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Sun H, Zeng GH, Xiong Y. Hidden in the mediastinum: a case of extramedullary hematopoiesis unveiled through thoracoscopy. J Int Med Res 2024; 52:3000605231221088. [PMID: 38190843 PMCID: PMC10775723 DOI: 10.1177/03000605231221088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
Extramedullary hematopoiesis (EMH) is a rare condition characterized by proliferation of hematopoietic stem cells outside the bone marrow, usually as a compensatory response to hematological disease. Although EMH primarily occurs in the liver and spleen, it can manifest in atypical locations, such as the mediastinum. We herein describe an asymptomatic 66-year-old man with incidentally discovered posterior mediastinal EMH. A 28- × 32-mm mass was detected during a routine examination. Laboratory findings were within normal limits. Computed tomography revealed a well-defined enhancing mass with a density of 60 Hounsfield units, suggestive of a neurogenic tumor. Surgical resection confirmed EMH, characterized by megakaryocytes and hematopoietic precursors. The patient recovered smoothly and was discharged 5 days postoperatively. Accurate preoperative diagnosis of EMH is challenging, as illustrated by this case. Although typically associated with anemia or hematological abnormalities, EMH can present without such signs. Surgical resection and histopathological examination are essential for diagnosis. This case emphasizes the diagnostic complexity of posterior mediastinal EMH, even in patients without overt hematological disorders. Posterior mediastinal EMH is exceedingly rare and diagnostically demanding. A high index of suspicion and histological tissue analysis are crucial for optimal management. Video-assisted thoracoscopic surgery enables both diagnosis and treatment through mass excision.
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Affiliation(s)
- Hui Sun
- Department of Thoracic Surgery, Ganzhou People’s Hospital, Ganzhou Hospital Affiliated to Nanchang University, Ganzhou Hospital Affiliated to Nanfang Hospital of Southern Medical University, Ganzhou, China
| | - Gan Hua Zeng
- Department of Thoracic Surgery, Ganzhou People’s Hospital, Ganzhou Hospital Affiliated to Nanchang University, Ganzhou Hospital Affiliated to Nanfang Hospital of Southern Medical University, Ganzhou, China
| | - Yu Xiong
- Department of Thoracic Surgery, Ganzhou People’s Hospital, Ganzhou Hospital Affiliated to Nanchang University, Ganzhou Hospital Affiliated to Nanfang Hospital of Southern Medical University, Ganzhou, China
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2
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Fujimoto A, Hamaguchi S, Suzuki R. Case of Pulmonary Extramedullary Hematopoiesis Responding to Ruxolitinib. Leuk Res Rep 2022; 17:100290. [PMID: 35198370 PMCID: PMC8844769 DOI: 10.1016/j.lrr.2022.100290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/21/2021] [Accepted: 02/06/2022] [Indexed: 11/25/2022] Open
Abstract
We report a case of 43-year-old woman diagnosed with essential thrombocythemia in 1992. She was diagnosed with secondary myelofibrosis in 2011. Later, she suffered mild dyspnea, which gradually worsened. She was admitted to our hospital to evaluate the cause in 2014. Chest computed tomography showed ground-glass opacity (GGO) in the lungs. A lung biopsy revealed various hematopoietic cells, including abnormal megakaryocytes, infiltrating the alveolar septum, suggesting pulmonary extramedullary hematopoiesis. She was successfully treated by ruxolitinib and her disease is well controlled for more than 7 years. To keep this phenomenon in mind when see the patients with dyspnea is important.
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Affiliation(s)
- Ayumi Fujimoto
- Department of Hematology, Shimane University Hospital, Izumo, Japan
- Corresponding author: Department of Hematology, Shimane University Hospital, 89-1 En-ya cho, Izumo, Shimane 693-8501, Japan, Phone: (+81) 853-20-2517, Fax: (+81) 853-20-2525
| | - Shunichi Hamaguchi
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, Izumo, Japan
| | - Ritsuro Suzuki
- Department of Hematology, Shimane University Hospital, Izumo, Japan
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3
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Singh H, Kurman JS, Jani CT, Rao N, Benn BS. An 80-year-old woman with myelofibrosis and diffuse mosaic attenuation on chest computed tomography. Respir Med Case Rep 2022; 38:101705. [PMID: 35864977 PMCID: PMC9293942 DOI: 10.1016/j.rmcr.2022.101705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/01/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Harpreet Singh
- Department of Medicine, Division of Pulmonary and Critical Care, Medical College of, Wisconsin, Milwaukee, WI, USA
- Corresponding author. Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road Milwaukee, Wisconsin, USA.
