis. Results Of 733 patients with advanced breast cancer, 33 patients were identified with BMM. All patients showed a hemoglobin decrease, and 25 (75.75%) presented with a fever of unknown origin. As for the metastasis breast cancer subtype, 25 (75.75%) were hormone receptor (HR) positive/human epidermal growth factor receptor 2 (HER2) negative, three (9.09%) had HER2 overexpression, and five (15.15%) were triple negative. The BMM patients had a median progression-free survival (PFS) of 7 months (1-21 months) and a median overall survival (OS) of 18 months (2-108 months). Among 25 HR+/HER2- BMM patients treated with different modalities, the median OS of the endocrine therapy (ET) group was 23 months, compared with 5 months in the chemotherapy group. Cox proportional hazards models suggested that higher Eastern Cooperative Oncology Group (ECOG) scores and old age were associated with shorter survival. Conclusion When breast cancer patients present with anemia and fever of unknown origin, BMM should be considered. For HR+/HER2- patients with good physical status and can receive active treatment, CDK4/6 inhibitors combined with ET can be used to control disease progression, improve quality of life, and prolong survival.
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Affiliation(s)
| | | | | | - Zheng Lv
- *Correspondence: Zheng Lv, ; Jiuwei Cui,
| | - Jiuwei Cui
- *Correspondence: Zheng Lv, ; Jiuwei Cui,
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9
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Nakano S, Minaga K, Tani Y, Tonomura K, Hanawa Y, Morimura H, Terashita T, Matsumoto H, Iwagami H, Nakatani Y, Akamatsu T, Uenoyama Y, Maeda C, Ono K, Watanabe T, Yamashita Y. Primary Hepatic Neuroendocrine Carcinoma with Thrombocytopenia Due to Diffuse Bone Marrow and Splenic Infiltration: An Autopsy Case. Intern Med 2022; 61:3361-3368. [PMID: 35400708 PMCID: PMC9751712 DOI: 10.2169/internalmedicine.9465-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
An 82-year-old man with fever and back pain was referred to our hospital and was thus found to be thrombocytopenic. A bone marrow biopsy revealed the diffuse infiltration of poorly differentiated neuroendocrine carcinoma (NEC). Computed tomography revealed a large hepatic mass. Considering the risk of bleeding due to thrombocytopenia, a needle biopsy was not performed. The patient rapidly deteriorated and died 10 days after presentation. An autopsy confirmed the diagnosis of primary hepatic NEC, with diffuse metastasis to the spleen, bone marrow, and systemic lymph nodes. This is an extremely rare case of NEC presenting with thrombocytopenia due to extensive bone marrow and splenic infiltration.
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Affiliation(s)
- Shogo Nakano
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Kosuke Minaga
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Yasuhiro Tani
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Kohei Tonomura
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Yusuke Hanawa
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Hiroki Morimura
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Tomoko Terashita
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Hisakazu Matsumoto
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Hiroyoshi Iwagami
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Yasuki Nakatani
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Takuji Akamatsu
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Yoshito Uenoyama
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Chikara Maeda
- Department of Radiology, Japan Red Cross Wakayama Medical Center, Japan
| | - Kazuo Ono
- Department of Pathology, Japan Red Cross Wakayama Medical Center, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Yukitaka Yamashita
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
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10
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Bancheno WM, Adidam SR, Melaku MA. Metastatic rectal neuroendocrine carcinoma presenting with treatment-refractory immune thrombocytopenia: A case report and literature review. Medicine (Baltimore) 2022; 101:e29616. [PMID: 35866784 PMCID: PMC9302362 DOI: 10.1097/md.0000000000029616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Colorectal neuroendocrine cancer (CRNEC) accounts for < 1% of all colorectal cancers. It presents in advanced stages and carries a risk of poor survival. CRNEC may be diagnosed incidentally on imaging or routine endoscopy. When symptomatic, it may mimic colorectal adenocarcinoma. Syncope and immune thrombocytopenic purpura (ITP) have not previously been reported as clinical presentations. PATIENT CONCERNS A 57-year-old man with human immunodeficiency virus infection on treatment, seizure and stroke without residue presented for the evaluation of fall and syncope. DIAGNOSIS Physical examination revealed tachycardia, swelling, and ecchymosis of his proximal left lower extremity. Laboratory tests showed a new isolated thrombocytopenia of 26,000/mm3. Computed tomography for a trauma survey showed an incidental left posterior rectal wall mass. After hospital admission, his platelet count dropped to 14,000/mm3. A peripheral blood smear revealed low platelet count, no schistocytes or immature cells. ITP at a high risk for bleeding was diagnosed and treated with standard medical therapy but remained refractory. Bone marrow biopsy showed metastatic neuroendocrine carcinoma, likely from the rectum. INTERVENTIONS Patient received courses of high-dose dexamethasone and intravenous immunoglobulin. He also receive eleven units of platelet transfusion. A course of rituximab was administered. The platelet count response was suboptimal or short lived with drop to a nadir of 4000/mm3. However, after initiation of Eltrombopag, the thrombocytopenia resolved. Patient was started on etoposide, carboplatin, Atezolizumab. His hospital stay was complicated by neutropenia and sepsis, which was successfully treated. OUTCOMES He was discharged to subacute rehab in stable condition. About 4 months later, he was readmitted for severe thrombocytopenia, septic shock, and acute respiratory failure. Despite appropriate treatment, the patient deteriorated and expired. CONCLUSION CRNEC is a rare aggressive disease with dismal outcome that lacks standardized treatment. Metastasis to the bone marrow is uncommon and concomitant ITP has not been reported. We report a rare case of rectal neuroendocrine carcinoma metastatic to bone marrow associated with refractory ITP and review the relevant literature.
