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Yun, Shin, Bo, Kim, Cho, Shin, Suh, and Ryang: Laboratory Evaluation of Bone Marrow Metastasis – Single Institute Study –
Original Article

Korean J Leg Med 2007;27(2):96-101.

Published online: 10 February 2007

DOI: https://doi.org/10.3343/kjlm.2007.27.2.96

Laboratory Evaluation of Bone Marrow Metastasis – Single Institute Study –

Hyeong-Kee Yun, M.D.1, Myung-Geun Shin, M.D.1, Ding Bo, M.D.2, Da-Woon Kim, M.D.1, Duck Cho, M.D.1, Jong-Hee Shin, M.D.1, Soon-Pal Suh, M.D.1, Dong-Wook Ryang, M.D.1

1Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea

2Chonnam National University Hwasun Hospital and Brain Korea 21 Project, Center for Biomedical Human Resources at Chonnam National University in 2006, Gwangju, Korea

Received 1 December 2006       Revised 7 February 2007       Accepted 10 February 2007

Copyright © 2007 The Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The incidence of bone marrow (BM) metastasis might be related with the occurrence of malignant tumors in ethnic groups. So, we investigated the type and the frequency of metastatic tumors of BM and analyzed the clinicopathologic variables of BM metastasis.

Methods

This study included 932 cases of primary malignant tumor which were requested for BM study from January 1995 to June 2006 in Chonnam National University Hospital and Chonnam National University Hwasun Hospital. Peripheral blood smears (PBS); aspirates, touch prints, and trephine biopsies of BM; and medical records including other laboratory test results were reviewed.

Results

Overall frequency of BM metastasis was 11.9% (111/932). Primary tumors with BM involvement in children comprised neuroblastoma (74.1%), rhabdomyosarcoma (7.4%), and malignant lymphoma (7.4%). For adult patients, they consisted of malignant lymphoma (56.0%), gastrointestinal cancer (20.2%), and lung cancer (6.0%). In the case of malignant lymphoma, diffuse large cell lymphoma was the most frequent one. Laboratory findings of patients with BM metastasis commonly showed anemia and thrombocytopenia; in addition, serum LD, ALP, AST and ALT were elevated in 81.5% (75/92), 63.4% (59/93), 63.5% (61/96) and 33.3% (32/96), respectively. Leukoerythroblastosis was observed only in 19.8% (22/111) on PBS examination.

Conclusions

The most common non-hematopoietic metastatic tumor was neuroblastoma in children and gastrointestinal tumors in adults. Leukoerythroblastosis, anemia, and the elevation of serum LD, ALP, and AST were useful markers for the prediction of BM metastasis.

Keywords: Bone marrow, Metastasis, Malignant tumor

References

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Table 1.
Annual incidence of bone marrow metastasis
Year N of total BM biopsy N of BM biopsy with malignant tumor N of BM invasion Percent (%)
1995 622 40 8 20.0
1996 736 14 4 28.5
1997 645 61 13 21.3
1998 683 52 11 21.1
1999 781 95 11 11.6
2000 693 67 5 7.4
2001 826 81 8 9.8
2002 900 104 5 4.8
2003 1,053 89 16 17.9
2004 1,025 74 11 14.8
2005 1,245 164 13 7.9
2006* 700 91 6 6.5
Total 9,909 932 111 11.9

* 2006. 1. 1–2006. 6. 30.

Abbreviation: BM, bone marrow.

Table 2.
Age and sex distribution of patients with bone marrow metastasis
Age (yr) Sex
 Total (%)
Male Female
<1 2 0 2 (1.8)
1–10 13 9 22 (19.8)
11–20   1 5 (4.5)
21–30 3 2 5 (4.5)
31–40 3 5 8 (7.2)
41–50 8 7 15 (13.5)
51–60 12 8 20 (18.0)
61–70 19 7 26 (23.4)
71- 6 2 8 (7.2)
Total (%) 70 (63.0) 41 (37.0) 111 (100.0)
Table 3.
Hematologic tests of patients with bone marrow metastasis
Test Range N (%)
Hemoglobin (g/dL)    
2–6 M <9.0 1 (50.0)
  9.0–14.0 1 (50.0)
6 M-6 yr <10.5 15 (88.2)
  10.5–14.0 2 (11.8)
6–12 yr <11.0 1 (50.0)
  11.0–16.0 1 (50.0)
>12 yr    
Male <14.0 45 (95.7)
  14.0–18.0 2 (4.3)
Female <12.0 29 (90.6)
  12.0–16.0 3 (9.4)
WBC count (/μL) <4,500 21 (21.0)
  4,500–11,000 60 (60.0)
  11,000–50,000 18 (18.0)
  >50,000 1 (1.0)
Platelet count (× 103/μL) <50 22 (22.0)
  50–100 17 (17.0)
  100–150 12 (12.0)
  150–400 46 (46.0)
  >400 3 (3.0)
MCV (fL) <80 16 (16.6)
  80–100 78 (81.3)
  >100 2 (2.1)
MCH (pg) <26 11 (11.4)
  26–34 79 (82.3)
  >34 6 (6.3)

Abbreviation: M, months.

