[Myelofibrosis caused by cancer: presentation of a clinical case with a very difficult diagnosis]

Fibrosis of the bone marrow or myelofibrosis, is a connective tissue response of the bone marrow, giving rise to alterations of various nature. From an etiological point of view, it may be divided into primitive or secondary forms. Since the therapeutic implications differ, it is important to make a correct differential diagnosis between the 2 forms. With this in mind, particular importance must be given to myelofibrosis secondary to neoplastic metastasis since it frequently presents with a clinical and hematological picture and bone marrow morphology typical of acute or chronic idiopathic myelofibrosis. In such a situation the particular course of the disease and the description fibrosis-sclerosis of the bone marrow are highly suggestive of myelofibrosis secondary to neoplastic metastasis. On the basis of these considerations, we found it interesting to report a case which came under our observations. The patient in this case presented a complex differential diagnosis which offered us the occasion to review and highlight the clinical and histological criteria fundamental to the 2 forms. The patient, a 40 year old woman, presented with a clinical picture typical of myelofibrosis following surgery for a cystic ovary. For 3 years she had felt violent bone pains and had progressively declined in her physical state to the point of cachexia. A careful histological exam of the bone marrow revealed metastasis from the gastric tumor thus giving a clear diagnosis of secondary myelofibrosis.