Bone marrow metastatic neuroendocrine carcinoma with unknown primary site: A case report and review of the literature

Abstract

BACKGROUND Metastatic neuroendocrine carcinoma (NEC) of bone marrow is uncommon. Here, we report a case of bone marrow metastatic NEC with an unknown primary site. CASE SUMMARY A 73-year-old Chinese woman was admitted to our hospital because marked chest distress and asthma lasting 1 d on March 18, 2018. She was initially diagnosed with pulmonary infection, cardiac insufficiency, thrombocytopenia and severe anemia. Following treatment with antibiotic therapy, diuresis and blood transfusion, the patient’s symptoms greatly improved. After bone marrow examinations, the patient was diagnosed with bone marrow metastatic NEC, bone marrow necrosis (BMN) and secondary myelofibrosis (MF). Further imaging workup did not show the primary tumor, we presumed that the primary site might regress spontaneously or merely be unexplored due to lack of positron emission tomography with gallium peptide. Everolimus (10 mg/d) was added to the treatment and the best supportive and symptomatic therapies were also administered. Unfortunately, the patient’s condition continued to deteriorate and she died on May 15, 2018. CONCLUSION Bone marrow invasion of NEC is rare and our patient who suffered from bone marrow metastatic NEC as well as secondary BMN and MF had an extremely poor prognosis. Bone marrow biopsy plays an important role in the diagnosis of solid tumors invading bone marrow.

Disseminated Carcinomatosis of Bone Marrow with or without an Unknown Primary Site: A Case Series

“…Regarding the unknown primary tumor site in the case of neuroendocrine carcinoma, the authors suggested that the primary site might have regressed spontaneously or been unexplored due to a lack of sensitive imaging studies. 7 Our CUPS cases were possibly to be caused similarly. Alternatively, the primary site(s) may emerge in future thorough investigations if they survive longer.…”

“…5 Among DCBM/CUPS cases, adenocarcinoma, neuroendocrine carcinoma, and melanoma have been described. [6][7][8] Although the primary site can generally be suspected from the morphology and immunohistochemistry of metastatic cells in the bone marrow and can be identified by endoscopic and imaging (CT/ MRI/ FDG PET-CT) studies, there are still cases of CUPS, such as the case of melanoma, in which bone marrow biopsy detected HMB-45-and S100-positive atypical large cells with brown pigmentation; however, skin lesions were not observed on the body surface. 8 Over the past 6 years since 2017, we experienced 8 cases of DCBM, two of which were DCBM/CUPS cases.…”

Clinical features and treatment of bone marrow metastasis

“…Bone marrow smear and bone marrow biopsy are the gold standard for the diagnosis of BMMs ( 9 ). However, it is not possible to identify tumour cells in a single bone marrow aspiration, since BMMs are multifocal and myelofibrosis occurs which increases the difficulty of obtaining the bone marrow ( 10 ). Multi-site bone marrow aspiration should be performed if necessary.…”