Tumor Metastases in Bone Marrow

Abstract

T HE NOTORIOUS tendency of some tumors to metastasize by way of the i)lOOd stream and lodge in the hone marrow has been discussed in a pre-vious communication dealing with carcinomas arising from the prostate glandl.1#{176} Individuals who have fever, pain, weight loss, etc., d!ue to widespread neoplastic disease before there are local signs or symptoms of tumor growth usually present difficult diagnostic problems. Infiltration of the hone marrow with tumor tissue may lead to blood abnormalities such as progressive anemia, sometimes with immature granulocytes and nucleated red cells in the circulating blood, throm-bocytopenic purpura,’#{176} etc. Skeletal disease, another common result of 1)lood-borne metastases, may resemble primary bone tumor, multiple myeloma, hy-perparathyroidism,’7 lipoid granuloma, or Paget ‘s disease.4 The possibility of recognizing tumor cells in bone marrow aspirated from the sternum was first studied! in 1936 by Rohr and Hegglin)4 They found tumor cells in 11 of 75 patients with neoplastic disease. Many investigators were sub-sequently able to identify tumor implants in aspirated hone marrow.2 ‘ ii. 12. i821 After Henning5 suggested using hones other than the sternum and choosing the site for aspiration by the presence of tumor nodules, roentgen abnormalities or areas of bone pain, an even higher percentage of positive find-ings was obtained. The present study was undertaken (1) to ascertain the reliability and practical usefulness of hone marrow aspiration in the diagnosis of tumor metastases in a large series of patients, (2) to correlate the morphology of tumor cells if possible with the site of their origin, and (3) to study the role of marrow infiltration in producing the anemia commonly associated with neoplasm. One hundred and! fifty-two patients with tumors of different types were chosen for study (table 1). Many had tumors that had spread locally or were suspected of having metas-tasized. A considerable number were first seen as diagnostic problems. The technical procedures were those previously employed.’6