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Wang C, Xie B, Yin S, Cao J, Huang J, Jin L, Du G, Zhai X, Zhang R, Li S, Cao T, Yu H, Fan X, Yang Z, Peng J, Xiao J, Lian L. Induction of filopodia formation by α-Actinin-2 via RelA with a feedforward activation loop promoting overt bone marrow metastasis of gastric cancer. J Transl Med 2023; 21:399. [PMID: 37337244 DOI: 10.1186/s12967-023-04156-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/25/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Bone marrow metastasis (BMM) is underestimated in gastric cancer (GC). GC with BMM frequently complicate critical hematological abnormalities like diffused intravascular coagulation and microangiopathic hemolytic anemia, which constitute a highly aggressive GC (HAGC) subtype. HAGC present a very poor prognosis with peculiar clinical and pathological features when compared with not otherwise specified advanced GC (NAGC). But the molecular mechanisms underlying BMM from GC remain rudimentary. METHODS The transcriptomic difference between HAGC and NAGC were analyzed. Genes that were specifically upregulated in HAGC were identified, and their effect on cell migration and invasion was studied. The function of ACTN2 gene were confirmed by GC cell lines, bone-metastatic animal model and patients' tissues. Furthermore, the molecular mechanism of ACTN2 derived-BMM was explored by multiple immunofluorescence staining, western blot, chromatin immunoprecipitation, and luciferase reporter assays. RESULTS We elucidated the key mechanisms of BMM depending on the transcriptomic difference between HAGC and NAGC. Five genes specifically upregulated in HAGC were assessed their effect on cell migration and invasion. The ACTN2 gene encoding protein α-Actinin-2 was detected enhanced the metastatic capability and induced BMM of GC cells in mouse models. Mechanically, α-Actinin-2 was involved in filopodia formation where it promoted the Actin filament cross-linking by replacing α-Actinin-1 to form α-Actinin-2:α-Actinin-4 complexes in GC cells. Moreover, NF-κB subunit RelA and α-Actinin-2 formed heterotrimers in the nuclei of GC cells. As a direct target of RelA:α-Actinin-2 heterotrimers, the ACTN2 gene was a positive auto-regulatory loop for α-Actinin-2 expression. CONCLUSIONS We demonstrated a link between filopodia, BMM and ACTN2 activation, where a feedforward activation loop between ACTN2 and RelA is established via actin in response to distant metastasis. Given the novel filopodia formation function and the new mechanism of BMM in GC, we propose ACTN2 as a druggable molecular vulnerability that may provide potential therapeutic benefit against BMM of GC.
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Affiliation(s)
- Caiqin Wang
- Department of Gastrointestinal Surgery and Department of Medical Oncology, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
- Department of General Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
| | - Bo Xie
- Department of Forensic Toxicology, Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510089, China
| | - Shi Yin
- Department of Gastrointestinal Surgery and Department of Medical Oncology, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
- Department of General Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
| | - Jianghua Cao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Junhao Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Longyang Jin
- Department of Gastrointestinal Surgery and Department of Medical Oncology, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
| | - Ge Du
- Department of Gastrointestinal Surgery and Department of Medical Oncology, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
| | - Xiaohui Zhai
- Department of Gastrointestinal Surgery and Department of Medical Oncology, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
| | - Rongqin Zhang
- Department of Nuclear Medicine, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
| | - Shanshan Li
- Department of Gastrointestinal Surgery and Department of Medical Oncology, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
| | - Taiyuan Cao
- Department of Gastrointestinal Surgery and Department of Medical Oncology, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
| | - Hongen Yu
- Department of Gastrointestinal Surgery and Department of Medical Oncology, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
| | - Xinjuan Fan
- Department of Pathology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
| | - Zuli Yang
- Department of Gastrointestinal Surgery and Department of Medical Oncology, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
- Department of Nuclear Medicine, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
| | - Junsheng Peng
- Department of Gastrointestinal Surgery and Department of Medical Oncology, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
| | - Jian Xiao
- Department of Gastrointestinal Surgery and Department of Medical Oncology, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China.
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China.
- Department of General Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China.
| | - Lei Lian
- Department of Gastrointestinal Surgery and Department of Medical Oncology, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China.
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China.
- Department of General Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China.
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Gajendra S, Sharma R. Cytomorphological evaluation of non-haematopoietic malignancies metastasizing to the bone marrow. Am J Blood Res 2023; 13:1-11. [PMID: 36937461 PMCID: PMC10017595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/25/2022] [Indexed: 03/21/2023]
Abstract
Bone marrow (BM) is one of the rare but important site of metastasis of solid tumors. The key steps of metastasis include invasion, intravasation, circulation, extravasation, and colonization. Tumor cells may express some adhesion molecules that promote the transmigration to the marrow space and link them to the marrow stroma with subsequent engraftment. It is important to detect the bone marrow metastasis for initial clinical staging, therapeutic selection, prognostic risk stratification, assessment of response to therapy and predicting relapse. Prognosis of non-hematopoietic malignancies with BM metastasis is dismal. Due to occulting and atypical clinical manifestations, bone marrow metastases can be easily missed or misdiagnosed, leading to higher mortality rates. The important factors on which the prognosis of patients with bone marrow metastases depends are primary tumor site, performance status, platelet count, and therapeutic regimens (systemic chemotherapy or palliative/supportive care). Further, in cases with BM metastasis with unknown primary sites, misdiagnosis can lead to delayed initiation of therapy and increased mortality. BM metastasis is seen in less than 10% of patients with metastatic cancer and is common in lung, breast or prostate carcinoma. Bone marrow metastasis can be presented as the initial presentation with hematological changes and may be misdiagnosed as a primary haematopoietic disorder. Leucoerythoblastic blood picture is the most common peripheral blood smear finding indicating BM metastasis, may be an indicator of associated BM fibrosis. Bone marrow aspiration and biopsy with immunohistochemistry (IHC) is an easy, cost effective and gold standard method of detection of BM metastasis. BM biopsy is superior to bone marrow aspirate for detection of metastasis. Morphology of metastatic cells is as per the primary site of tumor. Immunohistochemistry is a useful adjunct to morphology in reaching a definitive diagnosis even in case with carcinoma unknown primary (CUP) and also in diagnosing case of unsuspected malignancies. Though bone marrow is not among the most common site of involvement in CUP, which are liver, bone, lymph nodes and lung. But BM, if involved, the site of origin is determined using the immunohistochemistry panel applied to the metastatic deposits based on the morphology The aim of the review is to discuss the hematological findings of non-haematopoietic malignancies metastasizing to the bone marrow, emphasizing on histomorphology with IHC and its significance in establishing primary diagnosis in clinically unsuspected cases.
