Double Hematological and Solid Malignancy Diagnosed from Bone Marrow Studies: Case Report, Laboratory View

A 63-year-old male patient was evaluated for cytopenia at King Abdullah Medical City Makkah Al-Mukaramah. Complete blood count and bone marrow studies including flowcytometry revealed acute myeloid leukaemia (AML) with dysplastic changes and according to the WHO criteria published in 2018, it was categorised as AML-M2 not otherwise specified. The patient received azacytidine as a sole line of therapy because of his age and general condition. Ten months later, serum ferritin and prolactin level were elevated and the cytopenia became more severe, prompting new bone marrow studies for proper evaluation. Bone marrow metastasis from the existing non-hematopoietic malignant tumour were detected. A diagnosis of metastasis from adenocarcinoma of the lung was made by immunohistochemistry which showed positivity for cytokeratin 7(CK7), pancytokeratin (CKAE1AE3) and thyroid transcription factor (TTF). Additionally, CEA and CA 19-9 were elevated. To the best of our knowledge, this is the first case of a dual diagnosis of an haematological and a solid tumour in a patient, originating from the Makkah area, Saudi Arabia to be published. Keeping in mind that the patient was treated with azacytidine therapy, which was not licensed for use until now, for the development of secondary malignancies. Further studies for evaluation of its effect are worthy.