Bone marrow - nonneoplastic
Benign changes
Gelatinous transformation

Author: Xiangrong (Alex) Zhao, M.D., Ph.D. (see Authors page)

Revised: 10 July 2017, last major update August 2013

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PubMed Search: Gelatinous transformation[title] bone marrow

Cite this page: Gelatinous transformation. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bonemarrowseroustransformation.html. Accessed December 16th, 2017.
Definition / general
  • Rare disorder of unknown pathogenesis, characterized by fat cell atrophy, focal loss of hematopoietic cells, deposition of extracellular gelatinous substances which are mucopolysacchrides rich in hyaluronic acid and lacking chondrotin sulphate (Am J Surg Pathol 2000;24:56)
Terminology
Epidemiology
Pathophysiology
  • Exact pathogenic mechanism unknown
  • Deposition of seromucinous, gelatinous, hyaluronic acid rich material in bone marrow stroma
  • Associated with hematopoietic atrophy, which may be due to nonsupportive marrow microenvironment and inadequate hematopoietic substrate availability
  • May be reversible if underlying disorder is eliminated
Etiology
Clinical features
  • Usually malnutrition secondary to anorexia nervosa (Am J Clin Pathol 2002;118:582, Nouv Rev Fr Hematol 1994;36:S85) or starvation but also:
  • Infectious: bacterial enteritis, bronchopneumonia, enteric fever, septicemia, toxoplasma, tuberculosis, viral encephalitis or enteritis
  • Nutritional: protein calorie malnutrition, iron deficiency, folic / B12 deficiency
  • Hematological: aplastic anemia, bone marrow suppression
  • Malignancy: leukemia, lymphoma, metastasis
  • Miscellaneous: chronic obstructive airway disease, dilated cardiomyopathy, gouty nephropathy, grand mal seizures, Henoch Schönlein purpura, idiopathic thrombocytopenic purpura, ventricular septal defect (J Assoc Physicians India 2003;51:585)
Diagnosis
  • Bone marrow core biopsy with microscopic examination in correlation with clinical presentations
  • Radiologic studies may reveal focal lesions while the findings are usually nonspecific
Laboratory
  • Common nonspecific findings include those associated with malnutrition: anemia (Indian J Pathol Microbiol 2005;48:1), deficiency in trace elements or vitamins
  • Further laboratory workups are specific to underlying disorders
Radiology description
Treatment
  • Specific to underlying triggering conditions
Microscopic (histologic) description
  • Focal hypoplasia of fat cells and hematopoietic cells
  • Accumulation of extracellular gelatinous substances that appear as pink purple material on Romanowsky stained bone marrow preparation
Microscopic (histologic) images

Images hosted on other servers:

Prominent gelatinous transformation

Serous atrophy

Various images

Positive stains
  • Alcian blue (pH 2.5), PAS (Periodic Acid Schiff)
  • Pink purple on Romanowsky stain
Electron microscopy description
Differential diagnosis
  • Amyloidosis: Congo Red+, apple green birefringence on examination with polarized light
  • Changes at previous biopsy site: lack of adipose tissue and hematopoietic cells; granulation tissue and new bone formation present, e.g. osteoblasts seen along the endosteal surfaces
  • Marrow necrosis: see Cancer 2000;88:1769