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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