Original Article Non-Hematological Malignancies Seeding in Bone Marrow
A 6 Years’ Experience at Tertiary Care Hospital
Keywords:
Bone marrow, Metastasis, Solid tumours, Immunohistochemistry, adenocarcinoma, Carcinoma of Unknown Primary Site (CUPS)
Abstract
Background: Bone marrow is the site of origin for primary haematological malignancies and is the third common preferred site metastasized by the solid tumors. The malignant infiltration of the hematopoietic tissue alters the clinical course of disease, response of the treatment and influences the overall survival. The aim of this study was to assess pattern of bone marrow involvement by different solid tumors and their correlation with hematological parameters. Methods: In this retrospective study, 8064 bone marrow examinations from Jan 2011-Aug 2017 at tertiary health and research centre of Northern India were evaluated to access spectrum of different solid tumors infiltrating the bone marrow alongwith their clinical, hematological and histopathological findings. Result: Total 38 cases of non-hematological malignancies metastasizing to bone marrow were evaluated with main indications of lytic lesions, cytopenia and Pyrexia of Unknown Origin. The most common metastasis were adenocarcinoma of prostate and lung. In 33 cases, the clinical, cytomorphological and immunohistochemical analysis findings were correlated to know primary site, while in remaining five patients, even after complete diagnostic evaluation, the definitive origin could not be ascertained, therefore categorized as Carcinoma of Unknown Primary Site (CUPS). Conclusion: Our series showed that anemia as commonest parameter, followed by leukopenia, thrombocytopenia. Many cases were misdiagnosed as multiple myeloma due to lytic lesion, anemia and hypercalcemia. We concluded that unexplained cytopenia are strong indicators of bone marrow examination; an easy, convenient, sensitive, effective procedure of staging of tumor, monitoring the course and prognosis of solid tumors.References
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2. Kilickap S, Erman M, Dincer M, Aksoy S, Hakan H, Yalcin Y Bone marrow metastasis of solid tumors: clinicopathological evaluation of 73 cases. Turk J Cancer. 2007;37:85-88.
3. Moriwaki SMK, Okabe K, Yamauchi M, Yamamoto T, Kamei T Pathological analysis for bone marrow metastasis by aspiration and core needle biopsy. Jpn J Cancer Clinic. 2003;49:203-09.
4. Mohanty SK, Dash S Bone marrow metastasis in solid tumors. Indian J Pathol Microbiol. 2003;46:613-16.
5. Tasleem RA, Chowdhary ND, Kadri SM, Chowdhary QA Metastasis of solid tumors in bone marrow: a study from Kashmir India. J Clin Pathol. 2003;56:803-04.
6. Barbara J Bain et al. Bone marrow Pathology 3rd edition 2001;430-31.
7. Ingle JN, Tormey DC, Bull JM, Simon RM Bone marrow involvement in breast cancer: Effect on response and tolerance to combination chemotherapy. Cancer 1977;39:104-11.
8. Kanhere MH, Sharma YR, Kalra A Role of bone marrow examination in staging of carcinoma breast. Indian J Surg. 1988;1:54-58.
9. Valdes SM, Nava OA, Palacios RV et al Diagnoses of bone marrow metastasis in children with solid tumors and lymphoma; Aspiration or unilateral or bilateral biopsy? Arch Med Res. 2000;3:58-61.
10. Burkhardt R, Frisch B, Bartl R, Kettner G, Schlag R, Hill W: Detection of haematologic and nonhaematologic cancer by bone biopsy. Cancer Detect Prev. 1981;4:619-27.
11. Farah Moid, Louis DePalma. Comparison of relative Value of Bone Marrow Aspirates and Bone Marrow Trephine Biopsies in the diagnosis of solid tumor metastasis and Hodgkin's lymphoma: Institutional Experience and Literature Review. Arch Pathol Lab Med. 2005;129;497-501.
12. Gatter KC, Abdulaziz Z, Beverly P, Corvalan JR, Ford C, et al. Use of monoclonal antibodies for the histopathological diagnosis of human malignancy. J Clin Pathol. 1982;35:1253-67.
13. Gatter KC, Ralfkiaer E, Skinner J, Brown D, Heryet A, et al. An immunohistochemical study of malignant melanoma and its differential diagnosis from other malignant tumors. J Clin Pathol 1985;38:1353-57.
14. C.S. Galasko,The development of skeletal metastases, Nihon Seikeigeka Gakkai Zasshi. 1989;667-76.
15. Kaur G, Basu S, Kaur P, Sood T. Metastatic Bone Marrow Tumors: Study of Nine Cases and Review of the Literature. J Blood Disord Transfus. 2011;2:110.
16. Syed RiazMehdi , Madan Lal Brahma Bhatt. Metastasis of Solid Tumors in Bone Marrow: A Study from Northern India; Indian J Hematol Blood Transfus. 2011;27:93-95.
17. Sar R, Aydogdu I, Ozen S, Sevinc A, Buyukberber S. Metastatic bone marrow tumours: a report of six cases and review of the literature. Haematologia. 2001,31:215-23.
18. Bezwoda WR, Lewis D, Livini N: Bone marrow involvement in anaplastic small cell lung cancer. Diagnosis, hematologic features, and prognostic implications. Cancer. 1986;58:1762-65.
19. Tritz DB, Doll DC, Ringenberg QS, Anderson S, Madsen R, Perrt MC, Yarbro JW: Bone marrow involvement in small cell lung cancer. Clinical significance and correlation with routine laboratory variables. Cancer. 1989;63:763-66.
20. Campling B, Quirt I, DeBoer G, Feld R, Shepherd FA, Evans WK: Is bone marrow examination in small cell lung cancer really necessary? Ann Intern Med. 1986;105:508-12.
21. Jonsson U, Rundles RW. Tumor metastases in bone marrow. Blood. 1951;16: 16-25.
22. Chernow B, WallnerSF.Variables predictive of bone marrow metastases. Cancer. 1978 42:2373-78.
23. Rubins JR (1983) The role of myelofibrosis in malignant myelosclerosis. Cancer. 1983;51:308-11.
24. Kiely JM, Silverstein MN. Metastatic carcinoma simulating agnogenic myeloid metaplasia. Cancer. 1969;24:1041-44.
25. Spector JI, Levine PH Carcinomatous bone marrow invasion simulating acute myelofibrosis. Am J Med Sci. 1973;266:145-48.
26. Humpries JE: Dry tap bone marrow aspiration: Clinical significance. Am J Hematol. 1990;35:247-50.
27. Hyun BH: Bone marrow examination: Adventures in diagnostic hematology. Yonsei Med J. 1986;27:100-05.
Published
2020-07-30
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