BONE MARROW NECROSIS IN ACUTE LYMPHOBLASTIC LEUKEMIA: A CASE REPORT

Objective: Bone marrow necrosis (BMN) is an entity that necrotic cells are seen on amorphous eosinophilic ground with medullary infarctus but withouth cortical bone involvement. BMN is a postmortem diagnosis in most of the reports. Bone marrow biopsy and aspiration is essential for the diagnosis. Th...

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Autores principales:	Melike Nur Ünal, Demet Kiper Ünal, Tuğba Çetintepe, Şerife Solmaz, Bahriye Payzın, Betül Bolat Küçükzeybek
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Diseases of the blood and blood-forming organs RC633-647.5
Acceso en línea:	https://doaj.org/article/4bc61a82cb3446e3970bc6ad0a0200f6
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spelling	oai:doaj.org-article:4bc61a82cb3446e3970bc6ad0a0200f62021-11-10T04:34:49ZBONE MARROW NECROSIS IN ACUTE LYMPHOBLASTIC LEUKEMIA: A CASE REPORT2531-137910.1016/j.htct.2021.10.1016https://doaj.org/article/4bc61a82cb3446e3970bc6ad0a0200f62021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2531137921011639https://doaj.org/toc/2531-1379Objective: Bone marrow necrosis (BMN) is an entity that necrotic cells are seen on amorphous eosinophilic ground with medullary infarctus but withouth cortical bone involvement. BMN is a postmortem diagnosis in most of the reports. Bone marrow biopsy and aspiration is essential for the diagnosis. The case we report here is a patient who is diagnosed BMN and ALL at the same time with the first bone marrow biopsy, which is showed extensive necrosis. Case report: A 42-year-old man applied to our E.R. with lumbal pain. The initial blood count showed leukocyte:5.13 × 109/l, neutrophil:2.68 × 109/l, Hgb:10.7 g/dl, Hct: %31.5, thrombocyte:127 × 109/l, LDH:539 u/l (N:0-250), ALP:185 u/l (N:40-150), Total Bilirubin:0.81 mg/dl, CRP:337mg/l (N<5) ), ESH: 94mm/h, folic acide: 2.8ng/ml (N>5.4), Vitamin B12:398 pg/ml (N:210-900), ferritin: 5607 ug/l (N:22-320), fibrinogen:1304 mg/dl (N:200-400), D-Dimer:646 ug/l (N<243) and a normal range for PZ, aPTZ, INR. Methodology: Peripheral smear showed %38 PMN, %56 lymphocyte, %6 monocyte, normoblasts, rare tear drop cells and rare thrombocytes. Pathological evaluation revealed hypercellular bone marrow (%95), extensive necrosis, CD3(-) CD5(-) CD20(+), CD38(-), CD10 diffuse(+), BCL2(+) MPO(-) CD117(-), CD34(+) CD79a, Pax5 and TdT suboptimal (+). Flow cytometry showed no significant result because of the deficiency of material. PCR revealed no BCR-ABL transcript. Results: The patient diagnosed B precursor ALL. With the BFM IA protocol complete remission obtained. At the control BMB CD3, CD20, CD79a, Pax5, TdT, MPO, CD34 was applied but there was no neoplastic involvement. After the BFM IB protocol, complete remission has been pursued. The patient is currently receiving the BFM IC protocol. Conclusion: BMN is an uncommon pathology with poor prognosis. Primary etiology is malignancies, especially hematologic malignancies, at %90 of the cases. As we see at this case, while the clinical and laboratory findings are insignificant; when a patient shows fever with unknown origin, bone pain, newly developed cytopenias, we must keep in mind the diagnosis of BMN and if a patient is diagnosed BMN, necessary scaning must be done immediately for malignancies as the primary cause.Melike Nur ÜnalDemet Kiper ÜnalTuğba ÇetintepeŞerife SolmazBahriye PayzınBetül Bolat KüçükzeybekElsevierarticleDiseases of the blood and blood-forming organsRC633-647.5ENHematology, Transfusion and Cell Therapy, Vol 43, Iss , Pp S35- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the blood and blood-forming organs RC633-647.5
spellingShingle	Diseases of the blood and blood-forming organs RC633-647.5 Melike Nur Ünal Demet Kiper Ünal Tuğba Çetintepe Şerife Solmaz Bahriye Payzın Betül Bolat Küçükzeybek BONE MARROW NECROSIS IN ACUTE LYMPHOBLASTIC LEUKEMIA: A CASE REPORT
