New bone formation in haematological malignancies- a novel observation in a series of 5 cases
Keywords:
New Bone formation, Bone marrow, haematological malignancy, Leukemia
Abstract
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
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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.
Published
2016-07-28
Issue
Section
Case Report
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