Cases Of Bone Marrow Necrosis Research Articles

Analysis and Clinical Characteristics of 23 Cases of Bone Marrow Necrosis

BackgroundBone marrow necrosis (BMN) is a rare secondary disorder of many discrepant neoplastic processes. The etiology is diverse, and malignancy is the most common background disease. Patients and MethodsBetween 2005 and 2019, a total of 23 cases of BMN were detected and analyzed at Zhujiang Hospital and Nanfang Hospital. ResultsIn our study, the 40-60-year-old age group was the one with the highest incidence of BMN (n = 12, 52.2%). The background diseases of patients with BMN varied. Eighteen (78.3%) of 23 patients were diagnosed with hematologic diseases at the same time, most of which were acute B lymphocytic leukemia (n = 8, 34.8%). The complete blood count of these 23 patients noted a decrease in hemoglobin (100%), a decrease or increase in white blood cells and neutrophils, and thrombocytopenia (78.3%). The levels of lactate dehydrogenase (> 300 U/L) and serum ferritin (> 500 μg/L) were elevated in all patients, and 16 (94.1%) of 17 patients presented with increased d-dimer levels. The 2-week cumulative survival and 2-year cumulative survival of patients with BMN were 56.5% and 47.4%, respectively. The mortality probability within 2 weeks was 43.5%, and the adjusted mortality probability was 26.7% within 2 weeks to 2 years, indicating that patients with BMN had the greatest risk of death within 2 weeks. ConclusionBMN patients with B lymphocytic leukemia as the background disease had a better prognosis than those with other background diseases. BMN of unknown etiology may have an extremely poor prognosis. Therefore, diagnosing the background disease plays an important role in the treatment of BMN.

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

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

Bone Marrow Necrosis in Newly Diagnosed Acute Leukemia: Two Case Reports and Review of the Literature.

Bone marrow necrosis (BMN) in acute leukemia is a rare histopathological entity at the time of initial diagnosis. However, it represents an important diagnostic and prognostic challenge. Two cases of BMN are reported: a 44-year-old patient with B cell precursor (BCP) acute lymphoblastic leukemia (ALL) and a 27-year-old man with FAB-M5 acute myeloid leukemia (AML) who both presented with bone marrow failure and extensive necrosis. From these clinical cases, we conducted a brief review of the literature.

Extensive marrow necrosis due to miliary tuberculosis: A case report

Bone marrow necrosis (BMN) is a rare clinicopathologic entity caused by hypoxemia after the failure of microcirculation that frequently manifests with bone pain, fever, and peripheral cytopenia. In most reported cases of BMN resulting from extrapulmonary tuberculosis (TB), the presence of marrow granulomas, pulmonary infiltrates and/or extrapulmonary involvement are common. We report a case of an extensive BMN from miliary TB whose initial presentation was only mild anemia and multiple bone lesions.

Bone marrow necrosis as clinical presentation of plasmablastic lymphoma in an AIDS patient: First case reported and literature review

Patients with HIV/AIDS disease are at high risk of developing non-Hodgkin lymphoma (NHL) which is included as anAIDS-defining illness. Plasmablastic lymphoma (PBL) most frequently presents in the oral cavity and generally inpatients with HIV infection. Extra-oral PBL is a rare tumor but with a similar capability to local invasion and rapiddissemination to extra-oral sites. Bone marrow necrosis (BMN) associated with high grade B cell lymphoproliferative disease is a rare condition that should be suspected in HIV-infected patients with unexplained fever and cytopenias. Herewe describe the first case of BMN caused by a high grade NHL diagnosis as PBL in an AIDS patient.

A Case of Bone Marrow Necrosis of an Idiopathic Aetiology: The Report of a Rare Entity with Review of the Literature

