Javier de la Serna F, Martinez M A, Valdes M D, Hornedo J, Mestre M J, Morales J M
Department of Hematology, Hospital, 1 de Octubre, Madrid, Spain.
Med Pediatr Oncol. 1988;16(2):123-7. doi: 10.1002/mpo.2950160212.
Rhabdomyosarcoma and other small round-cell neoplasms of infancy and childhood frequently involve the bone marrow. An unusual clinical presentation of diffuse bone marrow involvement as the sole manifestation of the disease represents a difficult diagnostic challenge. We report the case of an 18-year-old boy presenting with lower back pain, sternum tenderness, anemia, thrombocytopenia, leukoerythroblastic blood film, hypercalcemia, and renal failure. No solid tumor was found. A diagnosis of rhabdomyoblastic bone marrow metastatic involvement was initially suggested by the morphological picture, and later confirmed by the ultrastructural findings. Hypercalcemia and renal failure were controlled, initially, with furosemide and calcitonin. The patient was treated with intensive chemotherapy, including vincristine, actinomycin D, cyclophosphamide, and doxorubicin. A remission was achieved, lasting 5 months until relapse.
横纹肌肉瘤及其他婴幼儿和儿童期的小细胞圆形肿瘤常累及骨髓。以弥漫性骨髓受累作为疾病唯一表现的不寻常临床症状是一项艰难的诊断挑战。我们报告一例18岁男孩，其表现为下背部疼痛、胸骨压痛、贫血、血小板减少、幼稚粒-幼红细胞血象、高钙血症及肾衰竭。未发现实体瘤。最初根据形态学表现提示为横纹肌母细胞性骨髓转移受累，随后超微结构检查结果证实了这一诊断。高钙血症和肾衰竭最初用速尿和降钙素控制。患者接受了强化化疗，包括长春新碱、放线菌素D、环磷酰胺和阿霉素。实现了缓解，持续5个月后复发。
