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Correspondence
Bone marrow localisation of metastatic melanoma and synchronous leukaemic evolution of low-risk myelodysplastic syndrome
  1. Valeria Ferla1,
  2. Alessandra Freyrie1,
  3. Francesca Guidotti1,
  4. Emanuela Bonoldi2,
  5. Umberto Gianelli2,
  6. Agostino Cortelezzi1
  1. 1Haematology and Transplantation Unit, Department of Clinical Sciences and Community, University of Milan Medical School, IRCCS Ca’ Granda—Ospedale Maggiore Policlinico Foundation, Milano, Italy
  2. 2Pathology Unit, Department of Pathophysiology and Transplantation, University of Milan Medical School, IRCCS Ca’ Granda—Ospedale Maggiore Policlinico Foundation, Milano, Italy
  1. Correspondence to Dr Valeria Ferla, Haematology and Transplantation Unit, Department of Clinical Sciences and Community, University of Milan Medical School, IRCCS Ca’ Granda—Ospedale Maggiore Policlinico Foundation, Via F. Sforza 35, Milan 20122, Italy; vale.ferla{at}gmail.com

https://doi.org/10.1136/jclinpath-2012-200949

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    Myelodysplastic syndromes (MDS) are haematopoietic stem-cell disorders characterised by peripheral cytopenia, dysplastic haematopoiesis, and a substantial risk of progression into acute myeloid leukaemia (AML).

    We report a case of low-risk MDS, according to the international prognostic scoring systems (IPSS), which evolved into AML simultaneously to metastatic bone marrow localisation of malignant melanoma.

    Case report

    A 70-year-old man was diagnosed with myelodysplastic syndrome in 2006. He presented with complaints of weakness for a month. He referred arterial hypertension and myocardial infarction 3 years before, treated with coronary revascularisation. Blood analysis revealed mild macrocytic anaemia.

    Bone marrow biopsy and aspirate evaluation at diagnosis showed a slightly hypercellular marrow, with significant dysplasia in the erythroid lineage, less than 5% of CD34-positive haematopoietic precursors and absence of marrow fibrosis. Cytogenetic analysis showed normal karyotype. According to the updated WHO classification, a diagnosis of refractory anaemia was made, and he was stratified as low risk by means of IPSS scoring systems.1

    He was included in a clinical trial with thalidomide for 9 months, which was interrupted for inefficacy, worsening of anaemia and appearance of moderate neutropenia.

    At this point, in January 2007, he was referred to our centre presenting with bicytopenia in the peripheral blood. Bone marrow re-evaluation was consistent with refractory cytopenia with multilineage …

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    Footnotes

    • Contributors The case is presented in collaboration between two units of the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy. VF and UG designed the study. UG and EB evaluated bone marrow trephine biopsies, and performed double immunostaining. Clinical history and follow-up were documented by AC, AF, VF and FG. Main text body was written in conjunction by VF, UG, AF.

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.