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Affiliation(s)
- Smeeta Gajendra
- Department of Laboratory Oncology, All India Institute of Medical Sciences, Dr. BRA IRCHNew Delhi 110029, India
| | - Rashi Sharma
- Department of Pathology and Laboratory Medicine, Medanta - The MedicitySector 38, Gurgaon, India
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3
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Guinot A, Tabone-Eglinger S, Isnardi V, Bahri H, Surdez D, Delattre O, Pierron G, Villemeur M, Lapouble E, Brahmi M, Bouhamama A, Corradini N, Marec-Bérard P. Staging of newly diagnosed Ewing sarcoma: Results of bone marrow aspiration and biopsy versus (18)FDG-PET/CT imaging for bone marrow involvement. Eur J Cancer 2023; 179:56-64. [PMID: 36502618 DOI: 10.1016/j.ejca.2022.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Ewing sarcoma (ES) is an aggressive bone or extraosseous tumour with an unfavourable prognosis when bone marrow metastases are present at diagnosis. The gold standard diagnosis for bone marrow (BM) involvement is cytological and pathological analysis through bone marrow aspiration and biopsy (BMAB). Several recent studies suggest that these invasive and painful procedures could be replaced by 18F-fluorodeoxyglucose-positron emission tomography/computed tomography ((18)FDG-PET/CT), as this nuclear imaging technique is highly sensitive at detecting bone and extraosseous metastases of ES. METHODS In order to study the precision of (18)FDG-PET/CT in the evaluation of bone marrow metastases at diagnosis, we compared the imaging results with cytological/histological analyses performed on BM samples. We retrospectively studied 180 patients with ES recorded at the Léon Bérard Centre over the past 10 years, who were evaluated by (18)FDG-PET/CT and BMAB at diagnosis. RESULTS Of the 180 patients, 13 displayed marrow metastases by cytological/histological examination, and only one of these did not have (18)FDG-PET/CT signs of bone marrow involvement, whereas the 167 remaining patients without marrow metastasis all had a negative (18)FDG-PET/CT, except for one. Hence, the sensitivity and specificity of (18)FDG-PET/CT in these patients was 92.3% and 99.4%, respectively. The overall survival at five years of all patients was 67.4% but decrease to 38.5% in the group with bone marrow metastases. CONCLUSION Given the results presented herein the bone sarcoma group of the French Sarcoma Group suggests that invasive BMAB no longer be systematically performed for the staging at the diagnosis of ES.
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Affiliation(s)
- A Guinot
- Department of Tumor Pediatrics, Centre Leon Berard, Lyon, France.
| | | | - V Isnardi
- Department of Nuclear Medicine, Centre Léon Bérard, Lyon, France
| | - H Bahri
- Department of Nuclear Medicine, Centre Léon Bérard, Lyon, France
| | - D Surdez
- PSL Research University, Institut Curie Research Center, INSERM U830, Paris, France; SIREDO: Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - O Delattre
- PSL Research University, Institut Curie Research Center, INSERM U830, Paris, France; SIREDO: Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Genetics, Institut Curie, Paris, France
| | - G Pierron
- Department of Genetics, Institut Curie, Paris, France
| | - M Villemeur
- PSL Research University, Institut Curie Research Center, INSERM U830, Paris, France; SIREDO: Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France; Department of Genetics, Institut Curie, Paris, France
| | - E Lapouble
- Department of Genetics, Institut Curie, Paris, France
| | - M Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - A Bouhamama
- Department of Interventional Radiology, Centre Léon Bérard, Lyon, France
| | - N Corradini
- Department of Tumor Pediatrics, Centre Leon Berard, Lyon, France
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Shi XB, Deng WX, Jin FX. Bone marrow metastatic neuroendocrine carcinoma with unknown primary site: A case report and review of the literature. World J Clin Cases 2022; 10:11074-11081. [PMID: 36338238 PMCID: PMC9631163 DOI: 10.12998/wjcc.v10.i30.11074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/08/2022] [Accepted: 08/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Metastatic neuroendocrine carcinoma (NEC) of bone marrow is uncommon. Here, we report a case of bone marrow metastatic NEC with an unknown primary site.
CASE SUMMARY A 73-year-old Chinese woman was admitted to our hospital because marked chest distress and asthma lasting 1 d on March 18, 2018. She was initially diagnosed with pulmonary infection, cardiac insufficiency, thrombocytopenia and severe anemia. Following treatment with antibiotic therapy, diuresis and blood transfusion, the patient’s symptoms greatly improved. After bone marrow examinations, the patient was diagnosed with bone marrow metastatic NEC, bone marrow necrosis (BMN) and secondary myelofibrosis (MF). Further imaging workup did not show the primary tumor, we presumed that the primary site might regress spontaneously or merely be unexplored due to lack of positron emission tomography with gallium peptide. Everolimus (10 mg/d) was added to the treatment and the best supportive and symptomatic therapies were also administered. Unfortunately, the patient’s condition continued to deteriorate and she died on May 15, 2018.
CONCLUSION Bone marrow invasion of NEC is rare and our patient who suffered from bone marrow metastatic NEC as well as secondary BMN and MF had an extremely poor prognosis. Bone marrow biopsy plays an important role in the diagnosis of solid tumors invading bone marrow.
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Affiliation(s)
- Xue-Bing Shi
- Department of Medical Oncology, Tongling People’s Hospital, Tongling 244000, Anhui Province, China
| | - Wen-Xia Deng
- Department of Medical Oncology, Tongling People’s Hospital, Tongling 244000, Anhui Province, China
| | - Feng-Xiang Jin
- Department of Hematology, Tongling People’s Hospital, Tongling 244000, Anhui Province, China
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5
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Wang HJ, Zhou CJ. Occult colon cancer with sepsis as the primary manifestation identified by bone marrow puncture: A case report. World J Clin Cases 2022; 10:2967-2973. [DOI: 10.12998/wjcc.v10.i9.2967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bone marrow metastasis is common in liver and lung cancer, but there are few reports on bone marrow metastasis in colon cancer. To date, there are no such reports from mainland China, and reports of bone marrow metastasis with septic shock as the main manifestation are even rarer.
CASE SUMMARY A 71-year-old woman with sepsis as the first symptom presented with high fever, low blood pressure and high inflammation indicators. Computed tomography (CT) examination revealed mild inflammation of the lungs and no obvious abnormalities in the abdomen. Blood culture suggested Escherichia coli, Aeromonas hydrophila and Aeromonas caviae infection. Antibiotic treatment significantly improved the patient’s sepsis symptoms; however, her thrombocytopenia (TCP) could not be corrected despite repeated platelet transfusions. Many malignant cells were ultimately found following a bone marrow puncture smear, and further positron emission tomography/CT (PET/CT) examination confirmed that the malignant tumor in the ascending colon was accompanied by multiple metastases, including the liver and bones. Colon adenocarcinoma was confirmed by autopsy.
CONCLUSION Patients with advanced colon cancer may not have typical clinical symptoms, and sepsis may be the first symptom. When patients have severe TCP that cannot be explained by sepsis of intestinal origin, it is necessary to be aware of the possibility of bone marrow metastasis of intestinal tumors. As such patients often cannot tolerate endoscopy, bone marrow biopsy smears or biopsy tests for specialized cells can help obtain a diagnosis, especially in less developed countries where PET/CT is scarce.
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Affiliation(s)
- Hua-Jun Wang
- Department of Critical Care Medicine, The Affiliated People's Hospital of Ningbo University, Ningbo 315040, Zhejiang Province, China
| | - Chen-Jie Zhou
- Department of Critical Care Medicine, The Affiliated People's Hospital of Ningbo University, Ningbo 315040, Zhejiang Province, China
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Wang HJ, Zhou CJ. Occult colon cancer with sepsis as the primary manifestation identified by bone marrow puncture: A case report. World J Clin Cases 2022; 10:2969-2975. [PMID: 35434087 PMCID: PMC8968824 DOI: 10.12998/wjcc.v10.i9.2969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/04/2022] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bone marrow metastasis is common in liver and lung cancer, but there are few reports on bone marrow metastasis in colon cancer. To date, there are no such reports from mainland China, and reports of bone marrow metastasis with septic shock as the main manifestation are even rarer.
