Bone marrow metastases - A 7 years study from a single tertiary centre in eastern India

Abstract

Author(s): Sarita Pradhan, Rashmi Patnayak, Sukanya Patra, Rajesh Kumar Bhola, Soumya Surath Panda, Sima Chauhan4 riyanka Samal

Introduction: Haematogenous spread of tumours to bone marrow is a common phenomenon and implies advanced stage of disease with poor prognosis. In most instances, the site of primary malignancies is known and is demonstrated in the bone marrow, when the procedure is carried out as a part of the staging process. However In some cases, detection is incidental and bone marrow involvement may be the first clue to these unsuspected non haematopoietic malignancies. Objective: In this study, we aim to analyse the clinic-pathological spectrum of non-hematopoietic neoplasms detected in bone marrow biopsies carried out in our setting. Methods: This is a descriptive cross-sectional study, where the Laboratory Information System (LIS) was used to screen all the bone marrow trephine biopsies done over the last 7 years, from January 2014 to December 2020. Out of total 4370 bone marrow trephine biopsies performed, 53 cases of bone marrow metastases by nonhematopoeitic malignancies were detected. All the stained slides and the tissue blocks of metastases were retrieved for observation and their laboratory parameters were retrieved from the Laboratory Information System (LIS). Results: Out of these 53 cases, primary was known in 16 (30.2%) cases prior to performing marrow biopsies. 15 (28.3%) cases presented with severe backache and/or presence of lytic lesions on radiological examination and underwent marrow examination with a clinical suspicion of multiple myeloma verses metastases. 16 (30.2%) cases were incidentally detected while evaluating for causes of cytopenias and leucoerythroblastic blood picture. Adenocarcinoma prostate was the most common tumour with first presentation as bone marrow metastases followed by adenocarcinomatous deposits from gastrointestinal tract. Conclusion: Bone marrow metastases by non-hematopoietic neoplasms can be the first presenting feature in many cases as seen in our study. So, performing a trephine biopsy routinely along with aspiration for any unexplained cytopenias is of paramount importance in clinching the primary diagnosis.

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