Bone Marrow Necrosis

Abstract

LA Al-Gwaiz, Bone Marrow Necrosis. 1997; 17(3): 374-376 Patchy and focal bone marrow necrosis (BMN) is a relatively common finding in routine bone marrow (BM) biopsy specimens, 2 however, severe BMN is rarely diagnosed in living patients and is more frequently diagnosed in autopsy BM.2-4 BMN has been described in a variety of neoplastic and non-neoplastic diseases. 2,3,[5][6][7][8][9][10] This is a retrospective analysis of consecutive BMN biopsies received over the last five years to assess the incidence of BMN in antemortem biopsies and the diseases associated with it. Materials and MethodsThe bone marrow trephine biopsies received between June 1991 and May 1996 at the Hematology Section, Department of Pathology at King Khalid University Hospital, Riyadh, Saudi Arabia, were retrospectively reviewed. The biopsies were obtained from the posterior iliac spine with a Jamshidi needle and stained with hematoxylin and eosin stain. The biopsies were evaluated for the presence of necrosis. Giemsa-stained BM aspirates obtained from the cases with necrosis were also assessed for evidence of necrosis, e.g., the presence of necrotic cells and necrotic eosinophilic materials for correlation with the biopsy findings.The records of patients with BMN were reviewed for age, sex, diagnosis and the clinical and laboratory features.

Bone Marrow Necrosis: Report of Five Cases and Review of the Literature

“…[3][4] In this study, the BMN had different underlying disease processes that were initially obscured in some patients because of the necrosis, just as in previous reports. [5][6][7][8][9][10][11][12][13][14][15][16] Similar to the report of Niebrugge et al, 16 BMN preceded the diagnosis of ALL in our case 5, while in case 2, the diagnosis was not established, as the patient died early. For case 1, BMN was the result of chemotherapy, while in case 3, it was associated with metastatic carcinoma, as in a previous report, 10 which in our case, was documented by immunohistochemistry ( Figure 2).…”

“…There have been reports of BMN leading to difficult aspiration and a dry tap. 7 This occurred in one of our patients, whereas in the others, necrotized particles were observed. Furthermore, MRI scanning has previously been used to assess the extent of bone marrow involvement.…”

“…Likewise, laboratory findings seen in our patients and commonly associated with BMN include pancytopenia, microangiopathic features and a leukoerythroblastic blood picture. 2,3,7 Elevated serum lactate dehydrogenase and alkaline phosphatase levels are known associated laboratory features, 2,3,7 and were also seen in four of our patients ( Table 1). The prognosis of patients with BMN has been considered poor, 1,2 however, there have been reports of recovery in some cases with adequate supportive management.…”

“…BMN is commonly the end result of infiltration by a neoplastic process, chemotherapy or vaso-occlusion. [2][3][4][5][6][7][8][9][10] It has also been related to the presence of antiphospholipid antibodies 4 and chemotherapy for cancer with a variety of agents. [11][12][13][14] The pathophysiology of BMN has been a subject of controversy and debate, 3 and has included toxic effects of chemotherapy, microvascular infarction, decreased oxygen tension due to increased proliferative capacity of infiltrating malignant cells, 3 tumor necrosis factor (TNF), 17 and thrombosis.…”

“…2 The relative frequency of BMN varies among different reports, ranging between 0.37%-6.5%. 3,7 Our five cases account for a relative frequency of 0.47%. BMN is commonly the end result of infiltration by a neoplastic process, chemotherapy or vaso-occlusion.…”