Pathological diagnosis and characteristics of bone marrow metastasis of breast cancer
ZHANG Jiu-cun
MA Ai-ling
HAN Chao-yang
ZHANG Yu-ying
MA Li-qiong
LIANG Shuang
LI Xia
SHI Lei
Abstract：Objective To analyze the imaging,cytological,and histopathological features of breast cancer with bone marrow metastasis,providing reference for clinical diagnosis and treatment.Methods A retrospective analysis of one case of breast cancer with bone marrow metastasis was conducted,supplemented by a literature review.Imaging manifestations,immunophenotypic characteristics,consistency with the primary lesion,and bone marrow metastasis risks across different molecular subtypes of breast cancer were evaluated.Results CT scans revealed abnormal marrow density in the iliac bones,vertebrae,and femurs with preserved anatomical structures,intact bone cortices,absence of osteolytic/osteoblastic lesions,clear marrow-trabecular interfaces,and no abnormal mineralization zones.These imaging features aligned with early-stage metastatic tumor-induced marrow stromal remodeling.Bone marrow biopsy immunohistochemistry demonstrated ER(>90%,3+),PR(>80%,2+),HER2(1+),CK7(+),GATA-3(+),GCDFP-15(focal weak+),and Ki-67(10%),consistent with the primary tumor phenotype(Ki-67 30%)but with reduced Ki-67 index,suggesting suppressed proliferative activity in the bone marrow microenvironment.Bone marrow aspirate smears showed clusters of variably sized round cells with enlarged nuclei,vesicular chromatin,visible nucleoli,and basophilic cytoplasm containing vacuoles.Histopathology revealed atypical epithelial cells arranged in cords,nests,or trabeculae,accompanied by reduced hematopoiesis,fibrosis,and necrosis.Conclusion Diagnosis of breast cancer bone marrow metastasis relies on PET-CT/MRI imaging and pathological confirmation via bone marrow biopsy with immunohistochemistry.Aspirates typically exhibit dense sheets,nests,or cords of tumor cells with abundant pale/vacuolated cytoplasm and visible nucleoli,while biopsies confirm marrow stromal infiltration and hematopoietic suppression.Immunophenotypes generally match primary tumors,though reduced Ki-67 indices may reflect microenvironmental modulation.Clinicians should suspect bone marrow metastasis in breast cancer patients presenting with anemia,thrombocytopenia,and PET-CT-detected diffuse marrow hypermetabolism,warranting confirmatory aspiration and biopsy.|
Keywords：Breast cancerBone marrow metastasisCytomorphologyHistopathological biopsy
Publication Date：2025-05-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 560-564 )