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Table 1 Clinical and cytopathological characteristics of patients

From: The bone marrow aspirate and biopsy in the diagnosis of unsuspected nonhematologic malignancy: A clinical study of 19 cases

No

Age/sex

Presenting symptoms/Onset of symptoms/Presence of constitutional symptoms

Performance status*/Physical findings

Cytological examination of peripheral blood

Cytological examination of bone marrow

Pathological examination of bone marrow

1

50/M

Back and chest pain/3 weeks/WL, F, NS

3/Pallor, subicterus

MAHA, LEB

Dilute, not optimal, not diagnostic

Adenocarcinoma with signet ring cell features (Suggestion: primary focus should be searched in GI tract)

2

40/M

Abdominal pain, failure to passage gas and stool by rectum, hematemesis/2 weeks/NS

3/Ecchymoses, tenderness in epigastrium and lower-right quadrant

MAHA, LEB

Dilute, not optimal, not diagnostic

Adenocarcinoma

3

41/F

Lumbar and extremity pain, lack of appetite, nausea/4 weeks/WL, F

3/Pain with deep palpation of whole abdomen

LEB, MAHA

Dilute, not optimal, not diagnostic

Adenocarcinoma

4

48/F

Lack of appetite, fatigue, nausea, vomiting, fever/2 months/F, WL

3/A few ecchymoses

LEB

Dry tap; touch preparation is not optimal for evaluation

Indifferentiated carcinoma (only CK positive strongly)

5

49/F

Dyspepsia, weakness/1 month/F

3/Pallor, multiple ecchymoses, axillary single microLAP

LEB

Dense foreign cell infiltration forming groups (adenocarcinoma)

Adenocarcinoma

6

71/M

Lumbar and leg pain, somnolence/20 days/-

4/Pallor, impaired consciousness, dysorientation, dyscooperation, agitation

LEB

Dry tap; imprint: highly dense atypical somewhat large round or oval cells infiltration in clusters

Atypical epithelial cells in clusters (round cells infiltration) (Suggestion: Primary focus should be investigated in lungs)

7

63/M

Cough, dysphagia, abdominal swelling, weakness, prominent loss in weight/WL, F, NS/1 month

2/Scleral icterus, 5 cm hepatomegaly, melana in rectal digital palpation

LEB

Epithelioid cells in solid clusters (small cell carcinoma infiltration)

Small cell carcinoma

8

57/F

Back, lumbar and leg pain, weakness, lack of appetite/3 months/WL

3/Scleral icter, left axillary 2 cm LAP

MAHA, LEB

Infiltration with signet ring cells

Metastatic carcinoma (signet ring cell adenocarcinoma)

9

45/M

Lumbar and leg pain, prominent loss in weight, generalized body pain/2 months/WL

3/Pallor;

LEB

Infiltration with atypical large epithelioid cells

Metastatic carcinoma (Suggestion: Primary tumor should be investigated in prostate)

10

25/F

Weakness, hip pain/6 months/ WL

2/Pallor, right inguinal 2 cm LAP, 1 cm hepatomegaly, 2 cm splenomegaly

Rare blastic cells

Infiltration with blastic cells with vacuolated cytoplasm (MPO negative; flow: B and T cell markers negative)

Higly dense atypical cells in alveolar structure-actin, desmin and vimentin positive, LCA and CK negative-(metastatic alveolar rhabdomyosarcoma)

11

35/M

Nausea, vomiting, prominent loss of weight, fatigue (alcohol, hashish and heroin dependence)/1 month/F, WL

4/Pallor, cachexia

MAHA

Adenocarcinoma cell forming groups

Metastatic adenocarcinoma

12

83/F

Prominent loss in weight, nausea, vomiting; backpain/6 months/WL

3/Pallor; multipl ecchymoses

MAHA, LEB

Infiltration with signet ring cell carcinoma cells

Metastatic adenocarcinoma (signet ring cell carcinoma metastasis)

13

61/F

Headache, sore throat, abdominal pain, constipation, nausea, vomiting (hematemesis and melana history), weakness/2 months/-

2/Pallor and scleral icterus, pain with palpation of right hypochondrium

LEB

Dry tap in first 2 attempts and very dilute without particle in 3rd attempt. No atypical cells; imprint: technically inadequate

Metastatic carcinoma (CK positive atypical epithelioid cell infiltration, some of them in signet ring cell shape)

14

75/M

Multiple ecchymoses on body and on extremities, purpura on lower extremities; hematuria/2 days/-

1/Ecchymoses and purpura; 1.5 cm supraclavicular LAP

Only minimal shift to left; no erythroblast or poikilocytosis

Non-hematopoetic cell infiltration forming groups and some with mucineous character

Metastatic adenocarcinoma (CK+ cells forming glandular and tubular structures

15

73/M

Confusion, adynamia/20 days/WL

4/Hypotension, hypothermia, dehydration, scleral icterus, pallor, cachexia, 2 cm hepatomegaly

Slight shift to left, toxic granulation, slight poikilocytosis, no erythroblast, no fragmentation

Dilute and not optimal but there are nonhematopoietic cells in small groups like adenocarcinoma cells

Nondiagnostic in first report but adenocarcinoma metastasis reported after meticulous examination of new further sections of blocks

16

75/F

Dyspnea, abdominal swelling/20 days/-

4/Rales bilaterally, 2 cm hepatomegaly, pretibial edema, petechia in lower extremities

LEB, no poikilositosis or fragmentation

Atypical non-haematopoetic cells (adenocarcinoma metastasis)

ND

17

68/M

Weakness, lack of appetite, prominent loss of weight, lumbar pain/3 months/WL

1/Enlargement and nodulation in prostate in digital examination

LEB, slight poikilocytosis, no fragmentation

Infiltration with adenocarcinoma cells showing acinar and tubular structures

Metastatic carcinoma compatible with prostate carcinoma (PSA +)

18

56/M

Pain in hips and legs, weakness/2 months/F, WL, SN

2/Pallor, cachexia, multiple microLAPs in servical, axillary and inguinal regions, a few petechiae and eccyhymoses

LEB, MAHA

Infiltration with atypical epithelioid cells forming papillar and acinar structures (adenocarcinoma metastasis)

CK + PAS- adenocarcinoma metastasis (Suggestion: Primary focus should be investigated in prostate)

19

45/M

Neck and hip pain, abdominal pain, weakness/ 1 month/WL

3/restriction in physical activity

LEB, MAHA

Infiltration with adenocarcinoma cells

Metastatic adenocarcinoma; CK+ epithelioid cells, some of them mucinous and in shape of signet cell (Suggestion: Primary focus should be investigated in stomach)

  1. *According to WHO/ECOG; WL: weight loss; F: fever; NS: night sweats; LAP: lymphadenopathy; MAHA: microangiopathic hemolytic anemia; LEB: leukoerythroblastosis; MPO: myeloperoxidase; CK: Cytokeratin LCA: leukocyte common antigen; ND: not done