CASE SUMMARY A 71-year-old woman with sepsis as the first symptom presented with high fever, low blood pressure and high inflammation indicators. Computed tomography (CT) examination revealed mild inflammation of the lungs and no obvious abnormalities in the abdomen. Blood culture suggested Escherichia coli, Aeromonas hydrophila and Aeromonas caviae infection. Antibiotic treatment significantly improved the patient’s sepsis symptoms; however, her thrombocytopenia (TCP) could not be corrected despite repeated platelet transfusions. Many malignant cells were ultimately found following a bone marrow puncture smear, and further positron emission tomography/CT (PET/CT) examination confirmed that the malignant tumor in the ascending colon was accompanied by multiple metastases, including the liver and bones. Colon adenocarcinoma was confirmed by autopsy.
CONCLUSION Patients with advanced colon cancer may not have typical clinical symptoms, and sepsis may be the first symptom. When patients have severe TCP that cannot be explained by sepsis of intestinal origin, it is necessary to be aware of the possibility of bone marrow metastasis of intestinal tumors. As such patients often cannot tolerate endoscopy, bone marrow biopsy smears or biopsy tests for specialized cells can help obtain a diagnosis, especially in less developed countries where PET/CT is scarce.
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Affiliation(s)
- Hua-Jun Wang
- Department of Critical Care Medicine, The Affiliated People's Hospital of Ningbo University, Ningbo 315040, Zhejiang Province, China
| | - Chen-Jie Zhou
- Department of Critical Care Medicine, The Affiliated People's Hospital of Ningbo University, Ningbo 315040, Zhejiang Province, China
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rani HS, Hui M, Manasa PL, Uppin SG, Uppin MS, Paul TR, Sadashivudu G. Bone Marrow Metastasis of Solid Tumors: A Study of 174 Cases Over 2 Decades from a Single Institution in India. Indian J Hematol Blood Transfus 2022; 38:8-14. [PMID: 35125707 PMCID: PMC8804032 DOI: 10.1007/s12288-021-01418-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 02/24/2021] [Indexed: 01/03/2023] Open
Abstract
To analyze the pathological findings in patients with marrow metastasis from solid tumors and to compare the accuracy of the bone marrow aspirate, trephine imprint and trephine biopsy in detecting metastasis. A total number of 174 cases diagnosed on bone marrow aspiration and/or bone marrow biopsy from January 2000 to December 2018 were included in the study. In addition to clinical and demographic data, we evaluated peripheral blood findings, and pattern as well as morphology of the tumor cells in bone marrow aspirate, imprint cytology and biopsy. The changes in the bony trabeculae were classified according to the classification of carcinomatous osteodysplasia. The most common laboratory findings included cytopenias and leucoerythroblastic blood picture. Trephine biopsy was found to be the most sensitive technique for detection of marrow metastases with a sensitivity of 99.4%. Trephine imprint cytology (89.9%) showed a significantly better detection rate than bone marrow aspiration (58.5%). Metastatic adenocarcinomas and undifferentiated carcinomas were more common than non-epithelial tumors. Metastatic carcinomas with known primary were mostly from breast, prostate and lung. Ewings/PNET and neuroblastoma were the commonest among metastatic non-epithelial tumors. Fibrosis (53.4%) was the most frequent stromal change and abnormalities in bony trabeculae were noted in 61.2% cases. Trephine biopsy has the highest sensitivity in detection of marrow metastasis followed by trephine imprint cytology. Immunohistochemistry on trephine section will help in confirming and or suggesting the primary tumor in unknown cases.
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Affiliation(s)
- Hanumanthu Sudha rani
- grid.416345.10000 0004 1767 2356Department of Pathology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082 India
| | - Monalisa Hui
- grid.416345.10000 0004 1767 2356Department of Pathology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082 India
| | - P. Lakshmi Manasa
- grid.416345.10000 0004 1767 2356Department of Pathology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082 India
| | - Shantveer G. Uppin
- grid.416345.10000 0004 1767 2356Department of Pathology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082 India
| | - Megha S. Uppin
- grid.416345.10000 0004 1767 2356Department of Pathology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082 India
| | - Tara Roshni Paul
- grid.416345.10000 0004 1767 2356Department of Pathology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082 India
| | - G. Sadashivudu
- grid.416345.10000 0004 1767 2356Department of Medical Oncology, Nizam’s Institute of Medical Sciences, Hyderabad, India
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Huang C, Jian B, Su Y, Xu N, Yu T, He L, Zhang X, Liu Y, Jin M, Ma X. Clinical features and prognosis of paediatric rhabdomyosarcoma with bone marrow metastasis: a single Centre experiences in China. BMC Pediatr 2021; 21:463. [PMID: 34670517 PMCID: PMC8529763 DOI: 10.1186/s12887-021-02904-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to summarize the clinical characteristics, therapeutic effects and prognosis of patients with rhabdomyosarcoma (RMS) and bone marrow metastasis, improve the understanding of this disease. METHOD This was a single-institution retrospective study involving the children with RMS, who presented with bone marrow metastasis at initial presentation to our hospital between 1st, Jan, 2006 and 31st, Dec,2019. Follow-up concluded on 31st, Dec, 2020 and the clinical data were collected and analysed. RESULT Between 1st Jan 2006 and 31st Dec 2019, 13 eligible patients presented to our hospital, including 10 males and 3 females, these eligible patients accounted for 4.5% of all RMS patients. The median age at onset was 5.6 years (range 1.7-14 years). The patients not only had unfavourable primary sites, but also had multiple metastases. The bone marrow aspirate samples of the patients comprised 8-95% blast-like cells. Nine of 13 patients were misdiagnosed with haematological malignancies or other solid tumours. With respect to histology, four of 13 children were classified as embryonal RMS and nine as alveolar RMS. Eleven patients underwent PAX-FOXO1 fusion testing; eight had the POX- FOXO1 fusion gene. Immunohistochemically(IHC) analysis revealed that the tumour cells were positive for Desmin, Vimentin, Myo-D1 and Myogenin. More importantly, the patients had extremely poor prognoses, the median EFS was 12.0 months (range 3-28.3 months) and the median OS was 27.0 months (range6-46.2 months). CONCLUSION This study demonstrates that children with RMS and bone marrow metastasis usually exhibit atypical primary sites and multiple metastases, with presentation mimicking haematological malignancies or other solid tumors at initial presentation. Pathology and IHC analysis combined with POX-FOXO1 fusion gene detections can effectively confirm the diagnosis. These patients are more likely to relapse or progress during early treatment and are prone to intracranial metastasis. While multidisciplinary therapy combined with Temozolomide may prevent it, further prospective research is required to evaluate the therapeutic effects.
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Affiliation(s)
- Cheng Huang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Ocology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China, 100045
| | - Binglin Jian
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Ocology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China, 100045
| | - Yan Su
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Ocology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China, 100045
| | - Na Xu
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Ocology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China, 100045
| | - Tong Yu
- Imaging Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China, 100045
| | - Lejian He
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China, 100045
| | - Xue Zhang
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China, 100045
| | - Yi Liu
- Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China, 100045
| | - Mei Jin
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Ocology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China, 100045.
| | - Xiaoli Ma
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Ocology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China, 100045.