| | - Jonathan S. Kurman
- Department of Medicine, Division of Pulmonary and Critical Care, Medical College of, Wisconsin, Milwaukee, WI, USA
| | - Chinmay T. Jani
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Nagarjun Rao
- Department of Pathology, Aurora Clinical Laboratories/Great Lakes Pathologists, Aurora West Allis Medical Center, West Allis, WI, USA
| | - Bryan S. Benn
- Department of Medicine, Division of Pulmonary and Critical Care, Medical College of, Wisconsin, Milwaukee, WI, USA
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4
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Chernak BJ, Rampal RK. Extramedullary hematopoiesis in myeloproliferative neoplasms: Pathophysiology and treatment strategies. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2021; 365:97-116. [PMID: 34756246 DOI: 10.1016/bs.ircmb.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Extramedullary hematopoiesis (EMH) is often a physiologic response to ineffective marrow production of hematologic cells. While this can be found incidentally in various physiologic and pathophysiologic states, the myeloproliferative neoplasms (MPNs) are some of the most common underlying conditions found in patients with EMH. Although this process can assist with hematologic production in defective states, the burden of EMH can lead to symptomatic discomfort and mechanical obstructive complications, most commonly in the spleen and liver. Here we describe the pathophysiology of EMH, treatment options, including medical, surgical and radiation-based approaches.
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Affiliation(s)
- Brian J Chernak
- Department of Leukemia, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Medicine, NewYork-Presbyterian Weill Cornell Medical Center, New York, NY, United States
| | - Raajit K Rampal
- Department of Leukemia, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
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5
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Khan NA, Ahuja KA, Wang X, Chaisson NF. Evaluation of hemodynamic parameters among patients with myeloproliferative neoplasms and suspected pulmonary hypertension. Leuk Lymphoma 2021; 62:1458-1465. [PMID: 33494630 DOI: 10.1080/10428194.2020.1864351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Myeloproliferative neoplasms (MPNs) are associated with pulmonary hypertension (PH). We studied MPN patients who underwent right-heart-catheterization (RHC) to identify hemodynamic differences between MPN-subtypes. Per RHC, hemodynamics were classified as pre, post or combined pre and post-capillary PH. One-way analysis-of-variance (ANOVA) was used to compare hemodynamic differences among MPN-subtypes. Correlation of RVSP between trans-thoracic echocardiography (TTE) and RHC was evaluated. We included 68 patients. Median age was 63. Fifty-nine percent were male and 87% Caucasian. Polycythemia vera and essential thrombocythemia were the most common subtypes. On TTE, 91.5% had PH. On RHC, only 29% met criteria for pre-capillary PH. No MPN-subtype was more likely than others to have pre-capillary PH. Bland-Altman analysis showed significant intra-person variability between TTE and RHC-derived right ventricular systolic pressures. Post-capillary involvement is more common than precapillary PH in MPN. Type of PH does not appear to differ by MPN-subtype.
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Affiliation(s)
- Nauman A Khan
- Department of Hospital Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Neal F Chaisson
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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6
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Tabares Calvache E, Tabares Calvache AD, Faulhaber GAM. Systematic review about etiologic association to the leukoerythroblastic reaction. Int J Lab Hematol 2020; 42:495-500. [PMID: 32562368 DOI: 10.1111/ijlh.13238] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Leukoerythroblastic reaction (LER) is characterized by the presence of immature erythroid cells and myeloid precursors (metamyelocytes, myelocytes, promyelocytes, myeloblasts, and blasts) as well as, exclusively in myelofibrotic disorders, teardrop cells in the peripheral blood (J Pathol Bacteriol, 42, 1936, 541; Semaine Med, 22, 1902, 373). Research on how to interpret LER and its meaning in clinical practice is scarce, and there is no consensus on the diagnostic criteria. We summarize the current evidence with the aim of clarifying the knowledge on this subject. METHODS We conducted a comprehensive search of the PubMed-MEDLINE, EMBASE and ELSEVIER databases, the Cochrane Library, Google Scholar, and medical journals to identify relevant papers. RESULTS Our search identified 425 papers, of which, 35 (11 trials and 24 case reports) ultimately met the inclusion criteria. These showed two principal groups of diseases associated with leukoerythroblastosis (LEB), corresponding to solid and hematological malignancies. The other etiologies, in order of frequency, were hemolytic diseases, infection, and others, while hemorrhage was only reported in the trials group. CONCLUSION The literature on LER is scarce and heterogeneous. The etiological factors of LER are diverse, and its presence in malignant disease is an indicator of disease progression and an adverse prognosis suggesting poor survival. In those cases where LER had neither hematological nor solid neoplasms, its manifestation, prognosis and its impact on our daily clinical practice are unknown.
