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A 65-year-old male with a h istory of pros tate cancer on hormonal therapy presen ts for evaluation of worsening fatigue and increasing bone pai n. Physical· examination reveals pallor and diffuse vertebral tenderness . Laboratory evaluation shows hemoglobin of 8.6 g/d l, leukocyte count of 22.600/,LLL. and platelet count of 58 .000/.uL. PSA is i ncreased 597 ng/ml. Peripheral blood smear is shown below. Bone marrow biopsy is obtained and reveals extensive replacement of the normal he-matopoietic elemen ts by an infiltrating process as shown below.
Bone marrow biopsy is obtained and reveals extensive replacement of the normal he-matopoietic elemen ts by an infiltrating process as shown below.
What is the most likely diagnosis?
- Myelophthisic anemia
- Anemia of chronic disease
- Aplastic anemia
- Androgen deficiency
- Autoimmune hemolytic anemia
Medicine
A. Myelophthisic anemia results from bone marrow involvement by a pathological process resulting in replacement of the normal hematopoietic elements by metastatic tumor cells, granulomas, or marrow fibrosis. Leukoerythoblastic anemia is associated with the diagnosis of progressive and metastatic to bone hormone refractory prostate cancer in up to 30% of cases. Immunohistochemical stain for prostate specific antigen (PSA) confirmed a diagnosis of metastatic prostate cancer in this patient. (Cancer. 1979;44(3):1009, Cancer. 1993;71(11):3594, Cancer. 1983;5 1(2):308).
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