Bone Marrow Necrosis (BMN) is regarded as a rare entity in the aspirates and the trephine biopsies which are obtained from living patients and it is a rare antemortem diagnosis. Usually, BMN is associated with a poor prognosis and it has a 90% association with malignancies (mainly haematological). Its other causes include infections, drugs and other non malignant haematological causes. BMN which occurs due to unknown causes (idiopathic), is very rare. The present case report describes a case of BMN in a 14 year old male child from rural background, who came to the medicine outpatient department of a tertiary care centre in north India, with the complaints of generalized weakness, severe bone pains, especially in the ribcage area and fatigue. His peripheral blood film revealed pancytopaenia. His bone marrow aspiration yielded a watery, sero-sanguinous fluid from 2 different sites. Microscopy revealed "ghost like" haematopoietic cells lying in eosinophilic, proteinaceous material. Bone marrow biopsies from both the sites revealed extensive foci of gelatinous transformation and necrosis. A diagnosis of BMN was rendered. No underlying neoplastic / non neoplastic cause was identified, even after a thorough systematic investigation (haematological/biochemical/ radiological and immunological). Thus, a final diagnosis of BMN due to an idiopathic cause, was finally given. The patient was given supportive treatment, after which he was referred to a higher centre. BMN which arises idiopathically is usually very rare and often precedes the aetiological diagnosis and obscures the diagnosis. Traditionally, the prognoses of the patients with BMN were considered as poor, but with better treatment aids (chemotherapy and supportive treatment), the prognoses of these patients have been found to improve. Vigorous supportive care, along with a disease specific treatment, is the key to its management. This case was worth reporting, as no cause of BMN was elicited in it and we have summarized the signs and symptoms, the associations, haematological and other lab investigations and the role of radiology, which helped in its diagnosis.

G-CSF-Associated Bone Marrow Necrosis in AML after Induction Chemotherapy

Bone marrow necrosis (BMN) is defined as necrosis of the myeloid tissues and stroma without involvement of the cortical bone. We report a case of 66-year-old male with AML-M4 (FAB classification) who was given induction chemotherapy with cytarabine and daunorubicin. Filgrastim at 480 micrograms was administered on days 15–19 to shorten the duration of neutropenia. Consequently patient developed severe pelvic bone pain, leukoerythroblastosis, and severe leukocytosis. Repeat bone marrow aspiration and biopsy on day 21 confirmed bone marrow necrosis. These manifestations responded quickly to discontinuation of filgrastim. Subsequently, he recovered full myelopoiesis. We suggest that there may be more cases of BMN associated with G-CSF that are undiagnosed.

Severe Extensive Bone Marrow Necrosis From Miliary Tuberculosis Without Granulomas and Pulmonary Presentations

Bone marrow necrosis (BMN) is a rare clinicopathologic entity caused by hypoxemia after failure of the microcirculation, which frequently manifests with bone pain, fever, and peripheral cytopenia. In most reported cases of BMN resulting from miliary tuberculosis (TB), the presence of marrow granulomas, pulmonary infiltrates and/or extrapulmonary involvement is common. We report a female patient with extensive BMN from miliary TB, whose initial presentation was only severe peripheral cytopenia with extensive marrow necrosis, with neither evident pulmonary manifestations nor granulomas in the marrow biopsy. Serial Ziehl-Neelsen stains and Mycobacterium tuberculosis cultures were negative. The diagnosis of suspected miliary TB was made by consecutive positive results from polymerase chain reaction analysis for TB of marrow samples at 2 separate examination time points and a good treatment response to anti-TB therapy. Magnetic resonance imaging showed a geographic pattern of multiple signal abnormalities, indicating bone infarcts over the bilateral iliac bones and T-L-spine vertebral bodies, compatible with extensive BMN. The unusual presentation of extensive BMN with severe peripheral cytopenia in the absence of granulomas or pulmonary presentations should alert clinical physicians in epidemic areas. We discuss the use of polymerase chain reaction analysis for TB and magnetic resonance imaging for diagnosis of these patients.

Diagnosis of bone marrow necrosis

Two cases of bone marrow necrosis (BMN) were diagnosed during life. Both patients developed BMN as a terminal event in the evolution of untreated malignant lymphoma. No earlier cases of BMN in untreated malignant lymphoma are reported in the literature. In one patient necrotic and normal bone marrow were simultaneously obtained from two different aspiration sites, showing the focal nature of the process. BMN itself being reversible, the diagnosis in vivo is important. A better knowledge of the significance of a yellow brown viscous fluid obtained by bone marrow aspiration and the exact interpretation of necrotic bone marrow films are essential to recognition of BMN.