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Affiliation(s)
- Wouhabe Marai Bancheno
- Internal Medicine, Howard University Hospital, Washington, DC
- * Correspondence: Wouhabe Marai Bancheno, MD, MSc, Internal Medicine, Howard University Hospital, 2041 GA Ave NW, Washington, DC 20060 (e-mail: )
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11
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Yue ZX, Xing TY, Zhao W, Zhao Q, Wang XS, Su Y, Gao C, Liu SG, Ma XL. MYCN amplification plus 1p36 loss of heterozygosity predicts ultra high risk in bone marrow metastatic neuroblastoma. Cancer Med 2022; 11:1837-1849. [PMID: 35137546 PMCID: PMC9041068 DOI: 10.1002/cam4.4583] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/14/2021] [Accepted: 01/04/2022] [Indexed: 01/02/2023] Open
Abstract
Background This study aimed to better understand the prognostic effect of multiple genetic markers and identify more subpopulations at ultra high risk of poor outcome in bone marrow (BM) metastatic neuroblastoma (NB). Methods We screened the MYCN, 1p36 and 11q23 loss of heterozygosity (LOH) statuses of 154 patients by interphase fluorescence in situ hybridization of BM cells. The clinical characteristics of patients with the three markers and their associations with prognosis were analysed. Results MYCN amplification and LOH at 1p36 and 11q23 were identified in 16.2%, 33.1% and 30.5% of patients, respectively. There were strong associations between MYCN amplification and 1p36 LOH as well as 11q23 LOH. Both MYCN amplification and 1p36 LOH were strongly associated with high levels of lactate dehydrogenase (LDH) and neuron‐specific enolase, more than 3 metastatic organs, and more events. 11q23 LOH occurred mainly in patients older than 18 months, and those who had high LDH levels. In univariate analysis, patients with MYCN amplification had poorer prognosis than those without. Patients with 1p36 LOH had a 3‐year event‐free survival (EFS) and overall survival lower than those without. 11q23 LOH was associated with poorer EFS only for patients without MYCN amplification. In a multivariate model, MYCN amplification was independently associated with decreased EFS in all cohorts. 11q23 LOH was an independent prognostic factor for patients without MYCN amplification, whereas 1p36 LOH was not an independent marker regardless of MYCN amplification. Compared with all cohorts, patients with both MYCN amplification and 1p36 LOH had the worst outcome and clinical features. Conclusions Patients with both MYCN amplification and 1p36LOH had the worst survival rate, indicating an ultra high‐risk group. Our results may be applied in clinical practice for accurate risk stratification in future studies.
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Affiliation(s)
- Zhi-Xia Yue
- Hematologic Disease Laboratory, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Tian-Yu Xing
- Hematologic Disease Laboratory, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Wen Zhao
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Beijing Key Laboratory of Pediatric Hematology Ocology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Qian Zhao
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Beijing Key Laboratory of Pediatric Hematology Ocology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Xi-Si Wang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Beijing Key Laboratory of Pediatric Hematology Ocology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Yan Su
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Beijing Key Laboratory of Pediatric Hematology Ocology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Chao Gao
- Hematologic Disease Laboratory, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shu-Guang Liu
- Hematologic Disease Laboratory, Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiao-Li Ma
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Beijing Key Laboratory of Pediatric Hematology Ocology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
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Garufi G, Carbognin L, Orlandi A, Palazzo A, Tortora G, Bria E. The Therapeutic Challenge of Disseminated Bone Marrow Metastasis From HR-Positive HER2-Negative Breast Cancer: Case Report and Review of the Literature. Front Oncol 2021; 11:651723. [PMID: 34692469 PMCID: PMC8529000 DOI: 10.3389/fonc.2021.651723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/10/2021] [Indexed: 01/15/2023] Open
Abstract
The efficacy and safety of the combination of endocrine therapy (ET) and CDK4/6 inhibitors for patients with hormone receptor (HR)-positive HER2-negative metastatic breast cancer (BC) presenting with visceral crisis or life-threatening conditions represent a challenge for daily clinical practice. Indeed, the peculiarity of this clinical presentation (signs and symptoms of rapidly progressive disease) does not allow to include such patients in a trial aiming for drug approval. On the basis of the scientific evidence available so far, chemotherapy represents the standard of care according to guidelines, on the basis of the more rapid activity in comparison with ET alone. Besides, the combination of ET and CDK4/6 inhibitors have demonstrated in clinical trials to have clinically impactful activity in a short time, thus suggesting a potential role in advanced tumors that require rapid response. Herein, we report the clinical history of a young woman with HR-positive HER2-negative metastatic BC and a pancytopenia due to carcinomatosis of the bone marrow receiving letrozole and leuprorelin plus the CDK4/6 inhibitor palbociclib, who significantly derived clinical benefit from treatment. Considering that these peculiar cases are excluded from clinical trials, the estimation of the magnitude of the benefit of the newer ET combination may potentially represent a practical question for large case series and real-world studies.
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Affiliation(s)
- Giovanna Garufi
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy.,Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Luisa Carbognin
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Armando Orlandi
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Antonella Palazzo
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Giampaolo Tortora
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy.,Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Emilio Bria
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy.,Università Cattolica Del Sacro Cuore, Roma, Italy
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13
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Wakamiya T, Tamura S, Kojima F, Kohjimoto Y, Hara I. Disseminated carcinomatosis of the bone marrow caused by prostate cancer diagnosed with only bone marrow biopsy. IJU Case Rep 2021; 4:303-306. [PMID: 34497990 PMCID: PMC8413210 DOI: 10.1002/iju5.12332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/07/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Disseminated carcinomatosis of the bone marrow caused by prostate cancer is a rare condition with poor prognosis. Diagnosis has mostly been by primary prostate biopsy. CASE PRESENTATION A 60-year-old man had malaise, low platelet count (9000/μL), and high prostate-specific antigen (1382 ng/mL). Bone marrow biopsy showed strongly positive immunostaining NKX3.1, leading to diagnosis of prostate cancer bone marrow metastasis, cT3aN1M1b. Definitive diagnosis by prostate biopsy was difficult because of the sparsity of atypical glands. He had progression to castration-resistant prostate cancer after 3 months of hormonal therapy, and received 27 courses of docetaxel and six courses of cabazitaxel as chemotherapy, but finally died of respiratory failure 33 months after the start of treatment. CONCLUSION Aggressive biopsy of the metastatic sites should be considered if a prostate biopsy at the primary site cannot be diagnosed definitively.
