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Japanese Journal of Clinical Oncology 2004 34(8):476-480; doi:10.1093/jjco/hyh082
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© 2004 Foundation for Promotion of Cancer Research

Case Report

A Case of Bone Marrow Necrosis with Thrombotic Thrombocytopenic Purpura as a Manifestation of Occult Colon Cancer

Jae-Lyun Lee1, Jung-Hoon Lee1, Min-Kyoung Kim1, Hee Soon Cho2, Young Kyung Bae3, Kil Ho Cho4, Sung Hwa Bae5, Hun Mo Ryoo5, Kyung Hee Lee1 and Myung Soo Hyun1

Department of 1 Medicine, 2 Laboratory Medicine, 3 Pathology 4 Diagnostic Radiology, Yeungnam University College of Medicine, Daegu 5 Department of Medicine, Daegu Catholic University College of Medicine, Daegu, South Korea

For reprints and all correspondence: Myung Soo Hyun, Department of Medicine, Yeungnam University College of Medicine, Daemyeong-dong, Nam-gu, Daegu, 705-717, South Korea. E-mail: hms{at}med.yu.ac.kr

Received March 2, 2004; accepted June 1, 2004

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.

Key Words: thrombotic thrombocytopenic purpura • bone marrow necrosis • colon cancer • microangiopathic hemolytic anemia


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