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Bone marrow necrosis
L Ranaghan1, T C Morris, Z R Desai
1Haematology Department, Belfast City Hospital, Northern Ireland.
Abstract:
Bone marrow necrosis is most frequently diagnosed at postmortem examination. Antemortem diagnosis is still uncommon. In a recent review of world literature, we have found 133 cases of bone marrow necrosis diagnosed during life. It has been observed during the course of a wide variety of diseases, most commonly in association with acute and chronic leukemia, carcinoma, malignant lymphoma, infections, and sickle cell disease. We report two intravitally diagnosed cases of bone marrow necrosis occurring in two patients with high-grade B-cell lymphoproliferative disease. These cases are unusual in that both patients had a triad of bone marrow necrosis, high-grade B-cell lymphoproliferative disease, and hypercalcemia. Despite chemotherapy, both cases ultimately proved fatal, with progressive involvement of the central nervous system.
Insights
Diagnosing bone marrow necrosis during life is rare. This study highlights two unusual cases of bone marrow necrosis in patients with high-grade B-cell lymphoproliferative disease and hypercalcemia, both proving fatal.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Bone marrow necrosis (BMN) is infrequently diagnosed antemortem.
- BMN is associated with various conditions including leukemia, carcinoma, lymphoma, infections, and sickle cell disease.
Observation:
- Two cases of intravitally diagnosed BMN are presented.
- Both patients had high-grade B-cell lymphoproliferative disease and hypercalcemia, a rare triad.
Findings:
- The presented cases of BMN, high-grade B-cell lymphoproliferative disease, and hypercalcemia were ultimately fatal.
- Central nervous system involvement progressed despite chemotherapy.
Implications:
- This report underscores the diagnostic challenges of antemortem BMN.
- The unusual association of BMN, B-cell lymphoproliferative disease, and hypercalcemia warrants further investigation.
- Understanding these rare presentations can improve patient management and prognostication.