Diffuse purely osteolytic lesions in myelofibrosis

Abstract

In myelofibrosis, the skeletal bones present radiologically as normal or with osteosclerotic or osteoporotic changes. Lytic lesions are very rare and when present are usually associated with osteosclerosis. We report on a case of a patient with myelofibrosis exhibiting diffuse purely osteolytic lesions.

Diffuse osteolytic lesions in leukemic transformation of myelofibrosis

“…In this case we found diffuse osteolytic bone lesions that are rarely reported in literature (10,11). In our patient the presence of diffuse osteolytic lesions can be related to the leukemic transformation per se by means of enhanced secretion of cytokines, or ectopic secretion of the parathormone, parathormone-like mediators or vitamin D3 (10)(11)(12)(13). Ectopic secretion of parathormone is usually associated with hypercalcemia, which is not case in this patient.…”

“…We previously reported that TNF-α can induce apoptosis in leukemic cell lines in vitro (9,14) and can stimulate osteoclast activation with subsequent development of bone degradation. Osteolytic lesions in myelofibrosis have been described but rarely and only in irradiated patients (1,11). Association of bone marrow necrosis and elevated TNF-α was described in leukemoid reaction in patients with metastatic prostate cancer (15).…”

Acute megakaryocytic leukemia presenting as hypercalcemia with skeletal lytic lesions

“…Diffusely lytic lesions have been described in the setting of myelofibrosis evolving from previous polycythemia vera (10). Interestingly, in that case the diffuse pain from lytic lesions disappeared after the patient underwent a splenectomy.…”

Non‐malignant lytic lesions of bone

“…However, there have been two single case reports documenting patients with myelofibrosis who were found to have lytic lesions on X‐ray. In one such case the patient was initially diagnosed with polycythemia rubra vera before developing myelofibrosis 3 . Discrete lytic lesions were found to have developed over a 2‐year period and the authors felt that this correlated with an accelerated phase of her disease.…”