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Karass M, Linder K, Agarwal A, Budhai A, Yusuf Y, Epelbaum O. A 54-year-old Woman with Myelofibrosis and Massive Hemothorax Due to Primary Extramedullary Hematopoiesis of the Pleura. Cureus 2018; 10:e3675. [PMID: 30761228 PMCID: PMC6367118 DOI: 10.7759/cureus.3675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Extramedullary hematopoiesis, which represents ectopic blood cell production, is usually an incidental finding accompanying hematologic pathology. The liver and spleen are the most common sites of extramedullary hematopoiesis, but thoracic involvement is likewise observed. Pleural effusions in the setting of intrathoracic extramedullary hematopoiesis have been attributed to mechanical interactions between the pleural surface and neighboring paravertebral masses consisting of hematopoietic tissue. Rupture of these highly vascularized lesions into the adjacent pleural space has been the putative mechanism in cases complicated by hemothorax. Histologically proven instances of islets of extramedullary hematopoiesis occurring on the pleural surface itself are exceedingly rare. Our case of a patient with myelofibrosis and massive pleural effusion is only the third such example described in the literature and the second to result in a confirmed hemothorax requiring surgery. As expected, technetium-99m sulfur (Tc-99m sulfur) colloid scanning accurately localized sites of extramedullary hematopoiesis in our patient, and there was a salutary response to radiation therapy.
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Affiliation(s)
- Michael Karass
- Internal Medicine, Westchester Medical Center, Valhalla, USA
| | | | - Anup Agarwal
- Internal Medicine, Westchester Medical Center, Valhalla, USA
| | | | - Yasmin Yusuf
- Pathology, Westchester Medical Center, Valhalla, USA
| | - Oleg Epelbaum
- Internal Medicine, Westchester Medical Center, Valhalla, USA
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8
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Complete response of pleural effusions caused by extramedullary hematopoiesis to low-dose, single fraction palliative radiation therapy: Case report and literature review. Adv Radiat Oncol 2018; 3:463-466. [PMID: 30202814 PMCID: PMC6128025 DOI: 10.1016/j.adro.2018.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/23/2018] [Accepted: 04/29/2018] [Indexed: 11/23/2022] Open
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9
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Yang M, Covington MF, Nguyen BD, Johnson GB, Mesa RA, Roarke MC. 99mTc-Sulfur Colloid Bone Marrow Scintigraphy in Diagnosis of Diffuse Pulmonary Extramedullary Hematopoiesis Secondary to Myelofibrosis. J Nucl Med Technol 2018; 46:368-372. [PMID: 29884685 DOI: 10.2967/jnmt.118.210534] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/31/2018] [Indexed: 11/16/2022] Open
Abstract
Our objective was to define the role of combined 99mTc-sulfur colloid bone marrow (SC BM) scintigraphy, SPECT or SPECT/CT, and chest CT in diagnosing diffuse pulmonary extramedullary hematopoiesis (PEMH) in patients with myelofibrosis. Methods: We retrospectively reviewed 99mTc-SC BM scintigraphy scans performed at our institution for the diagnosis of diffuse PEMH, as well as accompanying chest CT and SPECT/CT imaging findings. Relevant clinical information, including respiratory manifestations, pulmonary hypertension, and subjective response to whole-lung radiation therapy, was also summarized. Results: Twenty-two myelofibrosis patients with 27 99mTc-SC BM scintigraphy scans were diagnosed with diffuse PEMH. In 21 patients (95%) with accompanying chest CT and SPECT/CT scans, the most common CT findings were ground-glass opacity, interstitial infiltration, and pleural effusion. Of 20 patients (91%) who underwent 2-dimensional echocardiography studies, 12 (55%) were diagnosed with pulmonary hypertension. All 12 patients exhibited the aforementioned nonspecific CT imaging findings, with 8 (66%) of them presenting with respiratory symptoms, including dyspnea, shortness of breath, and cough. In the remaining 8 patients, without pulmonary hypertension, half had similar respiratory symptoms. Fourteen patients (64%) of this cohort received whole-lung radiation therapy, of whom 7 (50%) experienced symptom relief after therapy. Conclusion: Nonspecific respiratory symptoms should raise concern about pulmonary hypertension and diffuse PEMH in patients with advanced-stage myelofibrosis. Combined 99mTc-SC BM scintigraphy and SPECT/CT is a promising noninvasive imaging tool to diagnose this rare clinical entity.Key Words: hematology; respiratory; SPECT/CT; pulmonary hematopoiesis; Tc-99m sulfur colloid scintigraphy; myelofibrosis.