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9
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Sato S, Ishibashi Y, Kawasaki K, Yamazaki R, Hatao F, Morita Y, Imamura K. A case of disseminated carcinomatosis of the bone marrow from gastric cancer developing rapidly after a gastrectomy. Surg Case Rep 2021; 7:49. [PMID: 33591417 PMCID: PMC7887103 DOI: 10.1186/s40792-021-01135-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background Disseminated carcinomatosis of the bone marrow (DCBM) is often associated with disseminated intravascular coagulation (DIC) and a poor prognosis. Moreover, the timing of the diagnosis varies. We presented herein the first report of a case of DCBM from gastric cancer that developed rapidly after a gastrectomy. Case presentation A 42-year-old male patient was referred to us for gastric cancer. Preoperative laboratory tests were normal. Abdominal computed tomography (CT) revealed no obvious bone metastasis, and he underwent a laparoscopic distal gastrectomy. On postoperative day (POD) 1, laboratory data indicated severe thrombocytopenia. Postoperative bleeding requiring reoperation was found. Afterwards, he complained of lower back pain. His ALP and LDH gradually became elevated. On POD 8, DIC was diagnosed. CT and bone scintigraphy showed multiple, widespread bone metastases. Based on these findings, DCBM from gastric cancer was diagnosed. Systemic chemotherapy was started on POD 12. The DIC subsided during the first course, and he was discharged on POD 21. The patient died of tumor progression 7 months later. Conclusion When thrombocytopenia is observed immediately after a gastrectomy for gastric cancer, the possibility of DCBM should be considered.
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Affiliation(s)
- Shunsuke Sato
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Yuji Ishibashi
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan.
| | - Koichiro Kawasaki
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Ryoto Yamazaki
- Department of Surgery, Tokyo Metropolitan Matsuzawa Hospital, 2-1-1 Kamikitazawa, Setagaya City, Tokyo, 156-0057, Japan
| | - Fumihiko Hatao
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Yasuhiro Morita
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Kazuhiro Imamura
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
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10
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Alghandour R, Saleh GA, Shokeir FA, Zuhdy M. Metastatic colorectal carcinoma initially diagnosed by bone marrow biopsy: a case report and literature review. J Egypt Natl Canc Inst 2020; 32:30. [PMID: 32676803 DOI: 10.1186/s43046-020-00040-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/17/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Colorectal carcinoma still represents a global health burden despite the advances in its management. The most common sites of distant metastasis from colorectal carcinoma are hepatic and pulmonary metastases while metastases are rarely reported to affect the bone marrow. CASE PRESENTATION We report a 33-year-old female patient who presented with fever of unknown origin, bone aches limited to the lower back and pelvis, and pancytopenia. She was diagnosed by a bone marrow biopsy as a case of metastatic rectosigmoid carcinoma. Serum tumor markers were within normal ranges; CT, MRI, and colonoscopy confirmed the presence of malignant rectosigmoid mass with bone and ovarian metastases. CONCLUSION Though being rare, bone marrow metastasis should be suspected in colorectal carcinoma cases with abnormalities in peripheral blood count.
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Affiliation(s)
- Reham Alghandour
- Medical Oncology Department, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Gehad A Saleh
- Diagnostic Radiology Department, Mansoura University Hospitals, Mansoura, Egypt
| | | | - Mohammad Zuhdy
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, 35516, Egypt.
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11
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Sharma P, Singla S, Rastogi P, Bansal S, Ahluwalia J. Orbital Rhabdomyosarcoma Infiltrating the Bone Marrow: A Potential Mimic of a Haematopoietic Neoplasm. Indian J Hematol Blood Transfus 2020; 37:179-180. [PMID: 33707857 DOI: 10.1007/s12288-020-01314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Praveen Sharma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Research Block A, 5th Floor, Chandigarh, 160012 India
| | - Sonal Singla
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pulkit Rastogi
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Bansal
- Department of Otolaryngology (Head and Neck Surgery), Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasmina Ahluwalia
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Research Block A, 5th Floor, Chandigarh, 160012 India
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12
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Wu Y, Ni J, Chang X, Zhang X, Zhang L. Successful treatment of pyrotinib for bone marrow metastasis induced pancytopenia in a patient with non-small-cell lung cancer and ERBB2 mutation. Thorac Cancer 2020; 11:2051-2055. [PMID: 32458584 PMCID: PMC7327666 DOI: 10.1111/1759-7714.13480] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 11/28/2022] Open
Abstract
ERBB2 mutations are found in about 2% of patients with non‐small cell lung cancer (NSCLC). A recent study reported that pyrotinib (an irreversible pan ErbB inhibitor) had superior antitumor effect compared to other tyrosine kinase inhibitor therapies in patients with ERBB2 mutations. Bone marrow metastasis is rare in lung adenocarcinoma, and has been reported to be associated with poor prognosis. Here, we report the case of a 62‐year‐old female diagnosed with lung adenocarcinoma and bone marrow metastasis. ERBB2 exon 20 insertion mutation was confirmed by next‐generation sequencing (NGS) of lung tissue as well as bone marrow. The patient achieved stable disease and recovery of pancytopenia after two months of pyrotinib therapy. This is the first report of homogenous mutations of ERBB2 detected in bone marrow, as well as a good response of bone marrow to pyrotinib therapy. Key points This is the first report of a homogenous mutation of ERBB2 detected in the bone marrow of an NSCLC patient with bone marrow metastasis. Our patient with NSCLC ERBB2 mutation and bone marrow metastasis responded well to pyrotinib therapy.
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Affiliation(s)
- Yanyan Wu
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jun Ni
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoyan Chang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaotong Zhang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Li Zhang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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13
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Huang K, Columbie AF, Allan RW, Misra S. Thrombocytopenia with multiple splenic lesions - histiocytic sarcoma of the spleen without splenomegaly: A case report. World J Clin Oncol 2020; 11:162-168. [PMID: 32257847 PMCID: PMC7103523 DOI: 10.5306/wjco.v11.i3.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/09/2019] [Accepted: 12/14/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Histiocytic sarcoma (HS) of the spleen is reported to be a rare and lethal disease. The clinicopathological features of splenic HS have not been well described. The objective of this paper is to describe the diagnosis and treatment of a case of this rare disease and provide a review of the literature.
CASE SUMMARY In this article, we discuss the case of a 40-year-old Hispanic female who presented with progressive thrombocytopenia and multiple hypoechoic lesions in the spleen without splenomegaly. Positron emission tomography-computed tomography showed increased activity in cervical lymph nodes, as well as multiple bone and splenic lesions with positive uptake. Two bone marrow biopsies and fine-needle aspiration of the cervical lymph node were inconclusive. Laparoscopic splenectomy was performed, and gross examination showed a 110.1 g spleen with multiple rubbery, nodular lesions within the subcapsular sinus and splenic parenchyma. The microscopic findings showed multinodular histiocyte proliferation with atypia and multilobulated nuclei, which were positive for CD163, CD4, and CD68 by immunohistochemical analysis. The final pathologic diagnosis was difficult and was found to be low-grade HS of the spleen, after consultations with two renowned hematopathology institutions. At the patient’s five-month follow-up visit, her bone marrow metastasis had progressed. She is waiting to be enrolled in a clinical trial.
CONCLUSION Pathologic diagnosis of splenic HS can be challenging. Low-grade differentiation may be associated with a slow progressive disease.
