Chambers Isaac, Truong Phu, Kallail K James, Palko William
Internal Medicine, University of Kansas School of Medicine-Wichita.
Wesley Medical Center, University of Kansas School of Medicine-Wichita.
Cureus. 2016 Jun 13;8(6):e639. doi: 10.7759/cureus.639.
Acute myeloid leukemia (AML) is the most common leukemia in adults. In rare cases, bone marrow necrosis (BMN) and osteolytic lesions are presenting features of AML. The following case describes a patient with known polycythemia vera (PV) that presented with signs of multiple myeloma, including hypercalcemia, anemia, and lytic lesions of the thoracic spine and skull. Laboratory workup was not indicative of myeloma. A bone marrow biopsy was performed, which revealed extensive BMN and initial pathology was consistent with metastatic carcinoma. However, no immunohistochemical stains could be performed due to the extent of BMN; a repeat biopsy was therefore performed. Flow cytometry and CD45 staining were consistent with PV that had transformed to AML. Due to the patient's comorbidities, she was a poor candidate for stem cell transplant and did not wish to pursue chemotherapy. Ultimately, she pursued hospice care. Based on our literature review, both BMN and osteolytic lesions are rare manifestations of AML and have not been reported to occur simultaneously. These findings can lead to a diagnostic dilemma and suspicion of other malignancies. This case demonstrates that AML should remain in the differential diagnosis in those patients who present with BMN and osteolytic lesions.
急性髓系白血病（AML）是成人中最常见的白血病。在罕见情况下，骨髓坏死（BMN）和溶骨性病变是AML的表现特征。以下病例描述了一名已知真性红细胞增多症（PV）的患者，该患者出现了多发性骨髓瘤的体征，包括高钙血症、贫血以及胸椎和颅骨的溶骨性病变。实验室检查结果未提示骨髓瘤。进行了骨髓活检，结果显示广泛的BMN，初始病理结果与转移性癌一致。然而，由于BMN的程度，无法进行免疫组化染色；因此进行了再次活检。流式细胞术和CD45染色结果与已转化为AML的PV一致。由于患者存在合并症，她不适合进行干细胞移植，且不想接受化疗。最终，她选择了临终关怀。根据我们的文献综述，BMN和溶骨性病变都是AML的罕见表现，尚未有两者同时发生的报道。这些发现可能导致诊断困境，并引发对其他恶性肿瘤的怀疑。该病例表明，对于出现BMN和溶骨性病变的患者，AML应始终保留在鉴别诊断范围内。
