Abstract

Acute myeloid leukemia (AML) is the most common leukemia in adults. In rare cases, bone marrow necrosis (BMN) and osteolytic lesions are presenting features of AML. The following case describes a patient with known polycythemia vera (PV) that presented with signs of multiple myeloma, including hypercalcemia, anemia, and lytic lesions of the thoracic spine and skull. Laboratory workup was not indicative of myeloma. A bone marrow biopsy was performed, which revealed extensive BMN and initial pathology was consistent with metastatic carcinoma. However, no immunohistochemical stains could be performed due to the extent of BMN; a repeat biopsy was therefore performed. Flow cytometry and CD45 staining were consistent with PV that had transformed to AML. Due to the patient’s comorbidities, she was a poor candidate for stem cell transplant and did not wish to pursue chemotherapy. Ultimately, she pursued hospice care. Based on our literature review, both BMN and osteolytic lesions are rare manifestations of AML and have not been reported to occur simultaneously. These findings can lead to a diagnostic dilemma and suspicion of other malignancies. This case demonstrates that AML should remain in the differential diagnosis in those patients who present with BMN and osteolytic lesions.

Highlights

  • Acute myeloid leukemia (AML) is the most common leukemia in adults [1]

  • AML can present with bone marrow necrosis (BMN) [4] or granulocytic sarcoma (GS) [5]

  • The following case describes a patient with known polycythemia vera (PV) that transformed to AML who presented with both osteolytic lesions and bone marrow necrosis

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Summary

Introduction

Acute myeloid leukemia (AML) is the most common leukemia in adults [1]. Acute leukemia can develop from myeloproliferative neoplasms, including polycythemia vera (PV). AML can present with bone marrow necrosis (BMN) [4] or granulocytic sarcoma (GS) [5]. How to cite this article Chambers I, Truong P, Kallail K, et al (June 13, 2016) Extensive Bone Marrow Necrosis and Osteolytic Lesions in a Case of Acute Myeloid Leukemia Transformed from Polycythemia Vera. The following case describes a patient with known PV that transformed to AML who presented with both osteolytic lesions and bone marrow necrosis. The increasing blast count and flow cytometry results on the second biopsy were consistent with polycythemia vera transformation to AML. Given the potential toxicities and related mortality with the chemotherapy, the patient chose to pursue palliative care measures only and was transferred to an inpatient hospice unit

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