Osteolytic lesions in myelofibrosis.

Bony pain in patients with a history of myelofibrosis warrants further investigation. Although skeletal involvement in myelofibrosis is more commonly osteosclerosis or periostitis, it can also cause osteolytic lesions.

We present the case of a 58‐year‐old female with a history of secondary myelofibrosis and stage IIIA Merkel cell carcinoma, presenting with worsening hip pain 1 year after diagnosis of Merkel cell carcinoma. Pelvic X‐ray revealed infiltrative lytic lesions throughout the pelvis and femora concerning metastasis, but it was unclear which malignancy was primary (Figure 1). Further evaluation with PET‐CT revealed multiple FDG‐avid lytic lesions not only in the pelvis and femora but also in the scapulae (Figure 2). Biopsy demonstrated no evidence for Merkel cell carcinoma but was positive for myeloproliferative neoplasm consistent with myelofibrosis. Our patient had type ‐1 CALR mutation, with a high‐risk dynamic IPSS score and high‐risk karyotype (del 5q, 17p). Eventually, the patient underwent matched related donor allogeneic stem cell transplant, and she died of relapse on day 94 post‐transplant.

FIGURE 1

X‐ray of the pelvis demonstrating lytic lesions (arrows) of the left ilium

FIGURE 2

PET‐CT of the pelvis demonstrating a lytic lesion (arrow) of the left iliac crest

Skeletal involvement in myelofibrosis more frequently presents as osteosclerosis or as periostitis. Lytic lesions, while rare, are possible. To date, there have been 3‐7 cases reported in the literature. Myelofibrosis‐associated lytic lesions have been described in both long and flat bones, and frequently present with bone pain. To our knowledge, this is the first description of such lytic lesions in the pelvis.

CONFLICT OF INTEREST

None declared.

AUTHOR CONTRIBUTIONS

IS: provided case information, references, and wrote the manuscript. HA: provided case information and clinical images.

ETHICAL APPROVAL

Standard ethical approval was obtained.

CONSENT STATMENT

Published with written consent of the patient.