Original Article
[PDF Purchased from http://www.ijpmonline.org on Thursday, September 04, 2014]abce
The prognostic significance of bone marrow metastases: Evaluation of 58 cases Betul Bolat Kucukzeybek, Aylin Orgen Calli, Yuksel Kucukzeybek1, Sadi Bener, Yelda Dere, Ahmet Dirican1, Kadriye Bahriye Payzin2, Fusun Ozdemirkiran2, Mustafa Oktay Tarhan1 Departments of Pathology, 1Medical Oncology and 2Hematology, Izmir Katip Celebi University Atatürk Training and Research Hospital, Izmir, Turkey Address for correspondence: Dr. Betul Bolat Kucukzeybek, Department of Pathology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey. E-mail:
[email protected]
ABSTRACT
Access this article online
Background: Bone marrow biopsy is widely used method for diagnosis, followup and staging of hemato-oncologic diseases. This procedure is also used for determining the bone marrow metastasis in patients with solid tumors. In this study, clinical, hematological, and pathological features of 58 patients with bone marrow metastases diagnosed by bone marrow biopsies were examined retrospectively Materials and Methods: Among 3345 bone marrow biopsies performed in our hospital between January 2006 and August 2013, 58 cases with solid tumor metastasized to bone marrow were included in this study. Results: Among 58 cases with solid organ carcinoma metastasis in bone marrow, mean age was 59.9. Thirty-nine cases were found to have a known primary tumor focus. The most common tumors metastasized to bone marrow were breast carcinomas (23 patients, 59%), gastric carcinomas (6 patients, 15.3%), prostate carcinomas (4 patients, 10,2%), and lung carcinomas (3 patients, 7.7%), respectively. Nineteen patients were firstly diagnosed from bone marrow biopsies as metastatic carcinomas. The median overall survival after bone marrow metastasis was 28 days (95% confidence interval: 7.5-48.4). The median overall survival difference was not statistically significant between patients with primary known and unknown tumor (P = 0.973). Statistically significant difference was observed between the survival of breast cancer and gastric cancer (P = 0.028). The most common hematologic symptom was the coexistence of anemia and thrombocytopenia (31%), thrombocytopenia (27.6%) and anemia (20.7%) alone. The median overall survival difference was statistically significant between patients who have anemia and thrombocytopenia (P < 0.005). Conclusion: Bone marrow biopsy is an easily accessible, easily applied, a useful procedure for diagnosing metastatic diseases in patients with hematologic symptoms such as anemia and thrombocytopenia besides being an uncomfortable procedure for patients. Furthermore, it is useful in predicting the prognosis and short survey after diagnosing bone marrow metastasis. KEY WORDS: Anemia, bone marrow, neoplasm metastasis, thrombocytopenia
INTRODUCTION Bone marrow biopsy is a used technique either in diagnosis, staging and follow-up of hematological diseases or staging and determining bone marrow metastasis of solid tumors. Diagnosis of bone marrow metastasis is extremely important because of the effect on selecting treatment methods and survey in patients with solid tumors.[1] Bone marrow is a target of hematogenic spread of solid tumors as well as other solid organs.[2] In 1935, Reich reported as bone marrow aspirates from sternum may contain tumor cells, which was later proved by many researchers.[3,4] Bone marrow aspirates, and biopsies were found to be more useful than radiological methods and bone scintigraphy in the diagnosis of 396
Indian Journal
of
Pathology
and
Website: www.ijpmonline.org PMID: xxxxxxxxx (when available) DOI: 10.4103/0377-4929.138728 Quick Response Code:
metastatic tumors by 1970s. Furthermore, it was stated that bone marrow biopsy gets the better of bone marrow aspirates in diagnosis of bone marrow metastasis.[5] Anemia, thrombocytopenia, leukopenia, bi-cytopenia and pancytopenia can be encountered after the tumoral involvement of bone marrow. However, bone marrow metastasis could be established without any changes in hematologic parameters.[6] Bone marrow metastasis can be found in patients with widely metastatic solid tumors in addition to solid tumors firstly diagnosed by bone marrow biopsies. In this study, clinical, hematological, and pathological features of 58 patients with bone marrow metastases diagnosed by bone marrow biopsies were examined retrospectively. MATERIALS AND METHODS We included 3345 bone marrow biopsies examined in Pathology Department of Our Hospital between January 2006 and August 2013 in this study. All of the bone marrow biopsies were performed through
Microbiology - 57(3), July-September 2014
[PDF Purchased from http://www.ijpmonline.org on Thursday, September 04, 2014]abce Kucukzeybek et al.: The prognostic significance of bone marrow metastasis
the crista iliaca posterior and stained with hematoxylin and eosin, Reticulin and Giemsa. Immunohistochemical staining were added according to patients’ clinical and the biopsies’ histopathological features and if there were a primary known tumor. The age, sex, primary diagnosis, changes in hematologic parameters, interval between primary diagnosis and bone marrow metastasis, and the median overall survival after bone marrow metastasis were retrospectively evaluated. Total count of leukocytes
