Mielopatia infiltrativa por tumores não-hematológicos

Abstract

A infiltração de MO por tumores não-hematológicos tem sido descrita desde 1935 e, mais recentemente, desperta interesse da comunidade científica, pois inúmeros trabalhos têm relacionado a presença de células tumorais na MO com o processo de carcinogênese e a progressão tumoral. O presente estudo teve por objetivo o levantamento dos casos com diagnóstico de mielopatia infiltrativa por tumores nãohematológicos, provenientes da Faculdade de Medicina de Botucatu – UNESP e do Hospital Amaral Carvalho – Jaú, avaliados, retrospectivamente, no período de 1998 a 2008 (num universo de 15.191 coletas de MO). Incluímos 193 pacientes, dos quais 171 eram adultos e 22 crianças (idade ≤ 21 anos), com paridade entre os sexos (1:1) e mediana de idade de 55 anos. Foram analisados dados clínicos, diagnóstico e estadiamento do tumor primário, sítios de metástases, características laboratoriais (hemograma e marcadores tumorais séricos), características da MO, tratamento e a relação desses fatores com a sobrevida dos pacientes, através do programa de estatística SPSS®. Os resultados encontrados apontam que os tumores que mais frequentemente infiltraram a MO nos adultos foram: tumores de mama, próstata e sítio primário indeterminado, e neuroblastoma nas crianças. A análise da MO revelou positividade de 80% para mielograma e BMO, e presença de fibrose em 32% dos pacientes (40%, quando associados a áreas de necrose no mesmo material). Na avaliação hematológica observamos: anemia, alteração de leucócitos e plaquetopenia. Houve diferença, estatisticamente significante, com maior mediana de sobrevida global (p= 0,000) para pacientes do sexo feminino, portadores de adenocarcinoma de mama, em estádios iniciais e que receberam algum tipo de tratamento (quimio, radio e/ou hormonioterapia). Na análise de sobrevida, a partir do diagnóstico de mielopatia infiltrativa, houve...

Bone marrow (BM) infiltration by nonhematopoietic tumors has been described since 1935, and a increased number of papers about this topic have been published. Some of the studies have related the relationship between the presence of peripheral circulating tumors cells, bone marrow infiltration, carcinogenesis and tumor progression. This study has, as essential objective, the evaluation of infiltrative mielopathy by nonhematopoietic tumors from Faculdade de Medicina de Botucatu - UNESP and Hospital Amaral Carvalho – Jaú. Data were analised retrospectively from 1998 January to 2008 August (15.191 bone marrow samples). We have included 193 patients. One hundred seventy one were adults and 22 were children (considered age ≤ 21 years), with similar number of patients by gender, and median age 55 years. Medical records from the selected patients were analised, with focus on clinical aspects, primary site of tumor, initial stage, metastatic sites, hematologic and bone marrow features, treatment and the relationship between this data and survival. Results have demonstrated that most frequent solid tumors in adults were breast cancer, prostate cancer and undetermined primary site, and neuroblastoma among children. Bone marrow revealed infiltration in 80% of samples by myelogram and BM biopsy, and fibrosis in 32% (40% when associated with necrosis area). We observed anaemia, leukocyte alterations and thrombocytopenia as hematologic features. There were significant differences in global survival, wich was better among female patients, diagnosis of breast cancer, initial clinical stages and who has received any type of treatment (chemotherapy, radiotherapy and/or hormoniotherapy). When we analised survival since diagnosis of infiltrative mielopathy, adult patients with leucoeritroblastic reaction and trombocytopenia, and undetermined primary site tumors, melanoma or gastrointestinal tumors had... (Complete abstract click electronic access below)