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Affiliation(s)
- Ming Yang
- Department of Radiology, Mayo Clinic in Arizona, Scottsdale, Arizona
| | - Matthew F Covington
- Mallinckrodt Institute Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Ba D Nguyen
- Department of Radiology, Mayo Clinic in Arizona, Scottsdale, Arizona
| | - Geoffrey B Johnson
- Department of Radiology, Mayo Clinic in Rochester, Rochester, Minnesota; and
| | - Ruben A Mesa
- Division of Hematology, Mays Cancer Center at UT Health San Antonio, MD Anderson Cancer Center, San Antonio, Texas
| | - Michael C Roarke
- Department of Radiology, Mayo Clinic in Arizona, Scottsdale, Arizona
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10
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Adir Y, Elia D, Harari S. Pulmonary hypertension in patients with chronic myeloproliferative disorders. Eur Respir Rev 2015; 24:400-10. [DOI: 10.1183/16000617.0041-2015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Pulmonary hypertension (PH) is a major complication of several haematological disorders. Chronic myeloproliferative diseases (CMPDs) associated with pulmonary hypertension have been included in group five of the clinical classification for pulmonary hypertension, corresponding to pulmonary hypertension for which the aetiology is unclear and/or multifactorial. The aim of this review is to discuss the epidemiology, pathogenic mechanism and treatment approaches of the more common forms of pulmonary hypertension in the context of CMPD's: chronic thromboembolic pulmonary hypertension, precapillary pulmonary hypertension and drug-induced PH.
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11
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Monga V, Silverman M. Pulmonary extramedullary hematopoiesis involving the pulmonary artery. Hematol Rep 2015; 7:5714. [PMID: 25852851 PMCID: PMC4378208 DOI: 10.4081/hr.2015.5714] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 02/09/2015] [Indexed: 11/23/2022] Open
Abstract
Extramedullary hematopoiesis (EMH) occurs as a complication of hematologic disorders such as myelofibrosis, sickle cell anemia and thalassemia. The extramedullary tissue usually involves liver, spleen and lymph nodes, less frequently the chest. We present a recent case of a man with myeloproliferative neoplasm who developed pulmonary hemorrhage secondary to EMH in the lung and pulmonary artery. Radiation therapy was considered the best approach, but it didn’t work and the patient died a week after radiation therapy was completed. We also review herein the present literature.
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Affiliation(s)
- Varun Monga
- Division of Hematology/Oncology and Bone Marrow Transplantation, University of Iowa Hospitals and Clinics , Iowa City, IA, USA
| | - Margarida Silverman
- Division of Hematology/Oncology and Bone Marrow Transplantation, University of Iowa Hospitals and Clinics , Iowa City, IA, USA
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12
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Cox JA, Sevak PR, Grumbles LL, Swanson TA, Hatch SS. Single-fraction radiotherapy for palliation of myelofibrosis-related extremity pain syndrome. J Pain Symptom Manage 2014; 48:299-304. [PMID: 24315514 DOI: 10.1016/j.jpainsymman.2013.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 09/04/2013] [Accepted: 09/10/2013] [Indexed: 12/12/2022]
Affiliation(s)
- John A Cox
- Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, Texas, USA; Department of Radiation Oncology, Indiana University, Indianapolis, Indiana, USA.
