A case of disseminated carcinomatosis of the bone marrow arising from endometrioid adenocarcinoma of the corpus uteri

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  • 播種性骨髄癌腫症を呈した子宮体癌の1例
  • 症例報告 播種性骨髄癌腫症を呈した子宮体癌の1例
  • ショウレイ ホウコク ハシュセイ コツズイ ガンシュショウ オ テイシタ シキュウタイ ガン ノ 1レイ

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Abstract

<p>Disseminated carcinomatosis of the bone marrow (DCBM) is a form of metastasis of the carcinoma to the bone marrow, which has a very poor prognosis. Gastric, breast, and prostate cancer are the most common causes of this syndrome, which can lead to disseminated intravascular coagulation, leukoerythroblastosis, and microangiopathic hemolytic anemia. Here we report a rare case of DCBM in association with endometrioid adenocarcinoma of the corpus uteri. A 72-year-old woman, gravida 4 para 3, was referred to our office with a uterine tumor. Transvaginal ultrasound and magnetic resonance imaging revealed a solid tumor with accompanying fluid collection in the corpus uteri. Aspiration biopsy led to a diagnosis of a grade 3 endometrioid adenocarcinoma, and computed tomography scans revealed multiple metastases to the lung and lymph nodes. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed for tumor reduction. The final diagnosis was grade 3 endometrioid adenocarcinoma with squamous differentiaton of the corpus uteri, StageIVB (pT2NXM1). Patient was followed up without chemotherapy because of concomitant Alzheimer’s disease. At one month after surgery bone marrow biopsy was performed because of acute elevation of serum lactate dehydrogenase (LDH), alkalinephosphatase (ALP), and D-dimer levels and thrombocytopenia. Microscopic bone marrow sections included cells resembling the endometrial stromal and epithelia cells, thus, the patient was diagnosed with DCBM. Despite the enlargement of lung and liver metastases, her family elected to continue the best available supportive care, and the patient died on postoperative day 55. DCBM has a poor prognosis, and established treatment approaches are lacking. In patients with acute elevation of serum LDH or ALP levels, thrombocytepenia, and multiple bone metastases, bone marrow biopsy might help in its diagnosis and facilitate earlier intervention. [Adv Obstet Gynecol, 69 (1) :13-20, 2017 (H29.2)]</p>

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