Gelatinous transformation of bone marrow: rare or underdiagnosed?

Abstract

Gelatinous transformation of the bone marrow (GTBM) is a rare hematologic entity, which was first described by Paul Michael in 1930. GTBM is mostly associated with caloric intake/anorexia nervosa, although it also has been described accompanying other pathologic conditions, such as malignancy, systemic lupus erythematosus, HIV infections. Even though the diagnostic features of the hematopoietic tissue, such as hypoplasia, adipose cell atrophy, and deposition of a gelatinous substance in the bone marrow (which stains with Alcian blue at pH 2.5) are quite specific, the underlying pathogenic mechanisms remain poorly understood. Considering the evidence of reversibility-notably in cases of malnutrition and anorexia-this entity should be kept high on cards as a possible differential diagnosis of patients presenting with cytopenias and associated weight loss or starvation, especially in developing countries with nutritionally deprived populations. On an extensive review of the literature aimed at comprehensively addressing the evolution of the GTBM from the past century until now, we conclude that the lack of clinical suspicion and awareness regarding this pathologic entity has led to misdiagnosis and delayed diagnosis.

Keywords: Bone Marrow; Bone Marrow Disease; Bone Marrow Examination.

Figure 1. Photomicrography of the bone marrow. A – marked hypocellularity of the hematopoietic cells and scant fat tissue immersed in an amorphous eosinophilic material (H&E, 200X); B – this stains blue with Alcian blue staining (200X). This is consistent with the diagnosis of gelatinous transformation of the bone marrow in an autopsy case of a severely malnourished corpse (Figures provided by Dr. Aloísio Felipe-Silva, MD, PhD; chief of the Anatomic Pathology Service, Hospital Universitário, University of São Paulo).