Pure red cell aplasia is an uncommon cause of anaemia rarely associated with thymoma. A combination of immunosuppressive therapy and thymectomy offers a potential cure. Thymectomy alone rarely results in anaemia resolution. A seventy-three-year-old male with Klinefelter syndrome presented with progressively increasing shortness of breath and anaemia. Serological testing supported primary bone marrow pathology, and a bone marrow biopsy was performed. A pure red cell aplasia was seen on bone marrow examination, and computed tomography of the chest demonstrated a thymoma. Thymectomy was performed, and histology revealed a thymolipoma. Complete anaemia resolution was achieved following thymectomy alone. This suggests that thymomas may directly mediate immune dysregulation resulting in erythroid precursor destruction.
Medical education MJA 217 (7) ▪ 3 October 2022 346 • Diffuse or multifocal marrow infiltration on imaging warrants consideration of further investigation with bone marrow biopsy.
Treatment of breast cancer was commenced with anti-oestrogen therapy, exemestane. Molecular testing for myeloproliferative neoplasms is currently underway, which will help to determine if the fibrosis is secondary to breast cancer infiltration, or if there is a co-existing primary myelofibrosis. In any case, ruxolitinib is relatively contraindicated due to the severe thrombocytopaenia. Induction of bone marrow fibrosis by metastatic bone marrow infiltration of solid organ tumours has been described in occasional case studies and small case series. 1 More rarely however, there have been reports of a clinicopathologic entity similar to primary myelofibrosis. 2,3 As in this case, these features include splenomegaly, anaemia, thrombocytopenia, and a leucoerythroblastic blood picture in addition to increased reticulin fibrosis on bone marrow biopsy. This case report builds upon the paucity of available literature about this rare phenomenon. References 1. Kaur G, Basu S, Kaur P, et al. Metastatic bone marrow tumours: study of 9 cases and review of the literature. J Blood Disord Transfus 2011; 2: 1-3. 2. Yablonski-Peretz T, Sulkes A, Polliack A, et al. Secondary myelofibrosis with metastatic breast bancer simulating agnogenic myeloid metaplasia: report of a case and review of the literature.
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