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 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.
Lee
Jae-Lyun
JL
Department of Medicine, Yeungnam University College of Medicine, Daemyeong-dong, Nam-gu, Daegu 705-717, South Korea.
Lee
Jung-Hoon
JH
Kim
Min-Kyoung
MK
Cho
Hee Soon
HS
Bae
Young Kyung
YK
Cho
Kil Ho
KH
Bae
Sung Hwa
SH
Ryoo
Hun Mo
HM
Lee
Kyung Hee
KH
Hyun
Myung Soo
MS
D000368:Aged; D001853:Bone Marrow / Q000473:pathology*; D003110:Colonic Neoplasms / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D009336:Necrosis; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications* / Q000175:diagnosis / Q000473:pathology