6- A STUDY OF THE INCIDENCE OF BONE MARROW NECROSIS IN PRIMARY & SECONDARY MALIGNANT BONE TUMORS 32 ,
Basrah Journal of Surgery,
2009, Volume 15, Issue 1, Pages 32-42
AbstractDuring one year period, 21 newly diagnosed patients with different malignant bone tumors were
subjected to this study, 52.4% (11) of them were males & 47.6% (10) were females with a mean
age of 50.2 years. Detailed history & physical examination were taken including the age, sex,
the pathological type of the tumor, whether it is a primary or secondary & the site of the tumor,
the existence of bone pain, fever, weight loss, pallor, pathological fractures, neurological deficit,
any adjuvant treatment the patient had been put on, the existence of sickle cell disease, diabetes
mellitus and any history of a previous surgery. All cases were subjected to the following
tests: complete blood count (CBC) including the estimation of erythrocyte sedimentation rate
(ESR) & reticulocyte count, estimation of lactate dehydrogenase(LDH) & alkaline phosphatase
(ALP) enzymes & serum calcium. All cases were subjected to bone marrow examination including
both aspirate & trephine biopsy (with its touch imprint). Smears & sections were examined
thoroughly to assess marrow status with emphasis on the existence of bone marrow necrosis
Results showed that 19.1 % of cases had bone marrow necrosis. Their mean age was 50.25
years, with equal sex distribution, half of them had primary tumors, and 75 % of them had their
tumors situated in the spine. Clinically: all of them had weight loss, fever & bone pain while 75
% of them had pathological fractures. The mean values of the investigations done for them
were: Hb 94 g/L, PCV 0.29, reticulocyte count 2.43 %, WBCs 14.75 x 109/L. Peripheral blood
film for all showed leuco-erythroblastic picture. They showed an elevated mean serum LDH
(307.50 IU/L) & ALP (116.06 IU/L) levels.
Cases that showed no evidence of BMN constituted 80.9 % of total. They had a mean age of
5.15 years. 52.9 % were males while 47.1 % were females. Just more than half of cases (52.9
%) had primary while 47.1 % had secondary type of tumors & 47.05 % of them were located in
the spine. Clinically all of them had bone pain, 94.1 % had weight loss, 52.9 % pathological fractures,
29.4 % pallor & 23.5 % had fever. Their mean laboratory values were: Hb 108.1 g/L, PCV
0.33 %, reticulocyte count 1.36 %, WBCs 7.11 X 109/L, LDH 214.88 IU/L, ALP 83.48 IU/L.
Comparative study between cases with BMN & those without showed a significant relationship
between the following parameters & the presence of BMN at a level (p<0.05): fever, leukocytosis,
reticulocytosis, and high LDH levels. These results were comparable with some & contradicting
with other studies.
The paucity of studies in this field created difficulties to relate the results of this study to others,
especially in our Country. Further studies in the same field will probably clarify.
In conclusion, bone marrow necrosis, is not uncommon among primary & secondary malignant
bone tumors. It is associated with severe clinical-pathological features that may reflect a poor
outcome. Prolonged, follow up studies are in need to clarify this point.
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