Bone marrow necrosis complicating post-transplant lymphoproliferative disorder: Resolution with rituximab

Bone marrow necrosis is a rare cause of bone marrow failure. Malignancy is the most frequent cause of bone marrow necrosis. Among malignancies, non-Hodgkin lymphoma (NHL) accounts for 10% of cases of bone marrow necrosis. Virtually all reported cases of NHL-associated bone marrow necrosis have developed in immunocompetent hosts. We report on a case of bone marrow necrosis complicating post-transplant lymphoproliferative disorder (PTLD) and resolving after rituximab monotherapy. This case report provides the first evidence of (i) bone marrow necrosis as a complication of PTLD; (ii) rapid resolution of NHL-associated bone marrow necrosis after rituximab treatment.

MRI Features of Bone Marrow Necrosis

The purpose of this study was to illustrate and review the MRI appearance of histologically proven cases of bone marrow necrosis (BMN) and to review the literature on this clinicopathologic entity with emphasis on its distinction from avascular necrosis (AVN) of bone. BMN is a rare clinicopathologic entity separate from AVN and has a distinctive MRI appearance. As MRI comes to play an increasingly important role in the evaluation of bone marrow disease, BMN is likely to be more frequently encountered. Awareness of BMN and its MRI appearance and appreciation of the frequent association between BMN and underlying malignancy may assist in the early diagnosis of BMN and initiate an intensive search for occult malignancy.

Bone Marrow Necrosis in Adult Acute Leukemia and Non-Hodgkin's Lymphoma

Bone marrow necrosis is a rare finding in adult patients diagnosed with acute leukemia or non-Hodgkin's lymphoma. Previous reports have suggested that it is associated with a poor prognosis. It remains unclear however, whether improvements in patient care during the last decade have altered patient outcome. In a retrospective review of 581 bone marrow biopsies performed ante mortum on adult patients with acute leukemia or non-Hodgkin's lymphoma, we identified 10 cases of bone marrow necrosis (5 acute myeloid leukemia, 5 non-Hodgkin's lymphoma). Severe bone pain, elevated serum lactate dehydrogenase levels and leukoerythroblastic peripheral blood smears were common presenting features. Despite treating 8 of the 10 patients with curative intent, only 2 patients remain alive and disease-free. This study confirms that bone marrow necrosis in adults with acute leukemia and non-Hodgkin's lymphoma is a rare ante mortum finding and confers a poor prognosis. Whether these patients would benefit from more intensive therapy such as hematopoietic stem cell transplantation remains to be clarified.

Non-malignant bone marrow necrosis: A report of two cases

We present two cases of bone marrow necrosis not associated with malignancy, infection or sickle cell disease. The first case, a 28 year old woman with the antiphospholipid syndrome and a factor V Leiden abnormality, suffered an illness characterised by multiple organ thromboses, anemia and refractory thrombocytopenia. She had documented bone marrow necrosis of the posterior iliac spine and numerous hot spots on bone scanning suggestive of widespread marrow necrosis. This patient also suffered hepatic infarcts and a miscarriage and may represent an explanation for the previously described "catastrophic antiphospholipid syndrome". The second patient developed widespread bone pain over a three week period, underwent a cholecystectomy and suffered major post-operative complications including a delayed transfusion reaction and disseminated intravascular coagulation. Pancytopenia developed and bone marrow trephines from numerous foci revealed widespread bone marrow necrosis. The only predisposing factor to account for this presentation was that the patient had been sniffing glue for two months prior to the illness, as the foci of necrosis had healed on repeat marrow examination eight weeks later when the patient had abstained from glue sniffing. This case may represent a reversible, toxic cause of bone marrow necrosis.