description	Objective: Bone marrow necrosis (BMN) is an entity that necrotic cells are seen on amorphous eosinophilic ground with medullary infarctus but withouth cortical bone involvement. BMN is a postmortem diagnosis in most of the reports. Bone marrow biopsy and aspiration is essential for the diagnosis. The case we report here is a patient who is diagnosed BMN and ALL at the same time with the first bone marrow biopsy, which is showed extensive necrosis. Case report: A 42-year-old man applied to our E.R. with lumbal pain. The initial blood count showed leukocyte:5.13 × 109/l, neutrophil:2.68 × 109/l, Hgb:10.7 g/dl, Hct: %31.5, thrombocyte:127 × 109/l, LDH:539 u/l (N:0-250), ALP:185 u/l (N:40-150), Total Bilirubin:0.81 mg/dl, CRP:337mg/l (N<5) ), ESH: 94mm/h, folic acide: 2.8ng/ml (N>5.4), Vitamin B12:398 pg/ml (N:210-900), ferritin: 5607 ug/l (N:22-320), fibrinogen:1304 mg/dl (N:200-400), D-Dimer:646 ug/l (N<243) and a normal range for PZ, aPTZ, INR. Methodology: Peripheral smear showed %38 PMN, %56 lymphocyte, %6 monocyte, normoblasts, rare tear drop cells and rare thrombocytes. Pathological evaluation revealed hypercellular bone marrow (%95), extensive necrosis, CD3(-) CD5(-) CD20(+), CD38(-), CD10 diffuse(+), BCL2(+) MPO(-) CD117(-), CD34(+) CD79a, Pax5 and TdT suboptimal (+). Flow cytometry showed no significant result because of the deficiency of material. PCR revealed no BCR-ABL transcript. Results: The patient diagnosed B precursor ALL. With the BFM IA protocol complete remission obtained. At the control BMB CD3, CD20, CD79a, Pax5, TdT, MPO, CD34 was applied but there was no neoplastic involvement. After the BFM IB protocol, complete remission has been pursued. The patient is currently receiving the BFM IC protocol. Conclusion: BMN is an uncommon pathology with poor prognosis. Primary etiology is malignancies, especially hematologic malignancies, at %90 of the cases. As we see at this case, while the clinical and laboratory findings are insignificant; when a patient shows fever with unknown origin, bone pain, newly developed cytopenias, we must keep in mind the diagnosis of BMN and if a patient is diagnosed BMN, necessary scaning must be done immediately for malignancies as the primary cause.
format	article
author	Melike Nur Ünal Demet Kiper Ünal Tuğba Çetintepe Şerife Solmaz Bahriye Payzın Betül Bolat Küçükzeybek
author_facet	Melike Nur Ünal Demet Kiper Ünal Tuğba Çetintepe Şerife Solmaz Bahriye Payzın Betül Bolat Küçükzeybek
author_sort	Melike Nur Ünal
title	BONE MARROW NECROSIS IN ACUTE LYMPHOBLASTIC LEUKEMIA: A CASE REPORT
title_short	BONE MARROW NECROSIS IN ACUTE LYMPHOBLASTIC LEUKEMIA: A CASE REPORT
title_full	BONE MARROW NECROSIS IN ACUTE LYMPHOBLASTIC LEUKEMIA: A CASE REPORT
title_fullStr	BONE MARROW NECROSIS IN ACUTE LYMPHOBLASTIC LEUKEMIA: A CASE REPORT
title_full_unstemmed	BONE MARROW NECROSIS IN ACUTE LYMPHOBLASTIC LEUKEMIA: A CASE REPORT
title_sort	bone marrow necrosis in acute lymphoblastic leukemia: a case report
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/4bc61a82cb3446e3970bc6ad0a0200f6
work_keys_str_mv	AT melikenurunal bonemarrownecrosisinacutelymphoblasticleukemiaacasereport AT demetkiperunal bonemarrownecrosisinacutelymphoblasticleukemiaacasereport AT tugbacetintepe bonemarrownecrosisinacutelymphoblasticleukemiaacasereport AT serifesolmaz bonemarrownecrosisinacutelymphoblasticleukemiaacasereport AT bahriyepayzın bonemarrownecrosisinacutelymphoblasticleukemiaacasereport AT betulbolatkucukzeybek bonemarrownecrosisinacutelymphoblasticleukemiaacasereport
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BONE MARROW NECROSIS IN ACUTE LYMPHOBLASTIC LEUKEMIA: A CASE REPORT

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