| | - Parag R Sevak
- School of Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Loretta L Grumbles
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Todd A Swanson
- Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Sandra S Hatch
- Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, Texas, USA
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13
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Maccaferri M, Leonardi G, Marasca R, Colaci E, Paolini A, Soci F, Forghieri F, Potenza L, Narni F, Luppi M. Ruxolitinib for pulmonary extramedullary hematopoiesis in myelofibrosis. Leuk Lymphoma 2013; 55:2207-8. [PMID: 24354678 DOI: 10.3109/10428194.2013.873538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Monica Maccaferri
- Department of Medical and Surgical Sciences, UNIMORE, UO-C Ematologia, AOU Policlinico , Modena , Italy
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14
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Abstract
World Health Organization (WHO) group 5 pulmonary hypertension (PH) entails a heterogeneous group of disorders that may cause PH by unclear and/or multiple mechanisms. In particular, group 5 includes PH caused by hematologic disorders, systemic diseases, metabolic disorders, chronic renal failure, and disorders leading to pulmonary vascular occlusion or compression. This article discusses common pathogenic mechanisms leading to group 5 PH, followed by a detailed overview of epidemiology, pathogenesis, and disease-specific management of the individual group 5 conditions. Off-label use of vasomodulatory therapies, typically indicated for pulmonary arterial hypertension (WHO group 1 PH), in group 5 conditions is also discussed.
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Affiliation(s)
- Tim Lahm
- Division of Pulmonary, Allergy, Critical Care, Occupational and Sleep Medicine, Department of Medicine, Richard L. Roudebush VA Medical Center, Center for Immunobiology, Indiana University School of Medicine, 980 West Walnut Street, Room C400, Indianapolis, IN 46202, USA.
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15
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Machado RF, Farber HW. Pulmonary hypertension associated with chronic hemolytic anemia and other blood disorders. Clin Chest Med 2013; 34:739-52. [PMID: 24267302 DOI: 10.1016/j.ccm.2013.08.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Pulmonary hypertension (PH) has emerged as a major complication of several hematologic disorders, including hemoglobinopathies, red cell membrane disorders, chronic myeloproliferative disorders, and splenectomy. With the exception of sickle cell disease, there are a limited number of studies systematically evaluating the prevalence of PH using the gold standard right heart catheterization in these disorders. The cause of the PH in patients with hematologic disorders is multifactorial, and a thorough diagnostic evaluation is essential. More importantly, there are virtually no high-quality data on the safety and efficacy of PH-targeted therapy in this patient population.
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Affiliation(s)
- Roberto F Machado
- Section of Pulmonary, Critical Care Medicine, Sleep and Allergy, Department of Medicine, Institute for Personalized Respiratory Medicine, University of Illinois at Chicago, 909 South Wolcott Avenue, M/C 719, Chicago, IL 60612, USA.
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16
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Trow TK, Argento AC, Rubinowitz AN, Decker R. A 71-year-old woman with myelofibrosis, hypoxemia, and pulmonary hypertension. Chest 2011; 138:1506-10. [PMID: 21138888 DOI: 10.1378/chest.10-0973] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Terence K Trow
- Yale Pulmonary Vascular Disease Program, Department of Internal Medicine, Section of Pulmonary and Critical Care, Yale University School of Medicine, New Haven, CT 06520-8057, USA.
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17
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Bajwa AA, Usman F, Wolfson D, Laos LF, Cury JD. A 62-year-old woman with dyspnea, leukocytosis, and diffuse ground-glass opacities. Chest 2010; 137:1470-3. [PMID: 20525659 DOI: 10.1378/chest.09-2602] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Abubakr A Bajwa
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida College of Medicine, 655 W 8th St, Jacksonville, FL 32209, USA.
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18
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Abstract
Extramedullary hematopoiesis (EMH) is the formation and development of blood cells outside of the bone marrow. Of particular interest to chest physicians and radiologists is the occurrence of EMH in the lungs and pleura. There have been several reports of patients presenting with pulmonary EMH published in the literature and the majority are due to a secondary process, such as myeloproliferative disorders, hemolytic anemias, hereditary spherocytosis, and Gaucher disease. We present a case report of pulmonary EMH and a review of the literature concentrating on the etiology, clinical presentation, pathophysiology, diagnosis, and therapy for this uncommon disorder.
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19
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Ozbudak IH, Shilo K, Hale S, Aguilera NS, Galvin JR, Franks TJ. Alveolar airspace and pulmonary artery involvement by extramedullary hematopoiesis: a unique manifestation of myelofibrosis. Arch Pathol Lab Med 2008; 132:99-103. [PMID: 18181682 DOI: 10.5858/2008-132-99-aaapai] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2007] [Indexed: 11/06/2022]
Abstract
Pulmonary extramedullary hematopoiesis is a rare manifestation of myelofibrosis. We encountered a unique case of pulmonary extramedullary hematopoiesis occurring in a 59-year-old white man, where in addition to the typical foci of interstitial hematopoietic cells, a surgical lung biopsy showed airspace and arterial wall involvement. Airspace foci were associated with acute and organizing alveolar hemorrhage, while within arteries the hematopoietic elements had a striking predilection for the vascular intima. The hematopoietic foci included erythroid precursors, myeloid precursors, and megakaryocytes, which were immunoreactive with hemoglobin, myeloperoxidase, and CD61, respectively. Whether extramedullary hematopoiesis represents in situ embryonic stem cell differentiation or a compensatory seeding of hematopoietic cells from the bone marrow remains to be elucidated. However, familiarity with these findings in the lung could be helpful in uncovering occult hematological disorders accompanied by extramedullary hematopoiesis. Extramedullary hematopoiesis should also be considered as a cause of pulmonary hemorrhage, especially in the setting of myelofibrosis.