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Affiliation(s)
| | - Shinobu Tamura
- Department ofHematologyWakayama Medical UniversityWakayamaJapan
| | - Fumiyoshi Kojima
- Department ofHuman PathologyWakayama Medical UniversityWakayamaJapan
| | - Yasuo Kohjimoto
- Department ofUrologyWakayama Medical UniversityWakayamaJapan
| | - Isao Hara
- Department ofUrologyWakayama Medical UniversityWakayamaJapan
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14
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Akagi H, Shimada A, Chin K, Domoto H. Successful Stabilization of Symptomatic Bone Marrow Metastasis Two Times in a Breast Cancer Patient. Anticancer Res 2021; 41:3139-3144. [PMID: 34083308 DOI: 10.21873/anticanres.15099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/08/2021] [Accepted: 05/13/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Bone marrow metastasis is very uncommon in breast cancer. Cancer patients showing a dramatic response to chemotherapy with full recovery are very rare. CASE REPORT This is a case report of a 62-year-old woman who underwent partial mastectomy six years previously. The patient presented with increased fatigue and her hemoglobin level was 6.7 g/dl. Pathological examination of a bone marrow biopsy showed metastasis from breast cancer. Systemic therapy was initiated with doxorubicin and cyclophosphamide and pancytopenia was steadily improved. However, 15 months later, she felt severe fatigue again. Eribulin was administered and the patient showed sufficient recovery. She had two bone marrow metastases that caused pancytopenia including severe anemia. However, she survived twice with chemotherapy. CONCLUSION Bone marrow metastasis of breast cancer is life-threatening; however, chemotherapy may significantly improve survival.
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Affiliation(s)
- Hideko Akagi
- Department of Oncology, Keiyu Hospital, Yokohama, Japan
| | | | - Kenko Chin
- Department of Hematology, Keiyu Hospital, Yokohama, Japan
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15
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La Gioia A, Fiorini F, La Gioia N. Bone marrow involvement by metastatic invasive lobular breast cancer. Int J Lab Hematol 2021; 44:40-41. [PMID: 34086407 DOI: 10.1111/ijlh.13620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Antonio La Gioia
- Docemus Onlus, "Theoretical and Practical Training School for Improving Specialty Medicine", Torrevecchia Teatina, Italy
| | - Fabiana Fiorini
- UOC Medicina di Laboratorio, Azienda USL Toscana Nord Ovest, Pontedera, Italy
| | - Nicola La Gioia
- Docemus Onlus, "Theoretical and Practical Training School for Improving Specialty Medicine", Torrevecchia Teatina, Italy
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16
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Zhou Q, Li Z, Liu B, Zhao L, Tian B, Wang L, Xi Y. Occult olfactory neuroblastoma presenting with multiple bone metastases: a case report. Medicine (Baltimore) 2020; 99:e22630. [PMID: 33235061 PMCID: PMC7710244 DOI: 10.1097/md.0000000000022630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONABLE Olfactory neuroblastoma (ONB) is a rare malignant tumor of the nasal cavity, the primary local symptoms are usually inconspicuous. Patients are often admitted to various specialties based on different primary symptoms, which may result in delayed diagnosis and even a misdiagnosis. PATIENT CONCERNS Here we report a case of ONB that presented initially as multiple ostealgia without any local symptoms of the tumor and primarily misdiagnosed as multiple myeloma. The patient was a 47-year-old female with bone pain at multiple sites. The initial diagnosis was considered as multiple myeloma. However, the morphologic examination of bone marrow suggested that the tumor cells originated from the nervous tissues. After the positron emission computed tomography scan, the primary lesion in the nasal cavity was located, and a biopsy was performed. DIAGNOSIS The final diagnosis of ONB was confirmed by histopathological tests. INTERVENTIONS The patient was treated with metronomic chemotherapy. OUTCOMES The symptoms of bone pain were significantly relieved 3 months later. The emission computed tomography scan of the whole body bones and the magnetic resonance imaging of the head showed that the tumor size did not change significantly and proved a progression-free of the disease. LESSONS It is a reasonable strategy to identify the original latent tumor by a prompt positron emission computed tomography scan when the primary diagnosis indicates a metastatic disease, especially for the occult malignancies like ONB.
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Affiliation(s)
- Qi Zhou
- The First Clinical Medical College, Lanzhou University
| | - Zijian Li
- Department of Hematology, The First Hospital of Lanzhou University
| | - Bei Liu
- Department of Hematology, The First Hospital of Lanzhou University
| | - Long Zhao
- Department of Hematology, The First Hospital of Lanzhou University
| | - Baohong Tian
- Department of Oncology, Donggang Branch of The First Hospital of Lanzhou University
| | - Lina Wang
- Department of Hematology, The First Hospital of Lanzhou University
| | - Yaming Xi
- Department of Hematology, The First Hospital of Lanzhou University
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Abstract
This case report describes a 53-year-old Hispanic male who initially presented with acute hip pain. During workup, sclerotic bone lesions of the lumbar spine were identified on computed tomography (CT) in addition to extensive adenopathy involving the chest and abdomen. Upper endoscopy revealed chronic active gastritis, however, biopsies were negative for malignancy. Eventual bone marrow biopsy showed extensive infiltration by sheets of malignant epithelial cells with signet ring cell formation. Not only is this case significant for maintaining a broad differential in patients presenting with bone pain, but it also demonstrates a diagnosis of metastatic signet ring cell adenocarcinoma confirmed on bone marrow biopsy, which was not detected via earlier endoscopy.
