Extensive Bone Marrow Necrosis and Osteolytic Lesions in a Case of Acute Myeloid Leukemia Transformed from Polycythemia Vera

Abstract

Acute myeloid leukemia (AML) is the most common leukemia in adults. In rare cases, bone marrow necrosis (BMN) and osteolytic lesions are presenting features of AML. The following case describes a patient with known polycythemia vera (PV) that presented with signs of multiple myeloma, including hypercalcemia, anemia, and lytic lesions of the thoracic spine and skull. Laboratory workup was not indicative of myeloma. A bone marrow biopsy was performed, which revealed extensive BMN and initial pathology was consistent with metastatic carcinoma. However, no immunohistochemical stains could be performed due to the extent of BMN; a repeat biopsy was therefore performed. Flow cytometry and CD45 staining were consistent with PV that had transformed to AML. Due to the patient’s comorbidities, she was a poor candidate for stem cell transplant and did not wish to pursue chemotherapy. Ultimately, she pursued hospice care. Based on our literature review, both BMN and osteolytic lesions are rare manifestations of AML and have not been reported to occur simultaneously. These findings can lead to a diagnostic dilemma and suspicion of other malignancies. This case demonstrates that AML should remain in the differential diagnosis in those patients who present with BMN and osteolytic lesions.

Parathyroid Adenoma as a Rare Cause of Persistent Hypercalcemia in a Female with Polycythemia Vera

“…Hypercalcemia, which occurs in multiple myeloma, lymphoma, or any other solid tumor, is usually related to the disease itself, but in PV, it is usually due to other causes such as primary hyperparathyroidism, due to adenoma or carcinoma, or due to other solid malignancies. Also, it has been reported that hypercalcemia is associated with PV transformation into acute myeloid leukemia [6]. Although there are case reports and studies that describe an association between hypercalcemia and PV, most of them are old, from a time at which the PV diagnosis was unclear, and it was established before introducing the WHO criteria in 2008 [7].…”

Myeloproliferative Disorder with Intraoral Lesions in an Olive Baboon (Papio anubis)

“…4,9 AML is the most common leukemia in adult humans. 10 Clinical presentation of AML is diverse and non-specific. 11 It is often associated with cytopenias and may include fatigue, hemorrhage, infection, pallor, and dyspnea.…”

“…11 There have been rare reports of AML in humans associated with bone marrow necrosis and osteolytic lesions as seen in this baboon. 10 Adverse prognostic indicators in humans include age over 60 years, white blood cell count…”

In VivoMurine Model of Leukemia Cell-Induced Spinal Bone Destruction

“…BMN is a histopathologic diagnosis characterized by destruction of the medullary stroma with preservation of cortical bone. Severe BMN occurs in about 2.4% of AML [5]. The overall survival of AML with BMN is 3.7 months compared to 14 months in those without BMN [6].…”