147 Metastatic Neoplasms of Bone Marrow: A Clinicopathological Study

Al-Ghamdi, Yahya; Mahon, Brett; Reddy, Vijaya B.; Gattuso, Paolo

doi:10.1093/ajcp/aqx119.146

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“…In the same study, the majority of patients with bone marrow metastasis presented with an abnormal blood count prior to bone marrow evaluation. [18] Neuroendocrine cancer with bone marrow infiltration from an unknown primary tumor with multiple liver metastases, presenting with anemia and thrombocytopenia has been described. [33] Neuroendocrine carcinoma with bone marrow metastasis may present with pancytopenia, features of myeloproliferative disorders, or isolated thrombocytopenia, as in the present case.…”

Section: Discussionmentioning

confidence: 99%

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Metastatic rectal neuroendocrine carcinoma presenting with treatment-refractory immune thrombocytopenia: A case report and literature review

2022

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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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Section: Discussionmentioning

confidence: 99%

“…Bone marrow and brain metastasis are rare. [8–10,15,17,18] CRNEC presenting with refractory thrombocytopenia has not been described previously. Treatment of CRNEC involves surgery, chemotherapy, or radiation in various combinations based on the extent of the local tumor burden and metastasis.…”

Section: Introductionmentioning

confidence: 95%