Analysis Of Clinical And Hematological Features In 60 Patients With Metastatic Carcinoma Of Bone Marrow

Metastatic carcinoma of bone marrow (MCBM) is generic name which means that malignant tumor produced from the nonhematopoietic tissue metastasis to the bone marrow. Bone marrow is the common locus to which the nonhematopoietic tumor cells transfer. Bone marrow tumor metastasis can be early discovered by bone marrow puncture or biopsy. Anemia caused by bone marrow tumor metastasis is named myelopathic anemia, which is characterized by immature granulocyte and nucleated red cell on the blood film.Because the complex and atypical clinical manifestations of MCBM, many cases with anemia or thrombocytopenia of hematologic abnormalities come to see doctor. Through the bone marrow puncture or biopsy, MCBM is detected and unknown the neoplastic locus. Thus, Misdiagnosis is common in the preliminary diagnosis. Recognition of this disease , early diagnosis and optimal management have significance for improvement of life quality and prolongation of survival.Bone marrow smear or bone marrow biopsy is the simple effective approach to diagnosis MCBM. Detection of tumor cells in the marrow means unfavorable prognosis. Combined therapy such as chemotherapy, radiotherapy and supportive care are used to treat the patients of MCBM . Active and correct measurements can be used to prolong the overall survival and improve the life quality of MCBM patients.The objective of this study is to retrospectively analyze clinical features and causes of misdiagnosis of 60 cases of MCBM admitted to our hospital andthe third hospital of Jilin University, particularly focusing on the presenting features of hematology and marrow figures, and palliative treatment. We hope to enhance recognition of this disease and explore beneficial experience for treating these cases. Patients and Methods Patient SelectionThe material consisted 60 patients diagnosed in Jilin chemistry industrial hospital, the second hospital of Jilin university and Chinese-Japanese united friendship hospital from 1995 to 2005.Diagnostic Criteria(1) The primary malignant tumors were diagnosed by clinical manifestations, operation or pathology, cytology inspect, assisted with biochemistry and immune marker assay and medical image conformation.(2) MCBM was diagnosed by finding the metastatic tumor cell in the bone marrow smear or biopsy clear-cutlyMethodsBone marrow biopsy plastic-embedded-section stained by H-Giemsa-E.Treatment(1) Combined chemotherapy: chemotherapy regimens consisted of [COA-PVP], [CAF] , [CAP] or [NP ]regimens.(2) Local radiotherapy.(3) Supportive care.Statistical methodsThe X2 tests were used to assess the statistical significance of comparisons indifferent subgroups.Results1 .General clinical features and misdiagosis of patients with MCBMThe median age of patients with MCBM was 47 years old, and 65% patients aged between 40 and 60 years old. The majority of MCBM patients (69.5% and 50%) had anemia and bone pain as the main complains at first. Other manifestations may be febrile, weight loss, fatigue and bleeding et al. Of all the MCBM patients, lung cancer is the most common identified primary tumor (33.3%), next is breast cancer (15%) . 25 patients (41.7%) had unknown primary tumors. 39.3% of MCBM patients were misdiagnosed at the time of initial diagnosis involving 8 categories of disorders.2 .Hematological features and bone marrow images of MCBM patientsThe proportion of anemia in the MCBM patients is high (69.5%), but serious anemia is less common (11.9%). Nucleated erythrocytes were detected on the blood film from the 35.7% patients, primarily polychromatophilic normoblast and orthochromatic normoblast. Immature granulocytes were found from 21.7% patients, primarily myelocyte and metagranulocyte. In 16.7% MCBM patients, both nucleated erythrocyte and Immature granulocyte were detected on the blood film. No cancer cells could be seen on the smear. The majority of MCBM patients have hypoplasia and heavy hypoplasia in the marrow. Metastatic cancer cells scatter on the tail and rims of the smear clusterly. For bone marrow, the metastatic cancer cells are"foreign guests". Exclusive growth is one of the important behaviors in the marrow. Cancer cells inter-adhere compactly as nests ( cancer nest) or trabs distribution, whilehematopoietic tissue scattered relatively. MCBM often accompanied with myelofibrosis, hyperostosis or destruction of bone. MCBM originated from glandular epithelium is more than from scalelike epithelium.3 .Treatment and prognosis of MCBMBone marrow metastasis means poor prognosis for the patients with malignant tumor. Usually, combined therapies including chemotherapy, local radiotherapy and supportive care were used to treat MCBM patients. The selected drugs mainly aim at the primary tumor or according to the metastatic tumor cells pathological types for those primary tumor was unknown. In the cases we reported, on the basis of supportive care, biological response modifer and anticancer Chinese formulated products were used to treat patients, partly combined with chemotherapy or endocrine therapy, so that some patients improved quality of life and prolonged survival time.Conclusions1. The age of onset in MCBM patients is mostly between 40 and 60 years old. MCBM originated from glandular epithelium is more than from scalelike epithelium.2. Because the complex and atypical clinical manifestations and unspecific hematological changes of MCBM, the misdiagnosis rate in the preliminary diagnosis is high. Clinically appearance of hematological abnormality in patients of malignant tumor or unknown hematological changes, unknown fever, unknown intractable bone pain, pathological bone fracture, persistent fast ESR and high level ALP in patients, bone marrow puncture and biopsy should be done in case misdiagnosis and missed diagnosis,especially for whom immature granulocyte and nucleated red cell can be found on the blood film.3. Most of MCBM patients suffer from anemia. The majority of MCBM patients have hypoplasia and heavy hypoplasia in the marrow. Metastatic cancer cells scatter on the tail and rims of the smear clusterly.4. Final diagnosis of MCBM bases on bone marrow examination. Bone marrow aspiration and biopsy are effective, practical and reliable methods.5. Combined therapy such as chemotherapy, radiotherapy and best supportive care can usually be used to treat the patients of MCBM . These approaches can be prevent the tumor progression so that to improve quality of life and prolong survival in part patients. However, overall prognosis of MCBM patients is very poor.