This is most commonly seen with acute leukemia and in lymphomas involving the bone marrow but can be seen rarely with other tumors.
Clinical and laboratory features:
(1) bone pain
(2) fever
(3) fatigue
(4) anemia, leukopenia, thrombocytopenia (alone or as pancytopenia)
(5) leukoerythroblastic peripheral blood smear
(6) elevation of serum LDH and alkaline phosphatase (involving the bone fraction)
(7) hypercalcemia
Bone marrow biopsy shows (Tang et al):
(1) necrosis of the cells in the medullary spaces (usually absent in aplastic anemia)
(2) preservation of spicular architecture (not preserved in avascular necrosis)
(3) destruction of the reticular architecture (preserved in aplastic anemia)
Differential diagnosis - avascular necrosis (AVN) of bone:
(1) direct radiation and/or chemotherapy effect
(2) infection
(3) hypercoagulable state, including TTP and DIC
(4) transplant-related, including graft-vs-host disease
(5) vasculitis
(6) corticosteroids
(7) starvation related (including anorexia)
where:
• I am not sure if corticosteroids and hemoglobinopathies cause AVN, BMN or both.
The diagnosis of tumor-related stasis requires:
(1) appropriate clinical setting
(2) exclusion of the other causes
(3) pattern of necrosis in the bone marrow biopsy