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Affiliation(s)
- Sarah Burroughs
- Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, USA
| | - Robert Post
- Pathology, University of Illinois at Chicago, Chicago, USA
| | - Edward James
- Oncology, Advocate Lutheran General Hospital, Park Ridge, USA
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Abstract
BACKGROUND Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of adolescence and childhood. Although most patients with localized RMS are cured, outcome of those with metastatic disease remains unsatisfactory. RMS with bone marrow (BM) metastasis accounts for approximately 6% of all cases with RMS and has a 3-year event-free survival of 14%. Our study aims to describe our institution's experience of patients with metastatic RMS with BM involvement. METHODS This was a single-institution retrospective study from Memorial Sloan Kettering Kids, a tertiary pediatric oncology center. Patients with RMS who were diagnosed with BM metastasis between 1998 and 2018 were identified from pathology reports. RESULTS For patients with RMS and BM positivity at diagnosis (N = 27), the median survival was 1.5 years. The 1-, 2-, and 3-year overall survival (OS) were 81%, 32%, and 20%, respectively. There is one long-term (defined as >4 year) survivor who is still alive 14.9 years after diagnosis despite two metastatic recurrences. An Oberlin status of 4 that included BM metastasis portended a 3-year OS of 0%. CONCLUSIONS Although most patients will respond to initial therapy, BM metastasis at the time of diagnosis lends a near-fatal diagnosis in pediatric patients with RMS. Novel therapies are desperately needed to consolidate their initial remission.
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Kawashima I, Fukasawa H, Kasai K, Kumagai T, Koshiishi M, Nakajima K, Kondo T, Hashi A, Hirata S, Kirito K. Bone Marrow Invasion of Small Cell Neuroendocrine Carcinoma of the Endometrium: A Diagnostic Pitfall Mimicking a Haematological Malignancy. Intern Med 2019; 58:2561-2568. [PMID: 31118384 PMCID: PMC6761356 DOI: 10.2169/internalmedicine.2533-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Metastasis of cancer cells to the bone marrow is relatively rare, despite being one of the most important causes of myelosuppression in patients with solid tumours. A bone marrow examination via a biopsy is the standard method of diagnosing cancer cell invasion into the bone marrow. However, it is sometimes challenging to distinguish neuroendocrine carcinoma cells from haematopoietic cells due to their small, round shape and chromosomal abnormalities resembling haematological malignancies. We herein report a case of bone marrow invasion of small cell neuroendocrine carcinoma of the endometrium mimicking therapy-related myeloid malignancy.
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Affiliation(s)
- Ichiro Kawashima
- Department of Hematology and Oncology, University of Yamanashi, Japan
| | - Hiroko Fukasawa
- Department of Obstetrics and Gynecology, University of Yamanashi, Japan
| | | | - Takuma Kumagai
- Department of Hematology and Oncology, University of Yamanashi, Japan
| | - Megumi Koshiishi
- Department of Hematology and Oncology, University of Yamanashi, Japan
| | - Kei Nakajima
- Department of Hematology and Oncology, University of Yamanashi, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Japan
| | - Akihiko Hashi
- Department of Obstetrics and Gynecology, University of Yamanashi, Japan
| | - Shuji Hirata
- Department of Obstetrics and Gynecology, University of Yamanashi, Japan
| | - Keita Kirito
- Department of Hematology and Oncology, University of Yamanashi, Japan
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Abstract
BACKGROUND Bone marrow metastasis occurs in lung adenocarcinoma patients with a poor prognosis due to the late course and lack of definitive treatments, although reports on this are limited. This study analyzed the clinical manifestation, laboratory examination, treatment, and prognosis of patients with lung adenocarcinoma with bone marrow metastasis. METHODS All patients were confirmed to have bone marrow infiltration by bone marrow aspiration. The clinical data of 12 patients with lung adenocarcinoma with bone marrow metastasis were analyzed retrospectively. The prognostic factors were analyzed by Kaplan-Meier statistics. RESULTS The common biomarker abnormalities in 12 patients were elevated carcinoembryonic antigen in 12 cases (100%), elevated lactate dehydrogenase in 9 cases (75%), increased alkaline phosphatase and anemia in 8 cases each (66.7%), and thrombocytopenia in 4 cases (33.3%). After diagnosis of bone marrow metastasis, 5 patients were treated with platinum-based chemotherapy, 3 patients received chemotherapy and targeted drug tyrosine kinase inhibitor (TKI) therapy, 2 patients received simple TKI therapy, and 2 patients received only best supportive care (BSC) therapy. The median duration of survival after the diagnosis of bone marrow involvement was 422 days. The survival time of patients receiving TKI therapy after bone marrow metastasis was significantly better than that of patients receiving only BSC and chemotherapy (χ2=4.636, P=0.031). CONCLUSIONS The survival period of patients with lung adenocarcinoma with bone marrow metastasis is short, and targeted drug TKI treatment can prolong the survival time for patients with EGFR mutation-carrying lung adenocarcinoma with bone marrow metastasis.
