Bone marrow necrosis in pediatric malignancies: 10‐Year retrospective review and review of literature

Abstract

Bone marrow necrosis (BMN) is a rare pathologic finding, but when encountered is most often associated with malignancy. In adults, its presence correlates with an inferior prognosis, however in children the prognostic implication is unclear. We performed a retrospective review of 3,760 bone marrow specimens in patients ≤18 years over a 10-year period. BMN was identified in less than 1% of specimens and only in patients with leukemia, lymphoma, or neuroblastoma. BMN contributed to a delay in diagnosis; however, advanced medical imaging may serve as a tool to localize nonnecrotic areas for bone marrow sampling, facilitating an expedited diagnosis.

Bone marrow necrosis in childhood: The hunt for blasts

“…The observation of bone marrow necrosis is a rare phenomenon, 1 especially in pediatrics 2 . In the pediatric population, cancers are the leading cause of bone marrow necrosis (acute leukemia, metastatic neuroblastoma) 2 .…”

“…The observation of bone marrow necrosis is a rare phenomenon, 1 especially in pediatrics 2 . In the pediatric population, cancers are the leading cause of bone marrow necrosis (acute leukemia, metastatic neuroblastoma) 2 . In adults, hematological malignancies seem to be frequent causes of bone marrow necrosis, and are associated with a poor prognosis 1 .…”

“…2 In the pediatric population, cancers are the leading cause of bone marrow necrosis (acute leukemia, metastatic neuroblastoma). 2 In adults, hematological malignancies seem to be frequent causes of bone marrow necrosis, and are associated with a poor prognosis. 1 Non-malignant etiologies include severe infections, autoimmune diseases, disseminated intravascular coagulation, thrombotic disorders, and G-CSF exposure.…”

Bone marrow trephine immunohistochemistry is useful in characterizing malignancy‐associated myelonecrosis: A retrospective observational study

“…While malignancies (both primary hematolymphoid and metastases), infections, autoimmune diseases, hemoglobinopathies, chemoradiotherapy are commonly reported to be associated with MN, the etiology may still remain obscure in up to 10% of cases. [2][3][4][5] Cases with malignancy-associated MN (MMN) may pose diagnostic challenge for the hematopathologists; mainly because of lack of desired number of viable cells either in peripheral blood or in BM aspirate (BMA) to be evaluated morphologically and immunophenotypically using ancillary tools such as flow cytometry, immunocytochemistry; or by immunohistochemistry (IHC) on trephine biopsy (BMBx) tissue sections. Moreover, myelonecrosis may yield a difficult BMA which may require multiple procedures from different anatomic sites such as sternum and/or bilateral iliac crests for obtaining viable sample that can be used for early decision making.…”

“…Previous retrospective reviews have reported its incidence ranging from 0.3% to 2% in antemortem trephine biopsies. While malignancies (both primary hematolymphoid and metastases), infections, autoimmune diseases, hemoglobinopathies, chemoradiotherapy are commonly reported to be associated with MN, the etiology may still remain obscure in up to 10% of cases 2‐5 . Cases with malignancy‐associated MN (MMN) may pose diagnostic challenge for the hematopathologists; mainly because of lack of desired number of viable cells either in peripheral blood or in BM aspirate (BMA) to be evaluated morphologically and immunophenotypically using ancillary tools such as flow cytometry, immunocytochemistry; or by immunohistochemistry (IHC) on trephine biopsy (BMBx) tissue sections.…”