Introduction
Bone marrow necrosis (BMN), defined as the death of the medullary stroma
with preservation of the cortical bone, is a rarely reported finding in
the pediatric population. There are various etiologies for BMN including
medications, radiation, infection, autoimmunity, and sickle cell
disease. However, the vast majority (≈99%) are associated with
malignancies. BMN is encountered more frequently in adults, documented
in up to 5.6% of initial diagnostic acute leukemia bone marrow
specimens, and is associated with an inferior prognosis. BMN in the
pediatric population contributes to a challenging diagnostic process,
and its effect on cancer prognosis remains unknown. A prior review
described five cases of acute leukemia and two cases of neuroblastoma
related to BMN over a 10-year period. A separate review noted 12
patients with acute lymphoblastic leukemia (ALL) and concomitant BMN as
part of their initial presentation. In a 10-year retrospective review
performed at the University of Utah, we identified nine bone marrow
biopsies from six different pediatric patients with BMN, all associated
with malignancies.