A Case of Bone Marrow Necrosis with Thrombotic Thrombocytopenic Purpura as a Manifestation of Occult Colon Cancer

Thrombotic thrombocytopenic purpura (TTP) is a disseminated form of thrombotic microangiopathy. Although most cases are held to be idiopathic, its association with malignancy is well recognized and it usually occurs at the terminal stage of cancer. Bone marrow necrosis (BMN) is another rare disorder...

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Bibliographic Details
Published in:Japanese journal of clinical oncology 2004-08, Vol.34 (8), p.476-480
Main Authors: Lee, Jae-Lyun, Lee, Jung-Hoon, Kim, Min-Kyoung, Cho, Hee Soon, Bae, Young Kyung, Cho, Kil Ho, Bae, Sung Hwa, Ryoo, Hun Mo, Lee, Kyung Hee, Hyun, Myung Soo
Format: Article
Language:English
Subjects:
Aged
Bone Marrow - pathology
bone marrow necrosis
colon cancer
Colonic Neoplasms - drug therapy
Colonic Neoplasms - etiology
Colonic Neoplasms - pathology
Diagnosis, Differential
Humans
Male
microangiopathic hemolytic anemia
Necrosis
Purpura, Thrombotic Thrombocytopenic - complications
Purpura, Thrombotic Thrombocytopenic - diagnosis
Purpura, Thrombotic Thrombocytopenic - pathology
thrombotic thrombocytopenic purpura
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Summary:Thrombotic thrombocytopenic purpura (TTP) is a disseminated form of thrombotic microangiopathy. Although most cases are held to be idiopathic, its association with malignancy is well recognized and it usually occurs at the terminal stage of cancer. Bone marrow necrosis (BMN) is another rare disorder defined pathologically as the necrosis of myeloid tissue and medullary stroma with preservation of bone. While hematologic malignancy is the most common underlying disease associated with BMN, it can also be caused by solid tumors. Neither TTP nor BMN associated with colon cancer has been reported. We describe here a patient with the rare association of TTP and BMN displayed as the first manifestation of an advanced colon cancer. The anemia and thrombocytopenia responded not to plasma exchange but to the combination chemotherapy. This case indicates that metastatic cancer should be included in the differential diagnosis of TTP and BMN, and that the chemotherapy may improve the detrimental clinical course.
ISSN:0368-2811
1465-3621
1465-3621
DOI:10.1093/jjco/hyh082