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Marrow Changes in Renal Osteodystrophy

View larger version (167K): [in this window] [in a new window]   Figure 1. 50 year old Black male with end stage renal disease requiring chronic dialysis, secondary hyperparathyroidism and anemia unresponsive to Epogen underwent a bone marrow examination for the evaluation of his anemia. His CBC included an H/H of 7.5/24, WBC of 6300/ul and a platelet count of 128,000/ul. The marrow aspirate was hypocellular with no spicules present. There were numerous large multinucleated cells with abundant granular cytoplasm, two of which are shown in this image.

View larger version (85K): [in this window] [in a new window]   Figure 2. The large multinucleated cell shown is an osteoclast. Note the distinct separate nuclei, all of which have a round contour. The granular cytoplasm is similar to that seen in a megakaryocyte but the latter is multi-lobated rather than multinuclear.

View larger version (152K): [in this window] [in a new window]   Figure 3. The bony changes present are those of osteitis fibrosa cystica due to secondary hyperparathyroidism and osteomalacia. There is prominent bone formation with extensive remodeling. Medullary marrow space has been replaced with fibrosis resulting in impaired hematopoiesis and subsequent pancytopenia. (H&E 10x)

View larger version (172K): [in this window] [in a new window]   Figure 4. The marked remodeling of the bone and paratrabecular fibrosis is more evident in the view. Normal hematopoietic elements are not recognizable. Three osteoclasts are visible within a lacunar space in the lower center of the image. Osteoblasts (large cells with a single nucleus) can be seen lining the trabeculae. (H&E 20x)

View larger version (173K): [in this window] [in a new window]   Figure 5. In this high power view two osteoclasts are noted in the left center of the image. Note the scalloping of the trabeculae and the presence of osteoblasts lining the trabecular borders. (H&E 40x)

View larger version (147K): [in this window] [in a new window]   Figure 6. The reticulin immunohistochemical stain confirms the extensive fibrosis present in the medullary spaces. (H&E 10x)

View larger version (169K): [in this window] [in a new window]   Figure 7. The fibrosis was graded 3 out of 4 in the view shown. (H&E 20x)

View larger version (168K): [in this window] [in a new window]   Figure 8. The heavy reticulin (collagen) strands are most evident in this view. (H&E 40x)

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This Article Figures Only Services Similar articles in this journal Alert me to new content in the Image Bank Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lazarchick, J. Search for Related Content PubMed Articles by Lazarchick, J. Related Collections Bone marrow manifestations of inflammatory or other systemic (non-infectious disease) Related ASH-SAP Chapter Related Image Bank Image Sets Social Bookmarking                   What's this?