Table 4.
Clinical chemistry tests of patients with bone marrow metastasis
Test Range N (%) Total range
LD (U/L) <500 17 (18.5) 158–10,220
  >500 75 (81.5)  
ALP (IU/L) 20–130 34 (36.6) 55–5,424
  >130 59 (63.4)  
AST (IU/L) <8 1 (1.1) 6–415
  8–33 34 (35.4)  
  >33 61 (63.5)  
ALT (IU/L) <4 1 (1.1) 3–220
  4–36 63 (65.6)  
  >36 32 (33.3)  
BUN (mg/dL) <8 13 (13.5) 3.6–52.5
  8–23 68 (70.8)  
  >23 15 (15.7)  
Creatinine (mg/dL) ≤2 yr      
  0.3–0.6 6 (85.7) 0.3–1.0
  >0.6 1 (14.3)  
>2 yr <0.6 16 (17.9) 0.3–2.2
  0.6–1.2 66 (74.1)  
  >1.2 7 (8.0)  
Uric acid (mg/dL) <2.7 16 (18.4) 1.2–40
  2.7–8.5 66 (75.9)  
  >8.5 5 (5.7)  
Table 5.
Primary tumors and leukoerythroblastosis with bone marrow metastasis
Primary tumor Under 15 yr of age (%) Over 15 yr of age (%) Leukoerythroblastosis (%) N of case (%)
Malignant lymphoma 2 (7.4) 47 (56.0) 3 (6.1) 49 (44.1)
Diffuse large B-cell lymphoma 1 (3.7) 25 (29.8) 2 (7.7) 26 (23.4)
Marginal zone B-cell lymphoma 0 1 (1.2) 0 1 (0.9)
Extranodal NK/T cell lymphoma 0 2 (2.9) 0 2 (1.8)
Peripheral T-cell lymphoma 0 4 (4.8) 0 4 (3.6)
Angioimmunoblastic T-cell lymphoma 0 3 (3.6) 0 3 (2.7)
Follicular lymphoma 0 2 (2.9) 0 2 (1.8)
Hodgkin lymphoma 0 3 (3.6) 1 (33.3) 3 (2.7)
Mantle cell lymphoma 0 1 (1.2) 0 1 (0.9)
Precursor T lymphoblastic lymphoma 0 1 (1.2) 0 1 (0.9)
Lymphoma, NOS 1 (3.7) 5 (5.9) 0 6 (5.4)
Gastrointestinal cancer 0 17 (20.2) 7 (41.1) 17 (15.3)
Neuroectodermal tumor 1 (3.7) 0 0 1 (0.9)
Rhabdomyosarcoma 2 (7.4) 0 1 (50.0) 2 (1.8)
Neuroblastoma 20 (74.1) 0 3 (15.0) 20 (18.0)
Breast cancer 0 1 (1.2) 0 1 (0.9)
Lung cancer 0 5 (6.0) 1 (20.0) 5 (4.5)
Thymic cancer 1 (3.7) 1 (1.2) 1 (50.0) 2 (1.8)
Prostate cancer 0 2 (2.4) 1 (50.0) 2 (1.8)
Medulloblastoma 0 1 (1.2) 0 1 (0.9)
Squamous cell carcinoma of oral cavity 0 1 (1.2) 1 (100.0) 1 (0.9)
Unknown 1 (3.7) 9 (10.7) 4 (40.0) 10 (9.0)
Total (%) 27 (24.3) 84 (75.7) 22 (19.8) 111 (100.0)
Table 6.
Detection rate of metastatic tumors in bone marrow examination
  Diagnostic method
 N of case (%)
Aspiration smear Touch print Biopsy
  +     16 (14.4)
    +   3 (2.7)
      + 8 (7.2)
  + +   12 (10.8)
  +   + 4 (3.6)
    + + 1 (0.9)
  + + + 67 (60.4)
Total 89.2% 74.8% 72.1% 111
  (99/111) (83/111) (80/111)  
Table 7.
Comparison of primary sites of bone marrow metastatic tumors between present and previous studies
Byun et al.[10] (1985–1990) (70 cases)
 Present study (1995–2006) (111 cases)
Child* (17 cases)
 Adult† (53 cases)
 Child* (27 cases)
 Adult† (84 cases)
Lymphoma 47% GI tract cancer 38% Neuroblastoma 74% Lymphoma 56%
Neuroblastoma 41% Lymphoma 32% Lymphoma 7% GI tract cancer 20%
Rhabdomyosarcoma 6% Lung cancer 13% Rhabdomyosarcoma 7% Lung cancer 6%
Unknown 6% Breast cancer 2% Unknown 4% Prostate cancer 2%
    Unknown 11%     Unkown 11%

* less than 15 yr old;

† more than 15 yr old.

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