A Case of Bone Marrow Necrosis in B-Acute Lymphoblastic Leukemia with Philadelphia Chromosome at Presentation

Bone marrow necrosis (BMN) is a pathologic state which is derived from various disease entities. Most commonly, it is accompanied by hematologic malignancies such as acute leukemia. The patients with marrow necrosis are generally known to have dismal prognoses but variations exist according to early diagnosis. Here we report a case of BMN in an acute lymphoblastic leukemia patient with Philadelphia chromosome at presentation.

Malignant with bone marrow necrosis:a case report and literature review / 中国基层医药

Objective To investigate the pathogenesis,clinical feature,laboratory examination characteristics and the prognosis of the bone marrow necrosis.Methods To analyze the clinical data of one case of diagnostic bone marrow necrosis and review the relevant literature.Results The peripheral blood examinations were as follows:the hemoglobin(HGB)level was 36g/L,platelet count was 17 ×109 /L.The biochemistry tests showed that lactate dehydro genase (LDH)was 1 454.9U /L and alkaline phosphatase(ALP)was 1 319.4U /L.Bone marrow necrosis was detected by bone marrow smear.Bone marrow biopsy was considered as a bone marrow metastatic carcinoma,which was prone to adenocarcinoma.Conclusion The bone marrow necrosis is mainly caused by the cancer,the serious infection and the drug.Its main performances were bone pain,fever,progressive decline in bloods cells,the LDH and ALP increasing and poor prognosis.In order to extend the lifetime of this kind of patients,the key lies in the early detection,the early diagnosis,and the early treatment of its primary diseases.

Bone marrow necrosis: literature review / Necrose de medula óssea: revisão da literatura

ABSTRACT Introduction: Bone marrow necrosis (BMN) is a rare pathologic entity that is commonly undiagnosed, and often associated with hematologic diseases. Methodology: We conducted a literature review at PubMed using "bone marrow necrosis" as key words. Our search retrieved 25 articles written in English, and a further 65 case reports. Results and discussion: BMN pathophysiology is not well understood, but appears to be associated with vascular injuries that lead to oxygen and nutrient deprivation. Destructive tumor necrosis factor alpha (TNF-α) activity is also likely involved in the development of endothelial and bone marrow sinusoidal lesions. Diagnoses of BMN are commonly indicated by anemia, thrombocytopenia, high levels of lactic dehydrogenase and alkaline phosphatase, and the identification of leukoerythroblastic reactions. Bone marrow (BM) aspirate and biopsy, and magnetic nuclear resonance imaging are the main diagnostic options. The only available treatments are those directed against the primary cause, with associated supportive care for what is ordinarily a rapidly lethal state. Conclusion: The search for an underlying associated malignancy is important for the management of BMN.

RESUMO Introdução: Necrose de medula óssea (NMO) é uma entidade rara, frequentemente não diagnosticada e mais comumente associada a doenças hematológicas. Metodologia: Realizou-se revisão da literatura na base de dados do PubMed, utilizando o termo "necrose de medula óssea". Foram encontrados 25 artigos em inglês e 65 relatos de caso. Resultados e discussão: A fisiopatologia da NMO não é bem elucidada e parece estar associada a lesão vascular com consequente hipóxia celular por desbalanço na oferta de oxigênio e nutrientes. O fator de necrose tumoral alfa (TNF-α) provavelmente também está implicado na lesão endotelial e nos sinusoides da medula óssea. Sugere-se o diagnóstico pela presença de anemia, trombocitopenia, reação leucoeritroblástica, níveis elevados de desidrogenase lática e fosfatase alcalina. Aspirado e biópsia de medula óssea e ressonância nuclear magnética são os principais exames diagnósticos. As únicas possibilidades terapêuticas são tratamento da causa de base e medidas suportivas. Conclusão: O ponto mais importante no manejo da NMO é a busca por condições neoplásicas associadas.

Thrombotic Thrombocytopenic Purpura Associated with Bone Marrow Necrosis Complicating Metastatic Extra-Mammary Paget's Disease

As extra-mammary Paget's disease is rare and usually diagnosed at early stage when it is highly curable with surgical resection, it is much rarer to see patients with recurrent metastatic disease. Thrombotic thrombocytopenic purpura in patients with metastatic solid cancer is also a rare disease and may result from bone marrow metastasis or bone marrow necrosis. For the latter, the majority of cases are not eligible for systemic chemotherapy for rapid disease progression and poor performance status. Herein, authors report a patient with thrombotic thrombocytopenic purpura associated with bone marrow necrosis complicating extra-mammary Paget's disease who was successfully treated with docetaxel and carboplatin combination chemotherapy.

MRI Finding of a Case of Relapsed Acute Mixed Type Leukemia with Bone Marrow Necrosis

Bone marrow necrosis is a rare complication of a variety of diseases affecting the marrow. The cause and incidence are unknown, and reports of treatment response are rare. We describe a case of relapsed acute mixed type leukemia with bone marrow necrosis. The patient was a 10 year old female diagnosed with acute mixed type leukemia four years ago. She had been on second remission state for 1 year, presented with severe back pain, tenderness in lower extremities, low-grade fever and general weakness. Her level of serum lactic dehydrogenase on admission was increased. Bone marrow aspiration from both posterior iliac crest showed marrow necrosis. Subsequent examination showed the same feature. Hip MRI showed heterogenous low signal intensity in both iliac bone on T-1 weighted image and heterogenous high signal intensity on T-2 wieghted image. Remission induction therapy was started but she expired on 59th hospital day due to the complication of sepsis.

A Case of Bone Marrow Necrosis Preceeding Acute Monoblastic Leukemia / 대한임상병리학회지

Bone marrow necrosis is rarely diagnosed during life but is more often seen at autopsy by accident. The prognosis of patients with bone marrow necrosis secondary to neoplastic disease is extremely poor. We experienced a 59-year-old man with acute monoblastic leukemia who developed bone marrow necrosis preceding leukemia. He's main complaint was continuous lower back pain. First hematologic examination showed anemia with leukopenia and extensive bone marrow necrosis. After suffering from sepsis and only supportive management, he spontaneously recovered from pancytopenia and achieved hypercellular marrow with trilineage hematopoiesis. After 6 months, he was diagnosed as acute monoblastic leukemia (FAB, AML, M5a) from the sudden appearence of leukemic blasts on peripheral blood smears. After induction chemotherapy, complete remission was achieved. Our experience suggests that bone marrow necrosis is not uncommonly associated with hematologic malignancy and occult cancer. When bone marrow necrosis is found, we should do close follow-up to find out underlying hidden malignancy.

Bone Marrow Necrosis in CD7 positive Acute Myeloid Leukemia / 대한내과학회지

Bone marrow necrosis is infrequently diagnosed during life, and its presence often signifies a poor prognosis. It has been associated with a variety of disease, including acute and chronic leukemia, carcinoma, malignant lymph oma, infection and sickle cell disease. About 5-26% of acute myeloid leukemia has been reported to express lymphoid differentiation markers, of which CD7 is ex pressed very early during T-cell ontogeny. A 46-year-old male complaining severe bone pain had pancytopenia, leukoerythroblastosis and bone marrow necrosis. Peripheral blood immature cells expressed CD7 as well as myeloid markers such as CD13 and CD33 on immunophenotypic studies. We report a case of CD7 positive acute myeloid leu kemia associated with bone marrow necrosis, confirmed by bone marrow biopsy and immunophenotypic study.

A case of bone marrow necrosis in acute lymphoblastic leukemia

No abstract available.