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Int J Clin Exp Pathol 2013;6(8):1677-1682

Case Report
Prominent gelatinous bone marrow transformation presenting prior to myelodysplastic
syndrome: a case report with review of the literature

Ryota Nakanishi, Mitsuaki Ishida, Keiko Hodohara, Takashi Yoshida, Miyuki Yoshii, Hiroko Okuno, Akiko Horinouchi, Muneo Iwai, Keiko
Yoshida, Akiko Kagotani, Hidetoshi Okabe

Department of Clinical Laboratory Medicine, Division of Diagnostic Pathology, Department of Hematology, Shiga University of Medical Science,
Shiga, Japan. These three authors contributed equally to this work.

Received June 25, 2013; Accepted July 11, 2013; Epub July 15, 2013; Published August 1, 2013

Abstract: Gelatinous bone marrow transformation (GMT) is a rare disorder characterized by the presence of fat cell atrophy, loss of
hematopoietic cells, and deposition of extracellular gelatinous materials. GMT is not a specific disease, but is strongly associated with
malnutrition and drugs. Albeit extremely rare, GMT has been reported in patients with myeloproliferative disorders. Herein, we report the second
documented case of hypoplastic myelodysplastic syndrome (MDS) accompanying GMT. A 73-year-old Japanese male with excellent nutrition
status and no history of alcohol or drug intake was detected with pancytopenia. The initial bone marrow aspirate specimen reveled hypocellular
marrow without dysplastic signs in the myeloid cells. Bone marrow biopsy demonstrated hypocellular bone marrow with prominent GMT. He
received blood transfusions, however, pancytopenia continued to progress. The second bone marrow aspirate specimen showed dysplastic
changes, such as pseudo-Pelger-Huët cells, hypogranular or agranular granulocytes, and megakaryocytes with multiple small nuclei.
Cytogenetic study demonstrated deletion of chromosome 7. Therefore, an ultimate diagnosis of hypoplastic MDS accompanying GMT was
made. Only a limited number of cases of myeloproliferative disorders with GMT have been reported. Our analysis of these cases revealed that
chromosome 7 abnormality is frequently observed in this condition. Moreover, findings from the current case suggested that myeloproliferative
disorders including MDS must be included in the differential diagnostic considerations of GMT patients, who have no history of malnutrition or
drugs, and careful examination of the bone marrow smear specimen and cytogenetic analysis are necessary for early detection of underlying
myeloproliferative disorders. (IJCEP1306027).

Keywords: Gelatinous bone marrow transformation, myelodysplastic syndrome, bone marrow

Address correspondence to: Dr. Mitsuaki Ishida, Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga
University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan. Phone: +81-77-548-2603; Fax: +81-77-548-2407; E-mail:
mitsuaki@belle.shiga-med.ac.jp