Aims. To study the etiology, diagnostic features, and clinical significance of myelonecrosis. Methods. A retrospective review of all trephine biopsies done over 12 years (January 2000 to December 2012) in Department of pathology was done and all trephine biopsies showing MN were identified and studied. Results. Twenty-five cases accounting for 0.4% were identified. Fever and generalized weakness were the common presenting symptoms. Anemia was seen in all cases followed by thrombocytopaenia. Malignancy was the underlying cause in 64% of cases; hematolymphoid malignancy was seen in two-thirds and solid malignancies in one-third of the cases. Tuberculosis accounted for 16% of the cases and the etiology was unknown in 12%. Conclusions. The causes of MN are varied and hematological malignancy and solid malignancies are the most common causes. Presence of myelonecrosis is associated with a poor prognosis. Myelonecrosis may obscure the underlying disorder and hence a thorough search in the bone marrow biopsy itself with the help of immunohistochemistry may prove worthwhile in identifying the underlying disease. 1. Introduction Myelonecrosis (MN) or bone marrow necrosis is a rare and unique clinicopathological entity. It is characterized by the necrosis of the medullary stroma and hematopoietic cells in large areas of bone marrow [1–3]. It is seen in the trephine biopsy as amorphous eosinophilic areas with poorly defined necrotic cells, which may or may not be accompanied by necrosis of the cortical bone [4]. Though it is usually described in autopsy reports, it is uncommonly seen in antemortem trephine biopsies also. The causes of MN are multiple, hematolymphoid malignancy and metastasis by solid tumors being the most common underlying etiology. In this study, the cases of MN were evaluated to study their etiology, diagnostic features, and clinical significance. 2. Materials and Methods This is a descriptive study; a retrospective review of all trephine biopsies done over 12 years (January 2000 to December 2012) in Department of pathology was done and all trephine biopsies showing MN were identified. Both antemortem and postmortem trephine biopsies were included in the study. Postmortem biopsies were done in cases where peripheral smear findings suggested hematological abnormality; however patients expired before a bone marrow could be done, so postmortem trephine biopsy was done as a part of minimally invasive autopsy procedure followed in the institute. Trephine biopsies showing extensive necrosis were included and cases showing granulomas with central
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