title: [Gelatinous transformation of the bone marrow: A retrospective monocentric case series of 12 patients].
abstract: OBJECTIVE
  Gelatinous bone marrow transformation is a rare complication of unknown pathogenesis related to several underlying diseases. It is described as a focal loss of hematopoietic cells and a deposition of eosinophilic gelatinous substance rich in hyaluronic acid. We report a retrospective monocentric study followed by a literature review.
  
  
  METHODS
  We have identified 12 patients with gelatinous transformation from 1999 to 2014. Clinical, biological and cytological data were collected.
  
  
  RESULTS
  A bone marrow aspirate was performed for mild to severe pancytopenia (50%), less frequently for monocytopenia. Mean haemoglobin was 10.4g/dL, platelets 126.9G/L and leucocytes 3.82G/L. Gelatinous transformation was found in all patients. We have identified three hematologic malignancies, three cancers, three severe infections, two anorexia nervosa and one kidney injury. Ten patients had undernutrition, 9 out of the 12 patients died within a year due to advanced underlying disease and comorbidities.
  
  
  CONCLUSIONS
  Gelatinous bone marrow transformation is found in various situations of severe undernutrition including anorexia nervosa, advanced cancers or severe sepsis, especially in HIV infection. The deposition of hyaluronic acid probably reduces haematopoiesis. Due to a complex inflammatory process, it alters the hematopoietic microenvironment and the bone marrow stroma. Severe undernutrition and other mechanisms are reviewed in this study. Gelatinous degeneration is still a rare disorder, indicative of an advanced underlying disease; its recognition could help guide investigations.
authors.affiliation: Service d'hématologie et thérapie cellulaire, hôpital Bretonneau, CHRU de Tours, 37000 Tours, France. Electronic address: alban.villate@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Villate
authors.affiliation: Laboratoire d'hématologie, CHR d'Orléans, 45100 Orléans, France.
authors.forename: S
authors.initials: S
authors.lastname: Iquel
authors.affiliation: Laboratoire d'hématologie, CHR d'Orléans, 45100 Orléans, France.
authors.forename: E
authors.initials: E
authors.lastname: Legac
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000473:pathology*; D001855:Bone Marrow Diseases / Q000209:etiology* / Q000378:metabolism; D002648:Child; D005260:Female; D005780:Gelatin; D006801:Humans; D006820:Hyaluronic Acid / Q000378:metabolism*; D008297:Male; D044342:Malnutrition / Q000150:complications; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D005780:Gelatin; D006820:Hyaluronic Acid
keywords: Atrophie séreuse; Bone marrow; Degeneration; Dégénérescence; Dénutrition; Gelatinous transformation; Moelle osseuse; Serous atrophy; Starvation; Transformation gélatineuse