Malignant Infiltration of Bone Marrow


mri-abnormal-bm-signal

Many cancers may infiltrate the bone marrow, most common are carcinoma of the lung, breast, prostate, colon, and thyroid.

In malignant infiltration of bone marrow, the blood count may be normal although pancytopenia may occur and there may be leukoerythroblastic blood picture.

leukoerythroblastic-blood-picture

Marrow aspirates may be difficult because of fibrosis and trephine biopsies should also be performed.

The features of cancer cells include:

  • A tendency to form clumps.
  • High nuclear to cytoplasmic ratio.
  • Nuclear moulding.
  • Large prominent nucleoli.

malignant-infiltration-of-bone-marrow

Histology:

Some tumors can be clearly identified by cytochemistry. Adenocarcinoma cells, for instance, may stain with mucin stains.

malignant infiltration of bone marrow

the bone is almost completely replaced by masses of colon cancer

Other tumors can be very difficult to differentiate from hematological malignancies and cell marker studies may then be useful. The CD45 antigen is expressed on most hematological tumors but not other cancers.

Radiology:

The presence of lytic and blastic lesions on skeletal radiographic films is common in patients with prostate, lung, or breast cancer metastases.


Bone scans are sensitive for detecting bone metastases, while magnetic resonance imaging (MRI) scans of the involved area can detect marrow infiltration.

Treatment:

Treat the underlying disease and provide supportive measures for symptomatic patients.

Prognosis:

In malignant infiltration of bone marrow, mortality is dependent on the underlying condition. The leukoerythroblastic blood picture is often associated with imminent death in some extreme cases. Patients with varying degrees of cytopenia are at risk for infection or bleeding.

References:

Brochamer WL Jr, Keeling MM. The bone marrow biopsy, osteoscan, and peripheral blood in non-hematopoietic cancer. Cancer. 1977 Aug. 40(2):836-40.

Delsol G, Guiu-Godfrin B, Guiu M, Pris J, Corberand J, Fabre J. Leukoerythroblastosis and cancer frequency, prognosis, and physiopathologic significance. Cancer. 1979 Sep. 44(3):1009-13.

Emmanuel C Besa, MD Myelophthisic Anemia: Background, Etiology, Epidemiology and Prognosis http://emedicine.medscape.com/article/204647-overview Accessed: November 2015.

Makoni SN, Laber DA. Clinical spectrum of myelophthisis in cancer patients. Am J Hematol. 2004 May. 76(1):92-3.

Robert C. Mellors Biological Characteristics of Benign and Malignant Neoplasms http://www.medpath.info/MainContent/Neoplasia/Neoplasia_02.html

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