Bone Marrow Necrosis

American Journal of HematologyVolume 50, Issue 1 p. 65-66 Letters And Correspondence Bone Marrow Necrosis A. Bermejo, A. Bermejo Servicio de Hematologia y Hemoterapia, Hospital Universitario San Cartos, Madrid, SpainSearch for more papers by this authorF. A. Gonzalez, F. A. Gonzalez Servicio de Hematologia y Hemoterapia, Hospital Universitario San Cartos, Madrid, SpainSearch for more papers by this authorA. Villegas, A. Villegas Servicio de Hematologia y Hemoterapia, Hospital Universitario San Cartos, Madrid, SpainSearch for more papers by this authorC. Alarcon, C. Alarcon Servicio de Hematologia y Hemoterapia, Hospital Universitario San Cartos, Madrid, SpainSearch for more papers by this author A. Bermejo, A. Bermejo Servicio de Hematologia y Hemoterapia, Hospital Universitario San Cartos, Madrid, SpainSearch for more papers by this authorF. A. Gonzalez, F. A. Gonzalez Servicio de Hematologia y Hemoterapia, Hospital Universitario San Cartos, Madrid, SpainSearch for more papers by this authorA. Villegas, A. Villegas Servicio de Hematologia y Hemoterapia, Hospital Universitario San Cartos, Madrid, SpainSearch for more papers by this authorC. Alarcon, C. Alarcon Servicio de Hematologia y Hemoterapia, Hospital Universitario San Cartos, Madrid, SpainSearch for more papers by this author First published: September 1995 https://doi.org/10.1002/ajh.2830500117Citations: 10AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume50, Issue1September 1995Pages 65-66 RelatedInformation

Bone marrow necrosis

Bone marrow necrosis is most frequently diagnosed at postmortem examination. Antemortem diagnosis is still uncommon. In a recent review of world literature, we have found 133 cases of bone marrow necrosis diagnosed during life. It has been observed during the course of a wide variety of diseases, most commonly in association with acute and chronic leukemia, carcinoma, malignant lymphoma, infections, and sickle cell disease. We report two intravitally diagnosed cases of bone marrow necrosis occurring in two patients with high-grade B-cell lymphoproliferative disease. These cases are unusual in that both patients had a triad of bone marrow necrosis, high-grade B-cell lymphoproliferative disease, and hypercalcemia. Despite chemotherapy, both cases ultimately proved fatal, with progressive involvement of the central nervous system.

Nécroses médullaires au cours des hémopathies malignes. Sept observations

The authors report 7 cases of bone marrow necrosis during hematological malignant diseases:3 leukemia, 4 lymphoid malignancies. The main clinical features were bone pain and fever. The bone marrow aspiration and/or biopsy allow diagnosis. The prognosis was in all cases very poor.

Bone Marrow Necrosis Associated With Tumor Emboli and Disseminated Intravascular Coagulation

To the Editor. —Bone marrow necrosis, which has been described in sickle cell disease, infectious diseases, and cancer,1-6is a disorder rarely diagnosed during life. In the November 1982Archives(1982;142:2223-2225), Pardoll et al reported a case of bone marrow necrosis associated with sickle cell disease. Reticuloendothelial scans showed widespread abnormalities consistent with marrow infarction; widespread microvascular obstruction by masses of sickle cells seems plausible as a mechanism of marrow necrosis.5Nevertheless, the bone marrow necrosis pathogenesis is unknown in neoplasia and infectious diseases. We report a case of bone marrow necrosis diagnosed antemortem in a patient with gastric metastatic adenocarcinoma, where postmortem pathologic studies may bring further knowledge about necrosis physiopathology. Report of a Case. —A 60-year-old man was admitted to the hospital after three weeks of fever, dyspnea, and bone pain in the lower part of the back. Physical examination showed a severely ill patient, pale with petechia on the limbs, and necrosis in his right toes.

Bone marrow necrosis

The clinical findings of bone marrow necrosis in 13 patients undergoing bone marrow examination to investigate a peripheral blood cytopenia or leukoerythroblastic blood smear were reviewed and compared to those in the literature. Excluding sickle cell disease, all cases of bone marrow necrosis diagnosed during life were associated with a neoplastic process involving the marrow. A myeloproliferative disorder was found in five patients, metastatic carcinoma in five patients, a lymphoma in two patients, and both a myeloproliferative disorder and metastatic carcinoma in one patient. Marrow necrosis was found to involve the marrow at multiple sites in a piecemeal fashion with areas of necrotic marrow and structurally intact marrow adjacent to each other. Severe bone pain without roentgenographic abnormality was the major symptom in 85 per cent of the patients. Marrow and fat emboli, hypercalcemia and peripheral blood cytopenias were identified as direct complications of marrow necrosis. The prognosis of patients with marrow necrosis secondary to neoplastic disease was found to be extremely poor with a median survival of less than one month. However, one patient responded to antineoplastic chemotherapy and showed healing of the bone marrow.