Metastasis of solid tumors into bone marrow - Single center experience

Introduction: Metastases of solid tumors to the bone marrow are rarely reported. Clinical manifestation and laboratory findings remain uncharacteristic and lead to misdiagnosis. Detection of bone marrow metastases may have an impact on therapeutic decisions and is usually associated with poor prognosis. Aim: To characterize clinical picture and hematological findings in patients with bone marrow metastasis. Material and methods: We retrospectively reviewed medical records of patients with bone marrow metastases who were primary misdiagnosed with hematological malignancies. Results: Ten patients at median age of 51 years at diagnosis were included. There were following findings on admission: duopenia (n = 7), pancytopenia (n = 1), anemia (n = 1) and skeletal lytic lesions (n = 1). The diagnosis of prior cancer was reported in 3 patients and included multiple myeloma, breast cancer and oligoastrocytoma. Clinical manifestations were hepatomegaly (n = 4), lymphadenopathy (n = 4), skin pallor (n = 3), cachexia (n = 2) and hemorrhagic diathesis (n = 2). Imaging studies revealed diffuse bone lesions (n = 5), pulmonary infiltrates (n = 2) and liver masses (n = 2). Leukoerythroblastosis was demonstrated in 4 cases. Bone marrow aspirate detected the presence of abnormal cell population in 4 patients. In all studied patients a final diagnosis was established by immunohistochemistry of bone marrow biopsy. The following malignancies were detected: prostate adenocarcinoma (n = 2), anaplastic microcellular carcinoma of unknown origin (n = 2), adenocarcinoma of unknown origin (n = 2), Ewing's sarcoma (n = 1), breast cancer (n = 1), clarocellular renal cancer (n = 1) and neuroendocrine tumor (n = 1). Nine out of the 10 metastatic patients died shortly after chemotherapy. Conclusions: Unexplained hematological abnormalities should arise the suspicion of bone marrow metastases.