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Affiliation(s)
- Di Wang
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Luo
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Di Shen
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Yang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui-Ying Liu
- Department of Clinical Laboratory, Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing, China
| | - Yi-Qun Che
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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21
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Singh VK, Singh S, Bhupalam L. Anaplastic oligodendroglioma metastasizing to the bone marrow: a unique case report and literature review. Int J Neurosci 2018; 129:722-728. [PMID: 30526175 DOI: 10.1080/00207454.2018.1557165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Oligodendrogliomas are a rare type of primary brain tumor. They are genetically defined as diffuse gliomas carrying mutation in isocitrate dehydrogenase type 1 (IDH1) or type 2 (IDH2) and codeletion of chromosomes 1p and 19q. The WHO grading system distinguishes two histopathologic grades of ODs: grade II (low-grade) and grade III (anaplastic oligodendroglioma or AO). These tumors rarely metastasize outside of central nervous system with only few cases reported in the literature. Here we present a case of an AO, which metastasized to the bone marrow and other sites within a year of diagnosis despite aggressive treatment measures. Our patient eventually succumbed to his disease, raising many questions about this rare condition, its natural course and optimal management strategy.
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Affiliation(s)
- Vikas K Singh
- a James Graham Brown Cancer Center , University of Louisville , Louisville , KY , USA
| | - Shipra Singh
- b College of Education and Human Development , University of Louisville , Louisville , KY , USA
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22
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Abstract
A 64-year-old man with the bone marrow metastasis due to malignant pleural mesothelioma (MPM) was diagnosed with anemia, leukoerythroblastosis, thrombocytopenia, and lower back pain. A bone marrow biopsy demonstrated infiltrative malignant mesothelioma lesions in the bone marrow. The patient died within 15 days of the detection of the bone marrow involvement. Physicians should consider performing a bone marrow biopsy to diagnose bone marrow metastasis and treat patients with palliative chemotherapy at an earlier phase of the disease. To our knowledge, this is the first report of an MPM patient having bone marrow metastasis with anemia, leukoerythroblastosis, and thrombocytopenia.
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Affiliation(s)
- Hiroaki Ihara
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
- Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
- Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Naoko Shimada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
- Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Koichiro Kanamori
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
- Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Takuo Hayashi
- Department of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Toshimasa Uekusa
- Department of Pathology, Labour Health and Welfare Organization Kanto Rosai Hospital, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
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Thiel U, Wawer A, von Luettichau I, Bender HU, Blaeschke F, Grunewald TGP, Steinborn M, Röper B, Bonig H, Klingebiel T, Bader P, Koscielniak E, Paulussen M, Dirksen U, Juergens H, Kolb HJ, Burdach SEG. Bone marrow involvement identifies a subgroup of advanced Ewing sarcoma patients with fatal outcome irrespective of therapy in contrast to curable patients with multiple bone metastases but unaffected marrow. Oncotarget 2018; 7:70959-70968. [PMID: 27486822 PMCID: PMC5342601 DOI: 10.18632/oncotarget.10938] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/30/2016] [Indexed: 12/21/2022] Open
Abstract
Purpose Advanced Ewing sarcomas have poor prognosis. They are defined by early relapse (<24 months after diagnosis) and/or by metastasis to multiple bones or bone marrow (BM). We analyzed risk factors, toxicity and survival in advanced Ewing sarcoma patients treated with the MetaEICESS vs. EICESS92 protocols. Design Of 44 patients, 18 patients were enrolled into two subsequent MetaEICESS protocols between 1992 and 2014, and compared to outcomes of 26 advanced Ewing sarcoma patients treated with EICESS 1992 between 1992 and 1996. MetaEICESS 1992 consisted of induction chemotherapy, whole body imaging directed radiotherapy to the primary tumor and metastases, tandem high-dose chemotherapy and autologous rescue. In MetaEICESS 2007 this treatment was complemented by allogeneic stem cell transplantation. EICESS 1992 comprised induction chemotherapy, local therapy to the primary tumor only followed by consolidation chemotherapy. Results In MetaEICESS 8/18 patients survived in complete remission vs. 2/26 in EICESS 1992 (p<0.05). Survival did not differ between MetaEICESS 2007 and MetaEICESS 1992. Three MetaEICESS patients died of complications, all in MetaEICESS 1992. After exclusion of patients succumbing to treatment related complications (n=3), 7/10 patients survived without BM involvement, in contrast to 0/5 patients with BM involvement. This was confirmed in a multivariate analysis. There was no correlation between BM involvement and the number of metastases at diagnosis. Conclusion The MetaEICESS protocols yield long-term disease-free survival in patients with advanced Ewing sarcoma. Allogeneic stem cell transplantation was not associated with increased death of complications. Bone marrow involvement is a risk factor distinct from multiple bone metastases.
