New bone formation in haematological malignancies- a novel observation in a series of 5 cases
Keywords:
New Bone formation, Bone marrow, haematological malignancy, LeukemiaAbstract
New bone formation in haematological malignancies is rare and its clinical significance is not known. Only very few cases of new bone formation in haematological malignancies have been described however, it is well known in metastatic prostate and breast cancer. Cases of acute megakaryocytic leukemia, primary myelofibrosis and pediatric cases of acute myeloid leukemia have also demonstrated osteosclerosis and have been associated with poor prognosis.
New bone formation is an incidental finding in bone marrow biopsy and an association with cytopenias and fibrosis has been noted. Marrow replacement by new bone aggravates the already existent cytopenias, which occur due to malignant cells replacing the normal hematopoietic precursors.
 We describe two cases of acute Leukemia and three cases of Non-Hodgkin Lymphoma with new bone formation evident in bone marrow biopsy with the newly formed woven bone replacing the normal marrow elements. Pancytopenia was seen in 3 cases and bicytopenia in remaining two cases. Also fibrosis was present in two cases.
New bone formation may be found in hematological malignancies and contributes to pancytopenia and should be searched for. Medications modulating bone metabolism may be evaluated along with the chemotherapy in such patients, as they might increase the rate of remission in the hematological neoplasms. Recognition of bony changes in the marrow due to the leukemia effect per se; and not as a part of generalized bone disease, may prevent a battery of tests and further medication of the patient for bone disease.
References
2. Karasick S, Karasick D, Schilling J. Acute megakaryoblastic leukemia (acute “malignant†myelofibrosis): An unusual cause of osteosclerosis. Skeletal Radiol. 1982. 9:45-6.
3. Ward DE, Fondaw MB, Shroff SK, Reddy VS, Khaled YA. Diffuse osteosclerosis-associated acute myeloid leukemia. J Clin Oncol. 2012 Jan 1;30 (1):e3-4.
4. Diamond T, Smith A, Schnier R, Manoharan A. Syndrome of myelofibrosis and osteosclerosis: A series of case reports and review of the literature. Bone. 2002; 30:498-501.
5. Heinrich SD, Gallagher D, Warrior R, Phelan K, George VT, MacEwen GD. The prognostic significance of the skeletal manifestations of acute lymphoblastic leukemia of childhood. J Pediatr Orthop .1994 ;14(1):105-11.
6. Tripodo C, Sangaletti S, Piccaluga PP, Prakash S, Franco G, Borrello I et al. The bone marrow stroma in hematological neoplasms--a guilty bystander. Nat Rev Clin Oncol. 2011; 29; 8(8):456-66.
7. Schenkein DP, O'Neill WC, Shapiro J, Miller KB. Accelerated bone formation causing profound hypocalcemia in acute leukemia. Ann Intern Med. 1986;105(3): 375-8.
Downloads
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2016 Amita Jain Gupta, Poonam Rani, Roopal Rathi, Tejinder Singh
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).