Bone Marrow Necrosis

Abstract

Bone marrow necrosis is regarded as an uncommon entity that is associated with a poor prognosis. However, organized studies using either bone marrow biopsy specimens or autopsy material showed that bone marrow necrosis can be demonstrated in approximately one third of specimens. It is found in a large number of both malignant and nonmalignant disorders, in addition to occurring following large exposures to radiation or high dose cancer chemotherapy. In the absence of radiation or cancer chemotherapy, it probably eventuates from either vascular occlusion or blood stasis in small blood vessels. When bone marrow necrosis is prolonged, it may be associated with the development of bone marrow fibrosis, and it may serve as a predisposing etiology for idiopathic myelofibrosis. Most patients discovered with bone marrow necrosis have few symptoms, and they are eventually lost to follow-up without evident progression or development of a clinical illness. In acute disorders and in those who undergo effective therapy, recovery appears to occur without complications. This frequently overlooked finding is the subject of many case reports in the medical literature, but it has only been rarely systematically investigated. The latter is probably warranted because of the potential role of bone marrow necrosis in the pathophysiology of a number of disorders and the paucity of information for treatment of this pathological finding.

How I investigate bone marrow necrosis

“…A diagnosis of bone marrow necrosis is made when areas of the trephine biopsy specimen are lacking normal bone marrow architecture and there are affected areas containing either amorphous granular eosinophilic staining debris or shadows of cells (ghost cells) with indistinct cellular margins . Debris and hemosiderin‐laden histiocytes are also frequently seen.…”

“…Occasionally, there is necrosis of adjacent bone spicules. Proliferation of fibroblasts can be seen adjacent to the necrotic areas as part of the body's attempt to clear the necrotic debris and heal the wound . These characteristic findings are visible using basic hematoxylin and eosin staining and lower powered (10‐40x) microscopy.…”

Bone marrow necrosis related to paracoccidioidomycosis: the first eight cases identified at autopsy

“…The role of AIDS in suppressing the cellular immune response could have contributed to the spread of fungal BM in case 1. AIDS can also cause BMN, 1,4 but the large number of fungal cells within medullary necrotic areas strongly suggests that PCM played a greater role in the pathophysiology of this patient’s necrosis.…”

“…BMN prognosis is related to underlying disease severity and is generally poor 1,4,10 . It can, however, contribute to the death of some patients 1 as a consequence of cytopenia that share some of the risks.…”

“…Bone marrow necrosis (BMN) can be regarded as a clinicopathological entity when it affects the myeloid parenchyma and medullary stroma, compromising large areas of haematopoietic tissue 1 . It was described by Wade and Stevenson 2 in 1941, in a patient with sickle cell disease, and is regarded as a relatively rare finding 3,4 . Although more commonly diagnosed from autopsied than living patients, 5–10 the prevalence of BMN varies from 0.3% to 1% in non‐selected populations when considered extensive, from both bone marrow (BM) smears and biopsies 1 …”