Extensive Myelonecrosis: A Clinicopathological Study from A Tertiary Care Center
DOI:
https://doi.org/10.21276/apalm.2608Keywords:
Myelonecrosis, Bone Marrow Necrosis, Leukemia, Trephine Biopsy, Bone Marrow AspirationAbstract
Background: The pathophysiology of bone marrow necrosis (BMN) remains unclear; however, the occlusion of microcirculation, accompanied by hypoxemia, causes damage to the cells and plays an important role in development of BMN.
Methods: This is a descriptive study; a retrospective review of all trephine biopsies done over period of 22 months January 2017 to October 2018 in Department of pathology showing BMN were included. Only cases identified which showed extensive myelonecrosis > 20% of the diameter of trephine biopsy specimen was included in the study and BMN had to be diagnosed during life were included. Thirty cases met these criteria over this period.
Result: In the study period, BMN was diagnosed in 30 samples among 3000 trephine biopsies showed extensive necrosis accounting for 1.0%. Almost all patients on peripheral blood examination shows anemia (100%), around 50% patients present with pancytopenia, followed by anemia with thrombocytopenia. From bone marrow aspiration and trephine biopsy examination shows 30 cases MN,among them 16 patients were acute leukemia either newly diagnosed or post chemotherapy follow-up cases, 10 out of 12 patients had severe bone pain before intuition of chemotherapy, acute leukemia followed by necrotizing granulomatous inflammation metastatic carcinoma were other causes for MN and one case was sickle cell hemolytic anemia.
Conclusion: BMN is associated with many diseases, and yet presents with no clear patho physiology. In addition, clinical and laboratory characteristics are non-specific and, in many cases, symptoms are related to the causal condition that is most commonly a hematological disease.
References
2. Naeim F. Abnormal morphology: General considerations. In Pathology of Bone Marrow. Williams & Wilkins, 2nd ed.p99-100.
3. Bernard C, Sick H, Boilletot A, Oberling F. Bone marrow necrosis: acute microcirculation failure in myelomonocytic leukemia. Arch Intern Med 1978; 138:1567–9.
4. Jain D, Singh T, Kumar N. Hypo cellular acute myeloid leukemia with bone marrow necrosis in young patients: two case reports. J Med Case Rep. 2009; 3: 27-31.
5. Janssens A, Offner FC, van Hove WZ. Bone marrow necrosis. Cancer. 2000; 88: 1769-80.
6. Paydas S, Ergin M, Baslamisli F, et al. Bone marrow necrosis: clinicopathologic analysis of 20 cases and review of the literature. Am J Hematol. 2002; 70: 300-5.
7. Bashawri L, Satti MB. Bone marrow necrosis: report of five cases and review of the literature. Ann Saudi Med. 2000; 20: 78-82.
8. Campiotti L, Codari R, Appio L, et al. Bone marrow necrosis related to imatinib mesylate therapy for CML bilateral blast crisis. Leuk Res. 2007; 31: 1765-72.
9. Maisel D, Lim JY, Pollock WJ, Yatani R, Liu PI. Bone marrow necrosis: an entity often overlooked. Ann Clin Lab Sci. 1988;18(2):109–115.
10.Norgard MJ, Carpenter JT, Conrad ME. Bone marrow necrosis and degeneration. Arch Intern Med 1979;139:905–911.
11. Macfarlane SD, Tauro GP. Acute lymphocytic leukemia in children presenting with bone marrow necrosis. Am J Hematol. 1986;22(4):341–346.
12. Kiraly JF, 3rd, Wheby MS. Bone marrow necrosis. Am J Med. 1976; 60(3):361–368.
13. Forrest DL, Mack BJ, Nevill TJ, Couban SH, Zayed E, Foyle A. Bone marrow necrosis in adult acute leukemia and non-Hodgkin's lymphoma. Leuk Lymphoma. 2000;38(5–6):627–632.
14. Dunn P, Shin LY, Liaw S, Sun C. Bone marrow necrosis in 38 cancer patients. J Formos Med Assoc. 1985; 92: 1107-10.
15.Debdatta Basu, Parasappa J Yaranal Myelonecrosis – clinicopathological significance of a rare bone marrow lesion. Case Rep Clin Pract Rev, 2005; 6: 261-264.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 Neela Nirmala Jyothi, Pramod Kumar Pamu, T Roshini Paul, Shantveer G Uppin, Megha S Uppin, Sadashivudu Gundeti, K Radhika
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