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Affiliation(s)
- Kai Huang
- Department of General Surgery, Brandon Regional Hospital, HCA West Florida Division/USF Consortium, Brandon, FL 33511, United States
| | - Alvaro Frometa Columbie
- Department of Pathology and Laboratory Medicine, Brandon Regional Hospital, University of South Florida, HCA West Florida Division, Brandon, FL 33511, United States
| | - Robert W Allan
- Chief Pathology and Laboratory Medicine Service, North Florida and Southern Georgia VA System, Clinical Professor of Pathology, University of Florida, Gainesville, FL 32611, United States
| | - Subhasis Misra
- Department of General Surgery, Brandon Regional Hospital, HCA West Florida Division/USF Consortium, Brandon, FL 33511, United States
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14
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Yamaguchi T, Masumoto M, Sakurai U, Nakane M. Disseminated Carcinomatosis of the Bone Marrow from Occult Breast Cancer Responding to a Sequence of Endocrine Therapy. Case Rep Oncol 2020; 13:193-199. [PMID: 32231544 DOI: 10.1159/000505532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/31/2022] Open
Abstract
Patients with cancer of unknown primary (CUP) are generally treated with chemotherapy. Bone marrow involvement suggests an advanced stage, and CUP with disseminated carcinomatosis of the bone marrow (DCBM) appears to have a dismal prognosis. However, our case of CUP with DCBM was successfully treated with a sequence of endocrine therapy over a long period. A woman presenting with low back pain was found to have multiple bone metastasis without an identifiable primary tumor on imaging studies. Blood tests revealed anemia and thrombocytopenia. A bone marrow biopsy was performed and showed relatively uniform small cells, strongly positive for estrogen receptor and progesterone receptor expression. We considered chemotherapy to be risky due to bicytopenia and an aromatase inhibitor, letrozole, was initiated. The patient's symptoms and laboratory findings gradually improved and bone lesions almost disappeared on FDG-PET/CT after 1 year of treatment. After 2 years on letrozole, hemoglobin levels and platelet counts had been gradually decreasing. Although she had no symptoms and no significant changes were observed on a CT scan, disease progression was highly likely. Thus, second-line treatment with fulvestrant and palbociclib was commenced, and hemoglobin levels and platelet counts were restored to within the normal ranges. She currently continues to receive fulvestrant and palbociclib over a year later. CUP complicated with DCBM might be metastatic occult breast cancer, and endocrine therapy can be a valuable treatment option if tumors express hormone receptors.
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Affiliation(s)
- Takeshi Yamaguchi
- Division of Medical Oncology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Mariko Masumoto
- Division of Medical Oncology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Urara Sakurai
- Division of Pathology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Minoru Nakane
- Division of Medical Oncology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
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15
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Yue ZX, Xing TY, Gao C, Liu SG, Zhao W, Zhao Q, Wang XS, Jin M, Ma XL. Chromosome band 11q23 deletion predicts poor prognosis in bone marrow metastatic neuroblastoma patients without MYCN amplification. Cancer Commun (Lond) 2019; 39:68. [PMID: 31685009 PMCID: PMC6829843 DOI: 10.1186/s40880-019-0409-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 10/16/2019] [Indexed: 12/16/2022] Open
Abstract
Background Interphase fluorescence in situ hybridization (FISH) of bone marrow cells has been confirmed to be a direct and valid method to assess the v-myc avian myelocytomatosis viral oncogene neuroblastoma derived homolog (MYCN) amplification in patients with bone marrow metastatic neuroblastoma. MYCN amplification alone, however, is insufficient for pretreatment risk stratification. Chromosome band 11q23 deletion has recently been included in the risk stratification of neuroblastoma. In the present study, we aimed to evaluate the biological characteristics and prognostic impact of 11q23 deletion and MYCN amplification in patients with bone marrow metastatic neuroblastoma. Methods We analyzed the MYCN and 11q23 statuses of 101 patients with bone marrow metastatic neuroblastoma using interphase FISH of bone marrow cells. We specifically compared the biological characteristics and prognostic impact of both aberrations. Results MYCN amplification and 11q23 deletion were seen in 12 (11.9%) and 40 (39.6%) patients. The two markers were mutually exclusive. MYCN amplification occurred mainly in patients with high lactate dehydrogenase (LDH) and high neuron-specific enolase (NSE) levels (both P < 0.001), and MYCN-amplified patients had more events (tumor relapse, progression, or death) than MYCN-normal patients (P = 0.004). 11q23 deletion was associated only with age (P = 0.001). Patients with MYCN amplification had poorer outcomes than those with normal MYCN (3-year event-free survival [EFS] rate: 8.3 ± 8.0% vs. 43.8 ± 8.5%, P < 0.001; 3-year overall survival [OS] rate: 10.4 ± 9.7% vs. 63.5% ± 5.7%, P < 0.001). 11q23 deletion reflected a poor prognosis only for patients with normal MYCN (3-year EFS rate: 34.3 ± 9.5% vs. 53.4 ± 10.3%, P = 0.037; 3-year OS rate: 42.9 ± 10.4% vs. 75.9 ± 6.1%, P = 0.048). Those with both MYCN amplification and 11q23 deletion had the worst outcome (P < 0.001). Conclusions Chromosome band 11q23 deletion predicts poor prognosis only in bone marrow metastatic neuroblastoma patients without MYCN amplification. Combined assessment of the two markers was much superior to single-marker assessment in recognizing the patients at a high risk of disease progression.
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Affiliation(s)
- Zhi-Xia Yue
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, People's Republic of China
| | - Tian-Yu Xing
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, People's Republic of China
| | - Chao Gao
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, People's Republic of China
| | - Shu-Guang Liu
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, People's Republic of China
| | - Wen Zhao
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, People's Republic of China
| | - Qian Zhao
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, People's Republic of China
| | - Xi-Si Wang
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, People's Republic of China
| | - Mei Jin
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, People's Republic of China
| | - Xiao-Li Ma
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100045, People's Republic of China.
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16
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Nazco Deroy Á, Martín Batista S, Álvarez-Argüelles Cabrera H, García Hernández S, Raya Sánchez JM. Nasal embryonal rhabdomyosarcoma with bone marrow metastasis simulating acute leukemia: A case report and review of the literature. Rev Esp Patol 2018; 52:87-91. [PMID: 30902383 DOI: 10.1016/j.patol.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/05/2018] [Accepted: 08/15/2018] [Indexed: 11/29/2022]
Abstract
We present a case of a nasal rhabdomyosarcoma (RMS) in a 27-year-old male with epistaxis and nasal obstruction due to a mass, which was subjected to prophylactic tumor embolization. However, histopathological study on the nasal biopsy was impossible due to necrotic changes. As blast cells were present in peripheral blood samples, a bone marrow biopsy was recommended in order to reach a definitive diagnosis. The possibility of an RMS in cases of bone marrow infiltration by a diffuse tumor constituted by small, round, blast-like cells mimicking acute leukemia should be assessed. Immunohistochemical staining in bone marrow biopsy and flow cytometry in aspirate samples may help to establish the diagnosis (CD45 negativity and CD56 positivity) and cytogenetic studies can be useful in identifying a RMS subtype. When clinically possible, it is desirable to await the results of the tumor immunophenotype and those of the primary mass or bone marrow biopsy to avoid possible errors of diagnosis and treatment.
