A spindle cell tumor of unknown origin and diffuse bone marrow involvement in a patient with hypercalcemia.
BACKGROUND
Metastasis of unknown origin in bone marrow is infrequent, although, when it occurs, adenocarcinoma is the most common histologic type. Involvement of bone marrow by a spindle cell tumor and presentation with hypercalcemia are very rare.


METHODS
This report describes a 21-year-old man with diffuse bone marrow involvement from a spindle cell tumor.


RESULTS
The patient presented with low back pain, anemia, thrombocytopenia, azotemia, and hypercalcemia. Bone marrow biopsy revealed a spindle cell tumor that was positive for vimentin staining but whose primary site could not be identified. A bone marrow scan revealed absence of uptake, which suggested systemic disease. We treated this case as a type of sarcoma by giving combined chemotherapy consisting of vincristine, actinomycin-D and cyclophosphamide. The patient showed a clinical response for seven months, but the disease progressed despite chemotherapy and he died one year after diagnosis.


CONCLUSIONS
We have documented a rare case of spindle cell tumor involving bone marrow without evidence of the tumor's primary site.
Yim
J J
JJ
Department of Internal Medicine and Cancer Research Center, Seoul National University College of Medicine, Korea.
Kang
G H
GH
Heo
D S
DS
Kim
N K
NK
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D019046:Bone Marrow Neoplasms / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000556:secondary*; D002277:Carcinoma / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000556:secondary*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D017809:Fatal Outcome; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology*; D008297:Male; D009382:Neoplasms, Unknown Primary; D011877:Radionuclide Imaging; D013669:Technetium Tc 99m Medronate; D014750:Vincristine / Q000008:administration & dosage
D003609:Dactinomycin; D014750:Vincristine; C023568:technetium Tc 99m (Sn)methylenediphosphonate; D003520:Cyclophosphamide; D013669:Technetium Tc 99m Medronate