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Affiliation(s)
- Uwe Thiel
- Department of Pediatrics and Pediatric Oncology Center, Kinderklinik München Schwabing, Städtisches Klinikum München und Klinikum rechts der Isar, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Angela Wawer
- Department of Pediatrics and Pediatric Oncology Center, Kinderklinik München Schwabing, Städtisches Klinikum München und Klinikum rechts der Isar, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Irene von Luettichau
- Department of Pediatrics and Pediatric Oncology Center, Kinderklinik München Schwabing, Städtisches Klinikum München und Klinikum rechts der Isar, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Hans-Ulrich Bender
- Department of Pediatrics and Pediatric Oncology Center, Kinderklinik München Schwabing, Städtisches Klinikum München und Klinikum rechts der Isar, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Franziska Blaeschke
- Department of Pediatrics and Pediatric Oncology Center, Kinderklinik München Schwabing, Städtisches Klinikum München und Klinikum rechts der Isar, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Thomas G P Grunewald
- Laboratory for Pediatric Sarcoma Biology, Institute of Pathology, LMU, Munich, Germany
| | - Marc Steinborn
- Department of Radiology, Klinikum Schwabing, Städtisches Klinikum München, Munich, Germany
| | - Barbara Röper
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Munich Comprehensive Cancer Center, München, Germany
| | - Halvard Bonig
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany.,Department of Transfusion Medicine and Immunohematology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Thomas Klingebiel
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Peter Bader
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Ewa Koscielniak
- Department of Pediatric Oncology, Hematology and Immunology, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Michael Paulussen
- Vestische Kinder- und Jugendklinik, Datteln, Universität Witten/Herdecke, Datteln, Germany
| | - Uta Dirksen
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Münster, Münster, Germany
| | - Heribert Juergens
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Münster, Münster, Germany
| | - Hans-Jochem Kolb
- Department of Pediatrics and Pediatric Oncology Center, Kinderklinik München Schwabing, Städtisches Klinikum München und Klinikum rechts der Isar, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefan E G Burdach
- Department of Pediatrics and Pediatric Oncology Center, Kinderklinik München Schwabing, Städtisches Klinikum München und Klinikum rechts der Isar, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Munich Comprehensive Cancer Center, München, Germany
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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] [What about the content of this article? (0)] [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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Hanamura F, Shibata Y, Shirakawa T, Kuwayama M, Oda H, Ariyama H, Taguchi K, Esaki T, Baba E. Favorable control of advanced colon adenocarcinoma with severe bone marrow metastasis: A case report. Mol Clin Oncol 2016; 5:579-582. [PMID: 27900088 DOI: 10.3892/mco.2016.1029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/25/2016] [Indexed: 12/16/2022] Open
Abstract
Colorectal cancer (CRC) has a propensity to metastasize to the liver, lungs and regional abdominal lymph nodes, but rarely to the bone marrow. A 60-year-old man presented to the National Hospital Organization Kyushu Cancer Center with a 4-week history of persistent lower back pain, anorexia and difficulty defecating. Complete blood count revealed severe thrombocytopenia and erythroblastosis, suggesting a hematological malignancy. However, the bone marrow examination demonstrated involvement by a moderately to poorly differentiated adenocarcinoma, but no hematopoietic abnormalities. A computed tomography scan revealed thickening of the wall of the sigmoid colon, with para-aortic, hilar, mediastinal and supraclavicular lymphadenopathy. The patient was thus diagnosed with sigmoid colon adenocarcinoma with lymph node and bone marrow metastasis. Modified FOLFOX6 was promptly initiated, with concurrent therapy for disseminated intravascular coagulation (DIC). An increased number of thrombocytes was observed on day 6. After 3 cycles of treatment, the patient recovered from DIC and the levels of serum carcinoembryonic antigen and cytokeratin 19 fragment were decreased. Tumor biopsy during colonoscopy following recovery from DIC demonstrated poorly differentiated adenocarcinoma with mucin production, without mutations in the RAS, BRAF or PIK3CA genes, and a cytokeratin (CK) 7-negative, CK20-positive phenotype. The patient has been treated with chemotherapy for 150 days without disease progression. However, the efficacy of chemotherapy for rarely encountered bone marrow metastasis from CRC is poor. The present case was favorably maintained on chemotherapy and survived for 10 months.
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Affiliation(s)
- Fumiyasu Hanamura
- Department of Medical Oncology, Fukuoka Wajiro Hospital, Fukuoka 811-021, Japan; Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Yoshihiro Shibata
- Department of Medical Oncology, Fukuoka Wajiro Hospital, Fukuoka 811-021, Japan
| | - Tsuyoshi Shirakawa
- Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Miyuki Kuwayama
- Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Hisanobu Oda
- Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan; Department of Medical Oncology, Saiseikai Fukuoka General Hospital, Fukuoka 810-0001, Japan
| | - Hiroshi Ariyama
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Kenichi Taguchi
- Department of Cancer Biology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Taito Esaki
- Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Eishi Baba
- Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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Jian Y, Gao W, Wu Y, Li Y, Zhang Y, Yang G, Chen W. Oligodendroglioma metastasis to the bone marrow mimicking multiple myeloma: A case report. Oncol Lett 2016; 12:351-355. [PMID: 27347150 DOI: 10.3892/ol.2016.4568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 04/08/2016] [Indexed: 11/06/2022] Open
Abstract
The present study reports a case of a 59-year-old male suffering from oligodendroglioma that metastasized to the bone marrow (BM). The metastasis was detected 5 years after craniotomy was performed for the resection of the primary tumor; however, it manifested as multiple myeloma (MM)-like bone lesions, a small M component and myeloma cell-like morphology in the BM. A brain magnetic resonance imaging scan was performed; evidence from the previously performed oligodendroglioma resection was observed on the scan, but there were no significant findings, which made the diagnosis particularly challenging. The patient exhibited no response to the multiple combination therapies administered targeting MM and oligodendroglioma, and subsequently developed epilepsy and pneumonia, prior to succumbing to multiple organ failure. Among the various tumor types involving the central nervous system, oligodendroglioma is the least likely to metastasize; thus, distant metastases from brain oligodendrogliomas are extremely rare. To the best of our knowledge, this is the first case of metastatic oligodendroglioma presenting with typical MM-like symptoms and without any recurrence in the brain.
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Affiliation(s)
- Yuan Jian
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Wen Gao
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Yin Wu
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Yanchen Li
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Yong Zhang
- Department of Hematology, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, P.R. China
| | - Guangzhong Yang
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Wenming Chen
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
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Honda Y, Kawaoka T, Aikata H, Kan H, Fujino H, Kobayashi T, Fukuhara T, Naeshiro N, Hiramatsu A, Imamura M, Kawakami Y, Hyogo H, Arihiro K, Chayama K. Disseminated carcinomatosis of the bone marrow originating from hepatocellular carcinoma. A case report. Hepatol Res 2015; 45:705-10. [PMID: 25041322 DOI: 10.1111/hepr.12391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 06/20/2014] [Accepted: 07/10/2014] [Indexed: 02/08/2023]
Abstract
A 50-year-old male patient was admitted to the hospital for persistent high fever and back pain. He was diagnosed with hepatocellular carcinoma (HCC), bone marrow metastasis and disseminated intravascular coagulation (DIC). Despite the diagnosis and treatment, the general condition deteriorated rapidly and he died of cerebral hemorrhage associated with generalized bleeding tendency. Autopsy showed multiple HCC in the liver and systemic metastasis including bone marrow. The case describes a rare complication of HCC with disseminated carcinomatosis of the bone marrow (DCBM) complicated with DIC, with rapid deterioration and death. This is the first case of DCBM from HCC. Physicians need to be aware of DCBM in patients with HCC.