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Affiliation(s)
- Ángel Nazco Deroy
- Department of Pathology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain.
| | - Silvia Martín Batista
- Department of Haematology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | | | - Sonia García Hernández
- Department of Pathology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - José María Raya Sánchez
- Department of Haematology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
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17
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Fonocho E, Aydin N, Reddy S, Misra S. Recurrent gastric cancer metastasizing to the bone marrow: A case report of a rare presentation. Int J Surg Case Rep 2017; 37:165-168. [PMID: 28686925 PMCID: PMC5499109 DOI: 10.1016/j.ijscr.2017.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/13/2017] [Accepted: 06/13/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Gastric cancer notoriously recurs post curative surgical resection. While there may be visceral metastasis to peritoneal surfaces, bone marrow involvement may also occur although with rarity. We present a case report of recurrent gastric cancer with bone marrow metastasis in a patient with no evidence of systemic disease on follow-up for two years post surgical resection. This case demonstrates the need of heightened clinical suspicion in these patients. METHODS We reviewed the medical records of a patient who presented with metastatic gastric adenocarcinoma to the bone marrow two years post R0 subtotal gastrectomy with Roux-en-Y gastrojejunostomy without evidence of systemic disease on follow up for two years. RESULTS Laboratory and imaging studies of the patient on presentation two years post R0 subtotal gastrectomy with Roux-en-Y gastrojejunostomy is as follows; elevated alkaline phosphatase (ALP) of 472 U/L, CT chest/abdomen/pelvis that showed multiple new sclerotic lesions throughout osseous structures suspicious for metastasis, PET/CT that showed many sclerotic lesions throughout the axial and appendicular skeleton, some FDG-avid and suspicious for active osseous metastasis. Bone marrow biopsy showed metastatic poorly differentiated carcinoma consisted with known history of gastric cancer. CONCLUSION Gastric cancer has a high rate of recurrence post curative surgery. Despite the rarity of bone marrow metastasis, a high level of suspicion should be maintained in patients presenting with elevated ALP and evidence of pancytopenia post curative surgery.
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Affiliation(s)
- Ernest Fonocho
- Texas Tech University Health Sciences Center, 1400 S. Coulter St, Amarillo, TX 79106, United States.
| | - Nail Aydin
- Texas Tech University Health Sciences Center, 1400 S. Coulter St, Amarillo, TX 79106, United States.
| | - Srini Reddy
- Texas Oncology, 1000 S. Coulter, Unit 110, Amarillo, TX 79106, United States.
| | - Subhasis Misra
- Texas Tech University Health Sciences Center, 1400 S. Coulter St, Amarillo, TX 79106, United States.
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18
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Yue ZX, Huang C, Gao C, Xing TY, Liu SG, Li XJ, Zhao Q, Wang XS, Zhao W, Jin M, Ma XL. MYCN amplification predicts poor prognosis based on interphase fluorescence in situ hybridization analysis of bone marrow cells in bone marrow metastases of neuroblastoma. Cancer Cell Int 2017; 17:43. [PMID: 28367105 PMCID: PMC5374581 DOI: 10.1186/s12935-017-0412-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 03/28/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND MYCN gene amplification is related to risk stratification. Therefore it is important to identify accurately the level of the MYCN gene as early as possible in neuroblastoma (NB); however, for patients with bone marrow (BM) metastasis who need chemotherapy before surgery, timely detection of the MYCN gene is not possible due to the unavailability of primary tumors. METHODS MYCN gene status was evaluated in 81 BM metastases of NB by interphase fluorescence in situ hybridization (FISH) analysis of BM cells. The clinicobiological characteristics and prognostic impact of MYCN amplification in NB metastatic to BM were analyzed. RESULTS MYCN amplification was found in 16% of patients with metastases, and the results were consistent with the primary tumors detected by pathological tissue FISH. MYCN amplification was associated with age, lactate dehydrogenase (LDH) levels and prognosis (P = 0.038, P < 0.001, P = 0.026). Clinical outcome was poorer in patients with MYCN amplification than in those without amplification (3-year EFS 28.8 ± 13.1 vs. 69.7 ± 5.7%, P = 0.005; 3-year OS 41.5 ± 14.7 vs. 76.7 ± 5.5%, P = 0.005). CONCLUSIONS MYCN amplification predicts a poor outcome in NB metastatic to BM, and interphase FISH of bone marrow cells provides a timely direct and valid method to evaluate the MYCN gene status.
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Affiliation(s)
- Zhi-Xia Yue
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Beijing, 100045 China
| | - Cheng Huang
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Beijing, 100045 China
| | - Chao Gao
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Beijing, 100045 China
| | - Tian-Yu Xing
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Beijing, 100045 China
| | - Shu-Guang Liu
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Beijing, 100045 China
| | - Xing-Jun Li
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Beijing, 100045 China
| | - Qian Zhao
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Beijing, 100045 China
| | - Xi-Si Wang
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Beijing, 100045 China
| | - Wen Zhao
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Beijing, 100045 China
| | - Mei Jin
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Beijing, 100045 China
| | - Xiao-Li Ma
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Beijing, 100045 China
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Pereira JX, Azeredo MCB, Martins FS, Chammas R, Oliveira FL, Santos SN, Bernardes ES, El-Cheikh MC. The deficiency of galectin-3 in stromal cells leads to enhanced tumor growth and bone marrow metastasis. BMC Cancer 2016; 16:636. [PMID: 27526676 PMCID: PMC4986277 DOI: 10.1186/s12885-016-2679-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/05/2016] [Indexed: 01/13/2023] Open
Abstract
Background Galectin-3 is a multifunctional β-galactoside-binding lectin that once synthesized, is expressed in the nucleus, cytoplasm, cell surface and in the extracellular environment. Because of its unique structure, galectin-3 can oligomerize forming lattice upon binding to multivalent oligossacharides and influence several pathologic events such as tumorigenesis, invasion and metastasis. Methods In our study, balb/c Lgals3+/+ and Lgals3−/− female mice were inoculated in the fourth mammary fat pad with 4T1 breast cancer cell line. The primary tumor, inguinal lymph nodes and iliac bone marrow were evaluated 15, 21 and 28 days post-injection. The primary tumor growth was evaluated by measuring the external diameter, internal growth by ultrasound and weight of the excised tumor. The presence of cancer cells in the draining lymph nodes and iliac crest bone marrow were performed by immunohistochemistry, PCR and clonogenic metastatic assay. Results In this study we demonstrated that the deletion of galectin-3 in the host affected drastically the in vivo growth rate of 4T1 tumors. The primary tumors in Lgals3−/− mice displayed a higher proliferative rate (p < 0,05), an increased necrotic area (p < 0,01) and new blood vessels with a wider lumen in comparison with tumors from Lgals3+/+ mice (P < 0,05). Moreover, we detected a higher number of 4T1-derived metastatic colonies in the lymph nodes and the bone marrow of Lgals3−/− mice (p < 0,05). Additionally, healthy Lgals3−/− control mice presented an altered spatial distribution of CXCL12 in the bone marrow, which may explain at least in part the initial colonization of this organ in Lgals3−/− injected with 4T1 cells. Conclusions Taken together, our results demonstrate for the first time that the absence of galectin-3 in the host microenvironment favors the growth of the primary tumors, the metastatic spread to the inguinal lymph nodes and bone marrow colonization by metastatic 4T1 tumor cells. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2679-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonathas Xavier Pereira
- Programa de Pós-Graduação em Anatomia Patológica, Hospital Clementino Fraga Filho, UFRJ, Rio de Janeiro, Brazil
| | | | | | - Roger Chammas
- Laboratório de Oncologia Experimental e Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, São Paulo, Brazil
| | - Felipe Leite Oliveira
- Laboratório de Proliferação e Diferenciação Celular, ICB, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Sofia Nascimento Santos
- Centro de Radiofarmácia, Instituto de Pesquisas Energéticas e Nucleares (IPEN), São Paulo, Brazil
| | - Emerson Soares Bernardes
- Centro de Radiofarmácia, Instituto de Pesquisas Energéticas e Nucleares (IPEN), São Paulo, Brazil
| | - Márcia Cury El-Cheikh
- Laboratório de Proliferação e Diferenciação Celular, ICB, UFRJ, Rio de Janeiro, RJ, Brazil. .,Cidade Universitária, Ilha do Fundão, Instituto de Ciências Biomédicas, CCS, Av. Carlos Chagas Filho, 393. Bloco F, CEP. 21941-902, Rio Janeiro, RJ, Brazil.
