A patient with carcinoma of the breast, who developed a clinical syndrome resembling agnogenic myeloid metaplasia, is described. She was found to have secondary myelofibrosis with metastatic carcinoma of the marrow, extensive extramedullary hematopoiesis resulting in massive splenomegaly, and leukoerythroblastosis. These findings are rare and myeloid metaplasia with striking extramedullary hematopoiesis causing massive splenomegaly and mimicking agnogenic myeloid metaplasia is seldom seen in patients with metastatic carcinoma. Previous case reports of secondary extramedullary hematopoiesis simulating agnogenic myeloid metaplasia (AMM) in patients with solid tumors are also reviewed.

Eighty consecutive cancer patients with severe pain, uncontrolled by conventional narcotic analgesics, received a 2-mg test dose of morphine epidurally. Thirty-four of them had significant pain relief and were thus selected to receive continuous treatment. This consisted of 2-6 mg of morphine administered every 8-24 hours through an indwelling epidural catheter. The duration of treatment was from 1 to 28 weeks with a median of 4 weeks. Twenty-five (76%) of the patients experienced complete relief of pain, while nine had only a partial analgesic response. Complications were minimal. No sepsis, hypotension, or respiratory depression occurred. It is recommended that cancer patients with intractable pain will be selected for continuous epidural analgesia by evaluating their response to a test dose of epidural morphine.