Extensive Bone Marrow Necrosis in a Case of Acute Myeloid Leukemia Transformed from a Myeloproliferative Neoplasm

Abstract

Extensive necrosis affecting more than 50%percnt; of the bone marrow is an extremely rare histopathological finding. Relatively little is known about its clinical significance because it is most commonly identified at autopsy - whether it is an independent prognostic marker or whether it is a surrogate marker of underlying disease burden remains unclear. We describe herein a case of a 66-year-old patient with acute myeloid leukemia who presented with acute bone marrow failure and was found to have extensive necrosis. We include presenting clinical features, pathology attained at biopsy, and the challenge of treatment. Bone marrow necrosis is a rare but important clinicopathological entity whose recognition may herald the way for more effective prognostication of underlying disease.

Keywords: Acute myeloid leukemia; Bone marrow necrosis; Myeloproliferative neoplasm.

Fig. 1

a HE-stained section of bone marrow core biopsy shows massive necrosis with complete loss of the cellular details. ×100. b The marrow is occupied by granular eosinophilic material containing scattered nuclear debris. ×200.

Fig. 2

CT scan of the abdomen with axial and coronal sections showing marked hepatomegaly and splenomegaly as well as diffuse lymphadenopathy in the gastrohepatic and duodenal compartments.