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Basu S, Ranade R, Thapa P. Metastatic Neuroendocrine Tumor with Extensive Bone Marrow Involvement at Diagnosis: Evaluation of Response and Hematological Toxicity Profile of PRRT with (177)Lu-DOTATATE. World J Nucl Med 2016; 15:38-43. [PMID: 26912977 PMCID: PMC4729013 DOI: 10.4103/1450-1147.165353] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The aim of this study was to evaluate the response and hematological toxicity in peptide receptor radionuclide therapy (PRRT) with lutetium (177Lu)-DOTA-octreotate (DOTATATE) in metastatic neuroendocrine tumor (NET) with extensive bone marrow metastasis at the initial diagnosis. A retrospective evaluation was undertaken for this purpose: Patients with NET with extensive diffuse bone marrow involvement at diagnosis who had received at least three cycles of PRRT with 177Lu-DOTATATE were considered for the analysis. The selected patients were analyzed for the following: (i) Patient and lesional characteristics, (ii) associated metastatic burden, (iii) hematological parameters at diagnosis and during the course of therapy, (iv) response to PRRT (using a 3-parameter assessment: Symptomatic including Karnofsky/Lansky performance score, biochemical finding, and scan finding), (v) dual tracer imaging features [with somatostatin receptor imaging (SRI) and fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT)]. Based on the visual grading, tracer uptake in somatostatin receptor (SSTR)-positive bone marrow lesions were graded by a 4-point scale into four categories (0-III) in comparison with the hepatic uptake on the scan: 0 - no uptake; I - clear focus but less than liver uptake; II - equal to liver uptake; and III - higher than liver uptake]. Hematological toxicity was evaluated using National Cancer Institute (NCI)-Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 score. A total of five patients (age range: 26-62 years; three males and two females) with diffuse bone marrow involvement at the diagnosis was encountered following analysis of the entire patient population of 250 patients. Based on the site of the primary, three had thoracic NET (two patients bronchial carcinoid and one pulmonary NET) and two gastroenteropancreatic NET (one in the duodenum and one patient of unknown primary with liver metastasis). Associated sites of metastases included the liver (n = 5), breast (n = 1), and aortocaval nodes (n = 1). On baseline diagnostic study [68 Ga-DOTANOC/TATE or the technetium (99mTc)-hydrazinonicotinamide (HYNIC)-tektrotyd (TOC)], tracer uptake in the bone marrow in all patients was Grade III. At the time of analysis, the patients received three to four cycles of PRRT and a cumulative dose of 16.1-25.6 GBq with a follow-up duration ranging 10-27 months. The response as assessed by three parameters: (i) Symptomatic: All patients (except for one) reported excellent symptomatic palliation and better quality of life with improvement of Karnofsky/Lansky scores; the single case with nonresponse had shown symptomatic response in the initial 6 months following which he had a progressive disease and death at 18 months (ii) biochemical: Three patients had shown more than 50% reduction in the serum chromogranin level, one had shown increase but had demonstrated clinical evidence of response with radiologically stable disease while the other who had shown slight increase of chromogranin A (CgA) level had shown progressive disease thereafter (iii) radiological: Three patients demonstrated partial response (on FDG-PET/CT), one patient had stable disease and one patient had progressive disease following initial clinical response. As per the NCI-CTCAE score, only one patient had persistent Grade I anemia without any deterioration with the administered dose at the time of analysis. FDG uptake in the bone marrow metastatic lesions showed no obvious FDG avidity on visual assessment except for two patients (low-grade FDG uptake). Interestingly, the associated metastatic lesions [except for patient I with Mib1 labeling index (LI): 1-2%], demonstrated high FDG avidity. Thus, we observed that the majority (in our series four out of five patients, i.e. 80%) of the patients had excellent symptomatic response with at least stabilization of the disease at a follow-up period of 10-27 months. The single patient who had a progressive disease also had a good symptomatic response in the initial 6 months from the first dose of PRRT. Despite the extensive bone marrow involvement, no hematological toxicity was observed (only one patient showed Grade I anemia), suggesting that PRRT is well-tolerated by this particular subgroup.
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Affiliation(s)
- Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Mumbai, Maharashtra, India
| | - Rohit Ranade
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Mumbai, Maharashtra, India
| | - Pradeep Thapa
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Mumbai, Maharashtra, India
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Nawarawong N, Pongpruttipan T, Aswakul P, Prachayakul V. Mediastinal small cell carcinoma with liver and bone marrow metastasis, mimicking lymphoma. World J Clin Cases 2015; 3:915-919. [PMID: 26488030 PMCID: PMC4607812 DOI: 10.12998/wjcc.v3.i10.915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 09/07/2015] [Indexed: 02/05/2023] Open
Abstract
Primary mediastinal neuroendocrine tumors are a rare malignancy that accounts for < 10% of all mediastinal tumors. The case presented here involves a 52-year-old man who had been suffering for 3 mo from chronic cough, anorexia and substantial weight loss, as well as 2 wk of jaundice prior to his admission. A computed tomography scan showed a 4.3 cm × 6.6 cm mediastinal mass with multiple liver nodules scattered along both hepatic lobes. Endoscopic ultrasound showed a large heterogeneous hypoechoic mass at the mediastinum with multiple target-like nodules in the liver. Fine-needle aspiration specimens revealed numerous, small, round cells with hyperchromatic nuclei, scarce cytoplasm, and frequent mitotic features. Immunohistochemical study revealed positive results for AE1/AE3, CD56 and chromogranin A, with negative findings for synaptophysin, CK20, vimentin, CK8/18 and CD45. The patient was subsequently diagnosed with a poorly differentiated neuroendocrine carcinoma, small cell type. A bone marrow biopsy also revealed extensive involvement by the carcinoma.
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Chen YH, Huang CH. Esophageal squamous cell carcinoma with dural and bone marrow metastases. World J Gastroenterol 2014; 20:12691-12695. [PMID: 25253978 PMCID: PMC4168111 DOI: 10.3748/wjg.v20.i35.12691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/04/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
Patients with esophageal squamous cell carcinoma generally present at an advanced stage at the time of diagnosis. The most common sites of visceral metastasis are the lung, liver and bone, but brain and bone marrow involvement is exceedingly rare. Herein, we report a 62-year-old man with a 4-wk history of progressive low back pain with radiation to bilateral lower legs, dysphagia and body weight loss. Esophageal squamous cell carcinoma with regional lymph node, liver and bone metastases was diagnosed. He underwent concurrent chemoradiotherapy and got a partial response. Four months later, he complained of headache, diplopia and severe hearing impairment in the left ear. There was no evidence for bacterial, fungal, tuberculous infection or neoplastic infiltration. Magnetic resonance imaging of the brain demonstrated thickening and enhancement of bilateral pachymeninges and multiple enhancing masses in bilateral skull. Dural metastasis was diagnosed and he received whole brain irradiation. In addition, laboratory examination revealed severe thrombocytopenia and leucopenia, and bone marrow study confirmed the diagnosis of metastatic squamous cell carcinoma. This is the first described case of esophageal squamous cell carcinoma with dural and bone marrow metastases. We also discuss the pathogenesis of unusual metastatic diseases and differential diagnosis of pachymeningeal thickening.