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Affiliation(s)
- Yohji Honda
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomokazu Kawaoka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroshi Aikata
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiromi Kan
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Hatsue Fujino
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomoki Kobayashi
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Takayuki Fukuhara
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Noriaki Naeshiro
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Akira Hiramatsu
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Michio Imamura
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshiiki Kawakami
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Hideyuki Hyogo
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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Dittus C, Mathew H, Malek A, Negroiu A. Bone marrow infiltration as the initial presentation of gastric signet ring cell adenocarcinoma. J Gastrointest Oncol 2014; 5:E113-6. [PMID: 25436133 DOI: 10.3978/j.issn.2078-6891.2014.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/14/2014] [Indexed: 11/14/2022] Open
Abstract
This case report describes a 52-year-old African American man who initially presented with worsening back pain. The patient was found to have lytic lucencies in the T5 and T9 vertebral bodies and a subsequent bone marrow biopsy revealed an extensive infiltrate of signet ring cells. These findings prompted a workup for a gastrointestinal malignancy, and upper endoscopy revealed a mass in the gastric pylorus. A biopsy of this mass was positive for signet ring cell adenocarcinoma. This case is significant for two reasons. First, it highlights the importance of a broad differential diagnosis when approaching a patient with lytic bone lesions. Second, bone marrow involvement is more common in patients with diffuse type gastric cancer and occurs in particularly young patients. The increasing incidence of diffuse type gastric adenocarcinoma means bone marrow metastases will likely play a greater role in the presentation and management of gastric cancer.
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Affiliation(s)
- Christopher Dittus
- 1 Hematology-Oncology Department, Boston Medical Center, 820 Harrison Avenue, FGH Building, 1st Floor, Boston, MA 02118, USA ; 2 Internal Medicine Department, Boston Medical Center, 72 East Concord Street, Evans 124 Boston, MA 02118, USA ; 3 Pathology Department, Boston Medical Center, 670 Albany Street, Boston, MA 02118, USA
| | - Hannah Mathew
- 1 Hematology-Oncology Department, Boston Medical Center, 820 Harrison Avenue, FGH Building, 1st Floor, Boston, MA 02118, USA ; 2 Internal Medicine Department, Boston Medical Center, 72 East Concord Street, Evans 124 Boston, MA 02118, USA ; 3 Pathology Department, Boston Medical Center, 670 Albany Street, Boston, MA 02118, USA
| | - Anita Malek
- 1 Hematology-Oncology Department, Boston Medical Center, 820 Harrison Avenue, FGH Building, 1st Floor, Boston, MA 02118, USA ; 2 Internal Medicine Department, Boston Medical Center, 72 East Concord Street, Evans 124 Boston, MA 02118, USA ; 3 Pathology Department, Boston Medical Center, 670 Albany Street, Boston, MA 02118, USA
| | - Andreea Negroiu
- 1 Hematology-Oncology Department, Boston Medical Center, 820 Harrison Avenue, FGH Building, 1st Floor, Boston, MA 02118, USA ; 2 Internal Medicine Department, Boston Medical Center, 72 East Concord Street, Evans 124 Boston, MA 02118, USA ; 3 Pathology Department, Boston Medical Center, 670 Albany Street, Boston, MA 02118, USA
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29
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Braekeveldt N, Wigerup C, Gisselsson D, Mohlin S, Merselius M, Beckman S, Jonson T, Börjesson A, Backman T, Tadeo I, Berbegall AP, Ora I, Navarro S, Noguera R, Påhlman S, Bexell D. Neuroblastoma patient-derived orthotopic xenografts retain metastatic patterns and geno- and phenotypes of patient tumours. Int J Cancer 2014; 136:E252-61. [PMID: 25220031 PMCID: PMC4299502 DOI: 10.1002/ijc.29217] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 07/31/2014] [Accepted: 09/01/2014] [Indexed: 12/24/2022]
Abstract
Neuroblastoma is a childhood tumour with heterogeneous characteristics and children with metastatic disease often have a poor outcome. Here we describe the establishment of neuroblastoma patient-derived xenografts (PDXs) by orthotopic implantation of viably cryopreserved or fresh tumour explants of patients with high risk neuroblastoma into immunodeficient mice. In vivo tumour growth was monitored by magnetic resonance imaging and fluorodeoxyglucose–positron emission tomography. Neuroblastoma PDXs retained the undifferentiated histology and proliferative capacity of their corresponding patient tumours. The PDXs expressed neuroblastoma markers neural cell adhesion molecule, chromogranin A, synaptophysin and tyrosine hydroxylase. Whole genome genotyping array analyses demonstrated that PDXs retained patient-specific chromosomal aberrations such as MYCN amplification, deletion of 1p and gain of chromosome 17q. Thus, neuroblastoma PDXs recapitulate the hallmarks of high-risk neuroblastoma in patients. PDX-derived cells were cultured in serum-free medium where they formed free-floating neurospheres, expressed neuroblastoma gene markers MYCN, CHGA, TH, SYP and NPY, and retained tumour-initiating and metastatic capacity in vivo. PDXs showed much higher degree of infiltrative growth and distant metastasis as compared to neuroblastoma SK-N-BE(2)c cell line-derived orthotopic tumours. Importantly, the PDXs presented with bone marrow involvement, a clinical feature of aggressive neuroblastoma. Thus, neuroblastoma PDXs serve as clinically relevant models for studying and targeting high-risk metastatic neuroblastoma.
