Leucoerythroblastosis and thrombocytopenia as clues to metastatic malignancy

Mahdi, Eamon J.; Mahdi, Ali Jassem

doi:10.1136/bcr-2013-202612

Cited by 11 publications

(10 citation statements)

References 4 publications

(6 reference statements)

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“…Cases of breast cancer related microangiopathic hemolytic anemia (MAHA) has been reported, albeit rarely. [ 12 – 14 ] In those cases, the anemia and thrombocytopenia raised concern for bone marrow metastasis and indicated poor prognosis, but its pathophysiology remains largely unknown. Someone speculated it as paraneoplastic phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Anemia and thrombocytopenia as initial symptoms of occult breast cancer with bone marrow metastasis

Liu¹,

Zhang

Chen³

et al. 2017

Medicine

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Rationale:Occult breast cancer (OBC) is a rare type of breast cancer without any symptoms in the breast and is often presented with initial symptoms of axillary lymph node metastasis or other metastases. The low incidence rates of OBC make it a great challenge to diagnose and cure.Patient concerns:Our case was a 58-year-old female affected by dizziness and fatigue for nearly a month. Blood tests revealed anemia and thrombocytopenia, and pathological results of a bone marrow biopsy confirmed the metastatic carcinoma.Diagnoses:It was diagnosed as an OBC based on the positive immunohistochemical staining of cytokeratin (CK) and gross cystic disease fluid protein-15 (GCDFP-15).Interventions:Doctor advised her to check whether the bone metastases existed in order to choose an appropriate treatment. It is highly regrettable that the patient gave up all treatments and left the hospital.Outcomes:Recently, we conducted a telephone follow-up and received that the patient only took tramadol and other painkilling drugs to alleviate the pain caused by cancer.Lessons:The current case inferred that symptoms of anemia and thrombocytopenia should not be ignored for the diagnosis of OBC, and bone marrow biopsy is useful in reducing the rates of misdiagnosis and missed diagnosis of OBC.

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Section: Discussionmentioning

confidence: 99%

Anemia and thrombocytopenia as initial symptoms of occult breast cancer with bone marrow metastasis

Liu¹,

Zhang

Chen³

et al. 2017

Medicine

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“…Typical OBC cases are women who have adenocarcinoma or poorly differentiated carcinoma in the axillary lymph nodes and who have no evident primary breast lesion. Although less common, other metastatic sites have been reported in several case reports [2][3][4][5][6]. Disseminated carcinomatosis of the bone marrow (DCBM) is diffuse infiltration of the bone marrow by malignant cells.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have reported that bone marrow metastasis from solid tumors is frequently seen in stomach, prostate, and breast cancer [7,8]. Only a few reports of OBC with DCBM are available in the literature [3,5,6], and findings concerning the treatment and clinical course are scarce.…”

Section: Introductionmentioning

confidence: 99%

Disseminated Carcinomatosis of the Bone Marrow from Occult Breast Cancer Responding to a Sequence of Endocrine Therapy

et al. 2020

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Patients with cancer of unknown primary (CUP) are generally treated with chemotherapy. Bone marrow involvement suggests an advanced stage, and CUP with disseminated carcinomatosis of the bone marrow (DCBM) appears to have a dismal prognosis. However, our case of CUP with DCBM was successfully treated with a sequence of endocrine therapy over a long period. A woman presenting with low back pain was found to have multiple bone metastasis without an identifiable primary tumor on imaging studies. Blood tests revealed anemia and thrombocytopenia. A bone marrow biopsy was performed and showed relatively uniform small cells, strongly positive for estrogen receptor and progesterone receptor expression. We considered chemotherapy to be risky due to bicytopenia and an aromatase inhibitor, letrozole, was initiated. The patient's symptoms and laboratory findings gradually improved and bone lesions almost disappeared on FDG-PET/CT after 1 year of treatment. After 2 years on letrozole, hemoglobin levels and platelet counts had been gradually decreasing. Although she had no symptoms and no significant changes were observed on a CT scan, disease progression was highly likely. Thus, second-line treatment with fulvestrant and palbociclib was commenced, and hemoglobin levels and platelet counts were restored to within the normal ranges. She currently continues to receive fulvestrant and palbociclib over a year later. CUP complicated with DCBM might be metastatic occult breast cancer, and endocrine therapy can be a valuable treatment option if tumors express hormone receptors.

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“…Presentations of myelophthisis can include anemia, thrombocytopenia, neutropenia and varying degrees of pancytopenia. Treatment is generally directed against the underlying malignancy with supportive transfusions as needed, but the condition can be refractory to standard treatments such as chemotherapy [3,6]. With the emerging field of immune checkpoint blockade for cancer, little is known about these new agents and their efficacy in treating solid tumors involving the bone marrow or more generally, metastatic lesions present in the bones.…”

Section: Discussionmentioning

confidence: 99%

Response after treatment with pembrolizumab in a patient with myelophthisis due to melanoma: the role of checkpoint inhibition in the bone

Rosner

Şen

Postow

2017

j. immunotherapy cancer

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Background: Myelophthisis due to melanoma is a rare phenomenon. Treatment strategies for patients with this serious complication of malignancy have not been well documented, and none have previously reported efficacy of immune checkpoint inhibition. Since bone metastases are not measurable lesions per standard response criteria, the efficacy of immune checkpoint inhibition in the bones is also not well described. Case presentation: We describe a patient with widespread melanoma metastases involving the bone marrow causing myelophthisis and pancytopenia who responded to immune checkpoint inhibition with the antiprogrammed cell death-1 (PD-1) inhibitor pembrolizumab. Conclusions: This is the first report to our knowledge of disease response to immune checkpoint inhibition in a patient with myelophthisis. Clinical trials have recently emerged describing the efficacy of PD-1 inhibition for disorders regularly involving the bone marrow, such as hematologic malignancies, suggesting the importance of better understanding the bone marrow as an immunologically active compartment. Clinicians should be aware that immune checkpoint inhibition alone may be effective in treating malignancy involving the bone marrow, even in cases of extensive involvement resulting in pancytopenia due to myelophthisis from a solid tumor as our case suggests.

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Leucoerythroblastosis and thrombocytopenia as clues to metastatic malignancy

Cited by 11 publications

References 4 publications

Anemia and thrombocytopenia as initial symptoms of occult breast cancer with bone marrow metastasis

Anemia and thrombocytopenia as initial symptoms of occult breast cancer with bone marrow metastasis

Disseminated Carcinomatosis of the Bone Marrow from Occult Breast Cancer Responding to a Sequence of Endocrine Therapy

Response after treatment with pembrolizumab in a patient with myelophthisis due to melanoma: the role of checkpoint inhibition in the bone

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