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Abstract
Angiosarcomas are rare aggressive neoplasms of vascular endothelial origin with a high metastatic rate and poor prognosis. Involvement of the bone marrow by the angiosarcoma is exceedingly uncommon, and there have only been a few cases reported in the literature to date. Clinical manifestations and common laboratory findings of bone marrow involvement can mimic other more common bone marrow-replacing neoplasias such as lymphomas and acute leukemia. A definitive diagnosis is difficult to make from cytologic material, probably due to an associated bone marrow fibrosis, and requires bone marrow trephine biopsy with an immunohistochemical profile. Here we had the opportunity to study a case of metastatic angiosarcoma with positive cytologic findings and an unusual presentation that challenged its primary diagnosis.
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Affiliation(s)
- Rafael Dezen Gaiolla
- Hematology Service, Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil ; Institute of Oncology and Hematology - ONCOMED, Botucatu, Brazil
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Ekinci AŞ, Bal O, Ozatlı T, Türker I, Eşbah O, Demirci A, Budakoğlu B, Arslan UY, Eraslan E, Oksüzoğlu B. Gastric carcinoma with bone marrow metastasis: a case series. J Gastric Cancer 2014; 14:54-7. [PMID: 24765538 PMCID: PMC3996250 DOI: 10.5230/jgc.2014.14.1.54] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/12/2014] [Accepted: 02/20/2014] [Indexed: 01/13/2023] Open
Abstract
Gastric cancer is a major cause of cancer-related mortality. At the time of diagnosis, majority of the patients usually have unresectable or metastatic disease. The most common sites of metastases are the liver and the peritoneum, but in the advanced stages, there may be metastases to any region of the body. Bone marrow is an important metastatic site for solid tumors, and the prognosis in such cases is poor. In gastric cancer cases, bone marrow metastasis is usually observed in younger patients and in those with poorly differentiated tumors. Prognosis is worsened owing to the poor histomorphology as well as the occurrence of pancytopenia. The effect of standard chemotherapy is unknown, as survival is limited to a few weeks. This report aimed to evaluate 5 gastric cancer patients with bone marrow metastases to emphasize the importance of this condition.
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Affiliation(s)
- Ahmet Şiyar Ekinci
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Oznur Bal
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Tahsin Ozatlı
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Ibrahim Türker
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Onur Eşbah
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Ayşe Demirci
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Burçin Budakoğlu
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Ulkü Yalçıntaş Arslan
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Emrah Eraslan
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Berna Oksüzoğlu
- Department of Medical Oncology, Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
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Selcukbiricik F, Yildiz O, Yilmaz S, Tural D, Turna H, Mandel NM, Tuzuner N, Serdengecti S, Halac M. Increasing Role of FDG-PET/CT in Detecting Bone Marrow Metastasis of Solid Tumors in Adults: An Analysis of Ten Patients. World J Oncol 2013; 3:271-279. [PMID: 29147318 PMCID: PMC5649805 DOI: 10.4021/wjon598w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 12/22/2022] Open
Abstract
Background We aimed to test the hypothesis that whether FDG-PET/CT which was ordered for various purposes can predict suspected or particularly unsuspected bone marrow metastasis (BMM) from the complete blood count and therefore can change the management of these patients. Methods In this retrospective study, the study sample consisted of 68 subsequent patients presented to our institution’s pathology department with bone marrow metastases of solid tumors. PET/CT was found to have been ordered in 10 out of 68 patients (6.8%) for various purposes. All patients gave informed consent about the PET/CT examinations and bone marrow biopsies. Result FDG-PET/CT was ordered in 10 out of 68 solid tumor patients with pathologically proven BMM. Of these 10 patients, 3 were female and 7 were male; mean age was 54.7 years. While FDG PET/CT showed bone and BMM in 4 of 10 patients (40%), the rest of the patients had BMM without bone involvement. Five patients (50%) who had probable bone marrow involvement on their FDG PET/CT scans had unsuspected complete blood counts with regard to BMM. Conclusion PET/CT has the ability to detect a substantial number of metabolically active tumor cells in the bone marrow in all of our patients which we proved by bone marrow biopsies. We think that this cohort of patients with solid tumors is hypothesis-generating with regard to detecting early bone marrow metastases by FDG PET/CT.
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Affiliation(s)
- Fatih Selcukbiricik
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Medical Oncology, Istanbul University, Kocamustafapasa, Istanbul, Turkey
| | - Ozcan Yildiz
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Medical Oncology, Istanbul University, Kocamustafapasa, Istanbul, Turkey
| | - Sabire Yilmaz
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Nuclear Medicine, Istanbul University, Kocamustafapasa, Istanbul, Turkey
| | - Deniz Tural
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Medical Oncology, Istanbul University, Kocamustafapasa, Istanbul, Turkey
| | - Hande Turna
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Medical Oncology, Istanbul University, Kocamustafapasa, Istanbul, Turkey
| | - Nil Molinas Mandel
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Medical Oncology, Istanbul University, Kocamustafapasa, Istanbul, Turkey
| | - Nukhet Tuzuner
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Pathology, Istanbul University, Kocamustafapasa, Istanbul, Turkey
| | - Suheyla Serdengecti
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Medical Oncology, Istanbul University, Kocamustafapasa, Istanbul, Turkey
| | - Metin Halac
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Nuclear Medicine, Istanbul University, Kocamustafapasa, Istanbul, Turkey
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Shin SY, Park H, Chae SW, Woo HY. Microangiopathic hemolytic anemia as the first manifestation of metastatic signet ring cell carcinoma of unknown origin: a case report and review of literature. Korean J Lab Med 2011; 31:157-61. [PMID: 21779188 PMCID: PMC3129345 DOI: 10.3343/kjlm.2011.31.3.157] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 04/04/2011] [Accepted: 04/20/2011] [Indexed: 01/27/2023] Open
Abstract
Microangiopathic hemolytic anemia (MAHA) occurs occasionally as a paraneoplastic syndrome in some solid tumors, but MAHA accompanied by signet ring cell carcinoma of an unknown origin is very rare. In this study, we present the case of an 80-yr-old man who was admitted to the hospital because of a 1-month history of lower back pain and dyspnea. He was diagnosed with MAHA on the basis of the laboratory findings that revealed anemia with schistocytes, decreased haptoglobin levels, and a negative direct Coombs' test. Bone marrow examination, which was performed because of the progression of anemia, revealed bone marrow metastases of signet ring cell carcinoma with extensive bone marrow necrosis. However, the primary origin of this signet ring cell carcinoma was not found. When the cause of progressive MAHA is unknown, the possibility of cancer-associated MAHA must be excluded by performing additional tumor workup, including the detection of tumor markers, gastric and colorectal endoscopic examinations, bone marrow examinations, and positron emission tomography-computed tomography or bone scans.
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Affiliation(s)
- Sang-Yong Shin
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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