Bone marrow necrosis

Abstract

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.

Bone Marrow Necrosis: Report of Five Cases and Review of the Literature

“…5,7 It has been suggested that therapy for patients with BMN be aimed at promoting recovery of marrow stroma by the use of cytokines and chemotherapy not highly toxic to bone marrow stem cells and stroma. 2 In conclusion, our findings confirm that the conditions associated with BMN are varied and malignancy remains common. BMN may precede or obscure the diagnosis, and repeat biopsies are indicated to secure a diagnosis.…”

“…Likewise, laboratory findings seen in our patients and commonly associated with BMN include pancytopenia, microangiopathic features and a leukoerythroblastic blood picture. 2,3,7 Elevated serum lactate dehydrogenase and alkaline phosphatase levels are known associated laboratory features, 2,3,7 and were also seen in four of our patients ( Table 1). The prognosis of patients with BMN has been considered poor, 1,2 however, there have been reports of recovery in some cases with adequate supportive management.…”

“…In case 4, the patient recovered after an initial diagnosis of BMN associated with multisystem failure, the exact etiology of which was not established. Associated clinical features reported include fever and/or bone pain, [1][2][3] which were present in most of our patients (Table 1). Likewise, laboratory findings seen in our patients and commonly associated with BMN include pancytopenia, microangiopathic features and a leukoerythroblastic blood picture.…”

“…2 The relative frequency of BMN varies among different reports, ranging between 0.37%-6.5%. 3,7 Our five cases account for a relative frequency of 0.47%.…”

“…BMN is commonly the end result of infiltration by a neoplastic process, chemotherapy or vaso-occlusion. [2][3][4][5][6][7][8][9][10] It has also been related to the presence of antiphospholipid antibodies 4 and chemotherapy for cancer with a variety of agents. [11][12][13][14] The pathophysiology of BMN has been a subject of controversy and debate, 3 and has included toxic effects of chemotherapy, microvascular infarction, decreased oxygen tension due to increased proliferative capacity of infiltrating malignant cells, 3 tumor necrosis factor (TNF), 17 and thrombosis.…”