Abstract

Background:?Bone marrow involvement by solid tumor implicates advanced disease and dismal prognosis. Bone marrow aspiration and biopsy are routinely performed as staging workup for certain small round cell tumors and also for unexplained cytopenia in other solid tumors. It is important to rule out bone marrow involvement before planning for curative treatment.?Materials and Methods:?This was a retrospective observational study. The aim of our study was to evaluate the pattern of bone marrow involvement by different solid tumors and their correlation with the hematological abnormalities. We retrospectively evaluated bone marrow aspirations and biopsy performed in past 3 years.?Results:?At our institution, bone marrow examinations were performed in 440 patients during past 3 years for solid malignancies. Out of 440, 206 were pediatric cases and 234 were adult cases. Bone marrow was involved in 56 (12.7%) patients. Among the pediatric cases, bone marrow involvement was present in 30 (12.8%) cases, and in adult cases, bone marrow was involved was in 26 (11.1%) cases. Neuroblastoma (40%) was the most common malignancy, which involved the bone marrow among pediatric cases, followed by retinoblastoma (26.6%) and Ewing?s sarcoma (20%). Among adult patients, neuroendocrine carcinoma (23%) was at the top of the list of tumors involving bone marrow, which is followed by Ewing?s sarcoma (19.2%) and nasopharyngeal carcinoma (11.5%).?Conclusion:?Neuroblastoma and neuroendocrine carcinoma are the major cause of bone marrow involvement among the solid malignancies in pediatric and adult population, respectively. Use of immunohistochemistry markers on bone marrow biopsies may result in higher detection rate.

Introduction

Bone marrow involvement is commonly seen in hematopoietic disorders, but solid tumors too rarely involve bone marrow through hematogenous spread. Detection of bone marrow involvement by solid tumor is important for accurate staging, for prognostication and treatment.[1] Sometimes, bone marrow involvement may be the first evidence of disease manifestation. Rohr and Hegglin studied sternal aspirates of 75 patients with cancer and found marrow involvement in 11 of 13 patients with bone marrow metastases.[2] The metastasis can be reported by the examination of bone marrow aspiration only, but the bone marrow biopsy may be the more accurate procedure for detecting metastasis by solid tumors.[3] The purpose of bone marrow assessment in the solid tumor is either for staging purpose or as a reflex procedure on suspicion of marrow involvement, such as anemia, leukocytopenia, and/or thrombocytopenia.[4]

This study was undertaken to comprehensively analyze bone marrow metastasis in nonhematological malignancies diagnosed at a single tertiary care center in South India over the period of 3 years (2014?2016).

Materials and Methods

In this retrospective observational study, we reviewed the results of bone marrow aspiration and biopsy carried out for solid tumor at Kidwai Cancer Hospital, Bengaluru, India, between January 2014 and December 2016. Diagnosed cases of lymphoma were not included in this study.

For all patients, bone marrow aspiration and biopsy were performed from the posterior iliac crest using Jamshidi needle. Slides were prepared from bone marrow aspiration, imprint smears, and peripheral smears and stained by Romanowsky stains, either by Giemsa or Leishman. Bone marrow biopsies after standard processing were stained with hematoxylin and eosin and reviewed by hematopathologist. Patient?s name, age, sex, diagnosis, and purpose for performing the bone marrow assessment were recorded. Pediatric age was defined as a patient with age <14>

Results

A total of 440 cases of solid tumors were evaluated for bone marrow assessment either for staging workup or on suspicion of bone marrow involvement. Bone marrow was involved in 56 patients (12.7%). Out of 440, 206 were pediatric cases and 234 were adult cases. In pediatric cases, bone marrow involvement was present in 30 (12.8%) cases, and in adult cases, bone marrow was involved was in 26 (11.1%) cases [Table 1].

1. Reich C.?A study of the diagnostic value of sternal puncture in clinical hematology. Am J Med 1935; 189: 515-20
2. Motulsky AG, Rohn RJ.?The bone marrow in metastatic malignant melanoma. J Lab Clin Med 1953; 41: 526-33
3. Vald?s-S?nchez M, Nava-Ocampo AA, Palacios-Gonz?lez RV, Perales-Arroyo A, Medina-Sans?n A, Mart?nez-Avalos A. et al.?Diagnosis of bone marrow metastases in children with solid tumors and lymphomas. Aspiration, or unilateral or bilateral biopsy? Arch Med Res 2000; 31: 58-61
4. Landys K.?Prognostic value of bone marrow biopsy in breast cancer. Cancer 1982; 49: 513-8
5. Anner RM, Drewinko B.?Frequency and significance of bone marrow involvement by metastatic solid tumors. Cancer 1977; 39: 1337-44
6. Reid MM, Wallis JP, McGuckin AG, Pearson AD, Malcolm AJ.?Routine histological compared with immunohistological examination of bone marrow trephine biopsy specimens in disseminated neuroblastoma. J Clin Pathol 1991; 44: 483-6
7. Kilickap S, Erman M, Dincer M, Aksoy S, Hakan H, Yalcin Y.?Bone marrow metastasis of solid tumors: Clinicopathological evaluation of 73 cases. Turk J Cancer 2007; 37: 85-8
8. Mohanty SK, Dash S.?Bone marrow metastasis in solid tumors. Indian J Pathol Microbiol 2003; 46: 613-6

Address for correspondence

Publication History

Article published online:
24 May 2021

? 2019. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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1. Reich C.?A study of the diagnostic value of sternal puncture in clinical hematology. Am J Med 1935; 189: 515-20
2. Motulsky AG, Rohn RJ.?The bone marrow in metastatic malignant melanoma. J Lab Clin Med 1953; 41: 526-33
3. Vald?s-S?nchez M, Nava-Ocampo AA, Palacios-Gonz?lez RV, Perales-Arroyo A, Medina-Sans?n A, Mart?nez-Avalos A. et al.?Diagnosis of bone marrow metastases in children with solid tumors and lymphomas. Aspiration, or unilateral or bilateral biopsy? Arch Med Res 2000; 31: 58-61
4. Landys K.?Prognostic value of bone marrow biopsy in breast cancer. Cancer 1982; 49: 513-8
5. Anner RM, Drewinko B.?Frequency and significance of bone marrow involvement by metastatic solid tumors. Cancer 1977; 39: 1337-44
6. Reid MM, Wallis JP, McGuckin AG, Pearson AD, Malcolm AJ.?Routine histological compared with immunohistological examination of bone marrow trephine biopsy specimens in disseminated neuroblastoma. J Clin Pathol 1991; 44: 483-6
7. Kilickap S, Erman M, Dincer M, Aksoy S, Hakan H, Yalcin Y.?Bone marrow metastasis of solid tumors: Clinicopathological evaluation of 73 cases. Turk J Cancer 2007; 37: 85-8
8. Mohanty SK, Dash S.?Bone marrow metastasis in solid tumors. Indian J Pathol Microbiol 2003; 46: 613-6