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Lim DOH, Lee SI, Park KW. Bone marrow metastasis of colon cancer as the first site of recurrence: A case report. Oncol Lett 2014; 8:2672-2674. [PMID: 25364447 PMCID: PMC4214508 DOI: 10.3892/ol.2014.2581] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 08/29/2014] [Indexed: 11/05/2022] Open
Abstract
Bone marrow metastasis from solid tumors is usually accepted as not only incurable, but as fatal. Colon cancer is a relatively rare malignancy that involves the bone marrow, and to the best of our knowledge, there have been no studies in the literature reporting only bone marrow metastasis of colon cancer as the first presentation of relapse. The present study reports the case of a 74-year-old female patient treated by resection and adjuvant chemotherapy for stage IIIc colon cancer who presented with severe thrombocytopenia with intracranial hemorrhage, and the bone marrow was first and only site of metastasis. There was no evidence of skeletal metastasis. The clinical course was extremely aggressive and the patient succumbed ten days after admission, finally being diagnosed in the postmortem examination. The present study also discusses bone marrow metastasis of solid tumors, with particular respect to the diagnostic difficulties of such rare cases.
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Affiliation(s)
- DO Hyoung Lim
- Division of Hematology-Oncology, Department of Medicine, Dankook University College of Medicine, Cheonan, South Chungcheong 330-715, Republic of Korea
| | - Soon Il Lee
- Division of Hematology-Oncology, Department of Medicine, Dankook University College of Medicine, Cheonan, South Chungcheong 330-715, Republic of Korea
| | - Keon Woo Park
- Division of Hematology-Oncology, Department of Medicine, Dankook University College of Medicine, Cheonan, South Chungcheong 330-715, Republic of Korea
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31
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Xu L, Guo F, Song S, Zhang G, Liu Y, Xie X. Trastuzumab monotherapy for bone marrow metastasis of breast cancer: A case report. Oncol Lett 2014; 7:1951-1953. [PMID: 24932266 PMCID: PMC4049744 DOI: 10.3892/ol.2014.1999] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 02/26/2014] [Indexed: 01/05/2023] Open
Abstract
The current study presents the case of a 41-year-old female patient who received modified radical mastectomy and adjuvant chemotherapy and radiotherapy for infiltrating ductal cancer of the left breast. The pathological stage of the disease was IIA. In addition, the patient was negative for the estrogen and progesterone receptors, and human epidermal growth factor receptor-2 gene amplification was identified. At one year following surgery, the patient presented with severe pancytopenia and pain at multiple sites all over the body. Furthermore, the patient’s Eastern Cooperative Oncology Group performance status score was 3 and numeric rating scale pain score was 8. The bone marrow puncture indicated bone marrow metastatic cancer, and the positron emission tomography/computed tomography (CT) indicated multiple internal organ metastases and osseous metastasis. Chemotherapy treatment posed great risks due to the patient’s poor performance status and severe bone marrow suppression. Therefore, trastuzumab monotherapy was administered at a loading dose of 8 mg/kg and a maintenance dose of 6 mg/kg every three weeks. Following four doses of trastuzumab treatment, the patient’s performance status significantly improved and the peripheral blood cell counts had returned to within the normal ranges. Taxol was added to the trastuzumab treatment and seven cycles were completed. No metastatic cancer cells were found in the subsequent bone marrow smear test; however, CT showed metastatic foci in the left lung. Furthermore, the enlarged lymph nodes had subsided and the tumor in the right appendix region had decreased in size by 50%. The patient’s disease condition was maintained stable for 11 months.
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Affiliation(s)
- Long Xu
- Department of Oncology, PLA Cancer Center, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110840, P.R. China
| | - Fang Guo
- Department of Oncology, PLA Cancer Center, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110840, P.R. China
| | - Shuxi Song
- Department of Oncology, PLA Cancer Center, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110840, P.R. China
| | - Guojing Zhang
- Department of Oncology, PLA Cancer Center, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110840, P.R. China
| | - Yongye Liu
- Department of Oncology, PLA Cancer Center, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110840, P.R. China
| | - Xiaodong Xie
- Department of Oncology, PLA Cancer Center, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110840, P.R. China
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32
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Artac M, Koral L, Toy H, Guler T, Boruban MC, Altundag K. Complete response and long-term remission to anti-HER2 combined therapy in a patient with breast cancer presented with bone marrow metastases. J Oncol Pharm Pract 2013; 20:141-5. [PMID: 23676508 DOI: 10.1177/1078155213480201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Presentation with bone marrow metastasis at diagnosis is a rare event in breast carcinoma. Here, we report a rare presentation of metastatic breast cancer patient with bone marrow metastases, who was successfully treated with trastuzumab combined chemotherapy. The regimens initially applied for bone marrow metastasis were docetaxel/adriamycin, gemcitabine/vinorelbine, epirubicin/cyclophosphamide, capecitabine, docetaxel, gemcitabine, and paclitaxel. But, the best response to these regimens was not satisfactory. Our patient was completely treated with etoposide-cisplatin and trastuzumab combination. She is still on remission after five years of metastatic breast cancer diagnosis using letrozole and trastuzumab without complication. Physicians should be careful in treating bone marrow metastases in breast cancer, since patients can show improved marrow function after chemotherapy and long-lasting survival is possible.
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Affiliation(s)
- Mehmet Artac
- Department of Medical Oncology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
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