|IMAGE IN HEMATOLOGY
|Year : 2015 | Volume
| Issue : 4 | Page : 181-182
Bone marrow metastasis from prostate cancer
Maher M Aljohani1, Ali Alahmari2, Abdullah A Alharbi3
1 Department of Pathology, College of Medicine, Taibah University, Madinah and Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
2 Adult Hematology/HSCT, Oncology Center, Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
3 Department of Pathology, College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
|Date of Web Publication||16-Dec-2015|
Maher M Aljohani
Department of Pathology, College of Medicine, Taibah University, Universities Street, P.O. Box 344, Madinah
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Aljohani MM, Alahmari A, Alharbi AA. Bone marrow metastasis from prostate cancer. J Appl Hematol 2015;6:181-2
A 56-year-old Saudi male known to have diabetes mellitus type 2 on metformin daily and hypertension on amlodipine 10 mg daily. He was referred from other hospital as a case of possible multiple myeloma with symptoms of generalized body pain and fatigability associated with bone pain and weight loss started 1 year before presentation to the that hospital. The investigations in referral hospital showed: White blood cell (WBC) = 15.3, hemoglobin (Hb) = 6 g/dl, platelet = 84, creatinine = 90 µmol/L, lactate dehydrogenase (LDH) = 799, Ca = 2.16 mmol/l, alkaline phosphatase (ALP) = 556, aspartate aminotransferase (AST) = 215, alanine transaminase (ALT) = 41, erythrocyte sedimentation rate = 100, and reporting that the peripheral blood film showed microcytic hypochromic anemia with Rouleaux formation. Radiological images including skeletal survey and computed tomography scan showed multiple lytic lesions. Bone marrow trephine biopsy reported a myelofibrosis.
This patient referred to our hospital as a case of multiple myeloma for further management including stem cell transplant. The patient was seen in adult hematology and bone marrow transplant outpatient clinic with the same complaints he was presented with in the referral hospital.
In our hospital, the investigations and work up are initiated immediately including multiple myeloma work up. Complete blood count; WBC = 7.9, Hb = 88 g/L, platelet = 123, Retic = 3.6%. Creatinine = 109 µmol/l, Ca = 2.16 mmol/L, uric acid = 447 µmol/l, albumin = 31 g/l, total protein = 72 g/l, beta 2-microglobulin = 5.17 mg/L, immunoglobulin (Ig) free light chain (FLC) kappa, lambda = 45.3 mg/L (3.30–19.40), 34, 6 mg/L (5.71–26.30). Kappa/lambda FLC ratio, serum = 1.3 (0.26–1.56). LDH = 325 U/L, ALT = 14 U/L, AST = 8.2 U/L, ALP = 772 U/L. Thyroid-stimulating hormone = 21.030 mU/L (0.27–4.2), FT4 = 9.7 pmol/L (12–22), and 24 h urine protein = 0.10 g/day (0.04–0.15 g/day). IgG = 17.8 g/L, IgA = 3.35 g/L, and IgM = 0.73 g/L.
| peripheral Blood Examination|| |
It shows a moderate normocytic normochromic anemia, some teardrop cells, a marked polychromasia, and many nucleated red blood cell. The mild thrombocytopenia is confirmed. WBCs show a left shifted granulocytic cells and some atypical lymphocytes. These findings are consistent with a leukoerythroblastic blood picture [Figure 1].
Radiological imaging work up for multiple myeloma by skeletal survey revealed heterogeneous bone density with diffuse innumerable lytic lesions involving the axial and appendicular skeleton, worrisome for multiple myeloma [Figure 2].
Bone marrow assessment by trephine biopsy and aspiration showed these findings: Bone marrow aspirate is hypercellular and shows a marked clustering of abnormal looking cells. Frequent osteoblasts are seen. All hematopoietic elements are suppressed. No increase in plasma cells is noticed. Trephine biopsy is adequate and shows large area of fibrosis, suppression of all hematopoietic elements, and areas with hypercellularity and frequent infiltrations by atypical nonhemopoietic cells, and some preserved normal hemopoietic cells are shown in [Figure 3].
Immunohistochemical stain reveals that the infiltrating cells are positive for prostate-specific antigen (PSA) (strong) [Figure 4], negative for CD45 and cytokeratin, synaptophysin, ITF-1, and CDX-2.
Bone marrow opinion: the bone marrow shows an infiltration by an adenocarcinoma, most likely of prostatic origin.
After bone marrow findings, PSA level was send, PSA > 5000.0000 µg/L (reference; <3.100 µg/L).
Positron emission tomography scan shows a moderate intensity of fludeoxyglucose uptake by prostate tumor with involved locoregional nodes and extensive skeletal metastases. Magnetic resonance imaging of the head shows a very extensive bony metastasis.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]