The bone marrow aspirate and biopsy in the diagnosis of unsuspected nonhematologic malignancy: A clinical study of 19 cases

Division of Hematology, Department of Internal Medicine, Uludag University School of Medicine, Uludag University Hospital, Bursa, Turkey.
BMC Cancer (Impact Factor: 3.36). 02/2005; 5(1):144. DOI: 10.1186/1471-2407-5-144
Source: PubMed


Although bone marrow metastases can be found commonly in some malignant tumors, diagnosing a nonhematologic malignancy from marrow is not a usual event.
To underscore the value of bone marrow aspiration and biopsy as a short cut in establishing a diagnosis for disseminated tumors, we reviewed 19 patients with nonhematologic malignancies who initially had diagnosis from bone marrow.
The main indications for bone marrow examination were microangiopathic hemolytic anemia (MAHA), leukoerythroblastosis (LEB) and unexplained cytopenias. Bone marrow aspiration was not diagnostic due to dry tap or inadequate material in 6 cases. Biopsy results were parallel to the cytological ones in all cases except one; however a meticulous second examination of the biopsy confirmed the cytologic diagnosis in this patient too. The most common histologic subtype was adenocarcinoma, and after all the clinical and laboratory evaluations, the primary focus was disclosed definitively in ten patients (5 stomach, 3 prostate, 1 lung, 1 muscle) and probably in four patients (3 gastrointestinal tract, 1 lung). All work up failed in five patients and these cases were classified as tumor of unknown origin (TUO).
Our series showed that anemia, thrombocytopenia, elevated red cell distribution width (RDW) and hypoproteinemia formed a uniform tetrad in patients with disseminated tumors that were diagnosed via bone marrow examination. The prognosis of patients was very poor and survivals were only a few days or weeks (except for 4 patients whose survivals were longer). We concluded that MAHA, LEB and unexplained cytopenias are strong indicators of the necessity of bone marrow examination. Because of the very short survival of many patients, all investigational procedures should be judged in view of their rationality, and should be focused on treatable primary tumors.

Download full-text


Available from: Turkkan Evrensel, Apr 20, 2015
  • Source
    • "It has been reported that RDW is higher in prehypertensive and hypertensive patients compared with healthy controls [18]. It has been shown that RDW are elevated in cardiovascular disease pulmonary disease, liver disease, stroke, peripheral artery disease, inflammatory bowel disease, colon cancer, and neoplastic metastases to the bone marrow [19–27]. Many studies have identified RDW as a predictor of all-cause and cardiac mortality [28–30]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The aim of this study was to estimate the effects of exposure to chemical compounds on systemic biochemical inflammatory markers in printing industry workers. Material/Methods Fifty-eight printing workers from 19 different small- and medium-sized enterprises in the printing sector were investigated. For comparison, 80 healthy workers not subjected to workplace chemicals served as control subjects. Results No significant differences were observed between the printing workers and control subjects with respect to age, BMI, waist circumference/hip circumference ratio, smoking, and alcohol consumption. Printing workers had significantly higher serum TNF-alpha levels (11.02±5.34 vs. 9.26±3.87 pg/ml, p=0.039), plasma fibrinogen levels (1.74±0.49 vs. 1.38±0.5 mg/dl, p=0.012), and red blood cell distribution width (RDW-SD) (49.77±3.09 vs. 47.3±2.88 p<0.01) compared to control subjects. Conclusions Elevation of RDW, serum TNF-alpha, and plasma fibrinogen levels in printing workers may be due to systemic toxic effects of chemical compounds used in this sector. TNF-alpha is an inflammatory cytokine that has a wide spectrum of biological activities, and fibrinogen plays an important role in pathological processes. Some compounds may be carcinogenic or mutagenic. Better designed workplaces and working conditions will help to reduce the hazardous effects of chemical compounds.
    Medical science monitor: international medical journal of experimental and clinical research 11/2013; 19:1001-1005. DOI:10.12659/MSM.889694 · 1.43 Impact Factor
  • Source
    • "Moreover, a recent study by Beyzit et al [14] indicated that elevated RDW could be a useful biomarker in order to discriminate benign from malignant causes of biliary obstruction, with a sensitivity of 72% and specificity of 69%, using 14.8% as a cut-off value for RDW. Apart from the above mentioned, there are two other published studies, by Ozkalemkas et al and Seitanides et al, suggesting that elevated RDW was significantly correlated with disseminated solid malignancies to the bone marrow, with the study by Seitanides et al being the one including patients with breast cancer as the primary tumor, without providing, though, any other data concerning a possible correlation of RDW with the histopathological parameters of the breast lesions [15, 18]. Finally, in a study by Baicus et al, RDW was significantly elevated in a cohort of patients with various types of malignancies, when compared to non-cancer patients [13]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Red cell distribution width (RDW) is a parameter of the standard full blood count tests, measuring the size variability of erythrocytes. Recently, its elevation has been proven to reliably reflect the extent systematic inflammation, mainly in cardiometabolic diseases. Up to date, its association with solid malignancies has been scarcely investigated. We performed a retrospective study, in order to examine if RDW values comparing elevation is correlated with the histopathological parameters of breast cancer (tumor size, grade, lymphatic spread, overexpression of hormonal receptors and HER2 protein), as well as to assess the existence of any differences in RDW comparing two age-matched groups of patients with benign and malignant breast lesions respectively. RDW was significantly higher in patients with breast cancer, when compared to the enrolled patients with fibroadenomas. Moreover, in the breast cancer group, RDW elevation was significantly correlated with larger primary tumors, higher number of infiltrated axillary lymph nodes and HER2 overexpression, while it was inversely associated with the tumor grade. Our pilot study demonstrated tha Red cell distribution width may be a novel biomarker of the activity of breast cancer. Although our preliminary findings need to be evaluated by studies with larger samples of patients, based on commonly accepted pathophysiological principles, we presume that they will be applicable not only in breast cancer, but also in other types of solid cancers, providing a simple and cost-effective biomarker of cancer surveillance.
    Journal of Clinical Medicine Research 04/2013; 5(2):121-126. DOI:10.4021/jocmr1214w
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The skeletal system is a frequent site for metastases of urothelial carcinoma (UC) of the bladder (22-37%). Of those cases involving bone, the marrow is infiltrated in 27% of patients. Imaging modalities, such as X-ray and CT, will detect gross skeletal lesions in the vast majority of these patients with bone marrow involvement, however, most patients with bone involvement are symptomatic at presentation. Additionally, there have been few reports in the literature of bone marrow metastases from UC presenting with isolated thrombocytopenia. This case report describes the case of a 53-year-old male with muscle-invasive transitional cell carcinoma of the bladder treated with cystoprostatectomy. Preoperative evaluation was significant only for mild thrombocytopenia. Standard workup for metastatic bony involvement, which included history, physical, chest X-ray, and whole body CT, was negative. Postoperatively, the patient's thrombocytopenia worsened and he bled diffusely from his pelvic bed. Bone marrow biopsy was obtained and showed the entire marrow cavity to be filled with metastatic transitional cells. In the event of a similar future presentation of isolated thrombocytopenia in the setting of invasive UC, the clinician should consider a bone marrow biopsy, in addition to the standard workup for metastatic bony involvement, prior to proceeding with any surgical intervention.
    The Scientific World Journal 02/2007; 7:1000-3. DOI:10.1100/tsw.2007.168 · 1.73 Impact Factor
Show more