Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Hepatic Surgery Center, Institute of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Medicine (Baltimore). 2022 Nov 11;101(45):e31731. doi: 10.1097/MD.0000000000031731.
Metastatic carcinoma of bone marrow (MCBM) tends to present with atypical symptoms and can be easily misdiagnosed or miss diagnosed. This study was conducted to investigate the clinical-pathological and hematological characteristics of MCBM patients in order to develop strategies for early detection, staging, treatment selection and prognosis predicting. We retrospectively analyzed 45 patients with MCBM diagnosed by bone marrow biopsy in our hospital during the past 7 years. The clinical symptoms, hemogram and myelogram features, Hematoxylin and eosin staining and immunohistochemistry staining of bone marrow biopsies, location of primary carcinoma and corresponding treatment of the 45 MCBM patients were analyzed in this study. In total, 35 (77.9%) of all patients presented pains including bone pain (73.3%) as the main manifestation, and 37 (82.2%) patients had anemia. Metastatic cancer cells were found in only 22 patients (48.9%) upon bone marrow smear examination, but in all 45 patients by bone marrow biopsy. The bone marrow of 18 (40.0%) patients was dry extraction. Distribution of metastatic carcinoma was diffuse in 20 (44.4%) patients and multi-focal in 25 (55.6%) patients, complicated with myelofibrosis in 34 (75.6%) patients. For bone marrow biopsy immunohistochemistry, 97.8% of the patients were CD45-negative, while 75.6% of the patients were Cytokeratin-positive. There were 30 patients (66.7%) identified with primary malignancies. The overall survival (OS) of 1 year for MCBM patients was 6.7%. There was a trend that patients with cancer of known primary obtained better prognosis according to the survival curve, but the finding was not statistically significant with Log-rank P = .160. Complete MICM-P plays a significant role in early diagnosis of MCBM. Bone marrow biopsy combined with immunohistochemistry is an underappreciated method for the diagnosis of MCBM, which should be taken as part of regular tests as well as bone marrow smear. Understanding the clinical-pathological and hematological characteristics of MCBM and conducting bone marrow biopsy in time are of great significance for early detection and treatment selection.
骨髓转移癌（MCBM）往往表现出非典型症状，容易误诊或漏诊。本研究旨在探讨 MCBM 患者的临床病理和血液学特征，以制定早期检测、分期、治疗选择和预后预测策略。我们回顾性分析了 7 年来我院骨髓活检诊断的 45 例 MCBM 患者。分析了 45 例 MCBM 患者的临床症状、血常规和骨髓象特征、骨髓活检苏木精-伊红染色和免疫组织化学染色、原发癌的部位和相应的治疗。共 35 例（77.9%）患者有疼痛，包括骨痛（73.3%）为主诉，37 例（82.2%）患者有贫血。骨髓涂片检查仅在 22 例（48.9%）患者中发现转移癌细胞，但在所有 45 例患者中均行骨髓活检。18 例（40.0%）患者骨髓干抽。20 例（44.4%）患者转移癌呈弥漫性分布，25 例（55.6%）患者呈多灶性分布，34 例（75.6%）患者合并骨髓纤维化。骨髓活检免疫组织化学染色显示，97.8%的患者 CD45 阴性，75.6%的患者细胞角蛋白阳性。30 例（66.7%）患者明确诊断为原发性恶性肿瘤。MCBM 患者的 1 年总生存率（OS）为 6.7%。根据生存曲线，有趋势表明已知原发癌患者预后较好，但 Log-rank P=.160 提示差异无统计学意义。完整的 MICM-P 对 MCBM 的早期诊断具有重要意义。骨髓活检结合免疫组织化学是诊断 MCBM 的一种被低估的方法，应作为常规检查的一部分，以及骨髓涂片。了解 MCBM 的临床病理和血液学特征，及时进行骨髓活检，对早期发现和治疗选择具有重要意义。
