Extensive Bone Marrow Necrosis and Osteolytic Lesions in a Case of Acute Myeloid Leukemia Transformed from Polycythemia Vera.
Extensive Bone Marrow Necrosis and Osteolytic Lesions in a Case of Acute Myeloid Leukemia Transformed from Polycythemia Vera.
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DOI：
10.7759/cureus.639
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发表时间：
2016-06-13
期刊：
影响因子：
--
通讯作者：
Palko W
中科院分区：
文献类型：
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作者：
Chambers I;Truong P;Kallail KJ;Palko W
急性髓性白血病（AML）是成人中最常见的白血病。在极少数情况下，骨髓坏死（BMN）和溶骨性病变是AML的特征。以下病例描述了一名已知患有真性红细胞增多症（PV）的患者，其表现为多发性骨髓瘤体征，包括高钙血症、贫血和胸椎和颅骨溶解性病变。实验室检查未提示骨髓瘤。进行骨髓活检，发现广泛的BMN和初始病理学与转移癌一致。然而，由于BMN的程度，无法进行免疫组织化学染色;因此进行了重复活检。流式细胞术和CD 45染色与已转化为AML的PV一致。由于患者的合并症，她是干细胞移植的不良候选人，不希望进行化疗。最后，她接受了临终关怀。根据我们的文献回顾，骨髓嗜酸性粒细胞增多症和溶骨性病变都是AML的罕见表现，并且没有同时发生的报道。这些发现可能会导致诊断困境和怀疑其他恶性肿瘤。本病例表明，急性髓细胞白血病应保持在鉴别诊断的患者谁目前与骨髓瘤和溶骨性病变。
Acute myeloid leukemia (AML) is the most common leukemia in adults. In rare cases, bone marrow necrosis (BMN) and osteolytic lesions are presenting features of AML. The following case describes a patient with known polycythemia vera (PV) that presented with signs of multiple myeloma, including hypercalcemia, anemia, and lytic lesions of the thoracic spine and skull. Laboratory workup was not indicative of myeloma. A bone marrow biopsy was performed, which revealed extensive BMN and initial pathology was consistent with metastatic carcinoma. However, no immunohistochemical stains could be performed due to the extent of BMN; a repeat biopsy was therefore performed. Flow cytometry and CD45 staining were consistent with PV that had transformed to AML. Due to the patient’s comorbidities, she was a poor candidate for stem cell transplant and did not wish to pursue chemotherapy. Ultimately, she pursued hospice care. Based on our literature review, both BMN and osteolytic lesions are rare manifestations of AML and have not been reported to occur simultaneously. These findings can lead to a diagnostic dilemma and suspicion of other malignancies. This case demonstrates that AML should remain in the differential diagnosis in those patients who present with BMN and osteolytic lesions.