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Affiliation(s)
- Irem H Ozbudak
- Department of Pathology, University of Akdeniz School of Medicine, Antalya, Turkey
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20
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Abstract
Pulmonary hypertension is a frequently encountered problem in older patients. True idiopathic pulmonary arterial hypertension can also be seen and requires careful exclusion in older patients. Institution of therapies must be tempered with an appreciation of individual comorbidities and functional limitations that may affect patients' ability to comply and benefit from the complex treatments available for pulmonary arterial hypertension. This article reviews the existing data on the various forms of pulmonary hypertension presenting in older patients and on appropriate therapy in this challenging population.
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Affiliation(s)
- John R McArdle
- Division of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Pulmonary Hypertension Center, Yale University School of Medicine, 333 Cedar Street, LCI 105D, P.O. Box 208057, New Haven, CT 06520-8057, USA.
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21
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22
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Jayaraman G, Desai A, Velamuri S, Lan C, Green L, Kesavan RB, Guntupalli K. AN UNUSUAL CAUSE OF INTERSTITIAL LUNG DISEASE. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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23
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Mesa RA, Barosi G, Cervantes F, Reilly JT, Tefferi A. Myelofibrosis with myeloid metaplasia: disease overview and non-transplant treatment options. Best Pract Res Clin Haematol 2006; 19:495-517. [PMID: 16781486 DOI: 10.1016/j.beha.2005.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Myelofibrosis with myeloid metaplasia (MMM) is currently classified as a classic (i.e. not yet molecularly defined) myeloproliferative disorder (MPD), along with essential thrombocythemia (ET) and polycythemia vera (PV). All three MPDs represent stem-cell-derived clonal myeloproliferation that, in the case of MMM, is accompanied by an intense bone marrow stromal reaction that includes collagen fibrosis, osteosclerosis, and angiogenesis. To date, both the molecular basis of the primary clonal process and the pathogenetic mechanisms that underlie the secondary histological changes remain elusive. Clinically, MMM is characterized by anemia, multi-organ extramedullary hematopoiesis that often involves the spleen and liver, constitutional symptoms, and premature death from either leukemic transformation or other disease complications. Current diagnosis is based on characteristic but not diagnostic bone marrow histological features. Modern therapy remains palliative but allogeneic stem cell transplantation might be curative to a selected group of patients. This chapter reviews both the old and the new therapy with regard to non-transplant treatment options for MMM.
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Affiliation(s)
- Ruben A Mesa
- Laboratory of Clinical Epidemiology, IRCCS Policlinico S. Matteo, Pavia, Italy.
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Rumi E, Passamonti F, Boveri E, De Amici M, Astori C, Braschi M, Castagnola C, Magrini U, Cazzola M, Lazzarino M. Dyspnea secondary to pulmonary hematopoiesis as presenting symptom of myelofibrosis with myeloid metaplasia. Am J Hematol 2006; 81:124-7. [PMID: 16432861 DOI: 10.1002/ajh.20509] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We report a case of a patient with myelofibrosis with myeloid metaplasia (MMM) who presented with progressive dyspnea of unexplained origin. Splenomegaly, blood smear, and bone marrow findings allowed diagnosis of MMM. High-resolution CT chest scan revealed diffuse septal thickening, while echocardiography and electrocardiogram showed no indirect evidence of pulmonary hypertension. Finally, lung biopsy revealed irregularly distributed interstitial fibrosis with islands of erythroblasts, immature granulocytic elements, and dysplastic megakaryocytes, allowing diagnosis of pulmonary extramedullary hematopoiesis (EMH). The patient received hydroxyurea as cytoreductive agent, obtaining a good hematologic response and an improvement of dyspnea. Note that, in this patient, dyspnea was the first clinical symptom of MMM; the dyspnea was not associated with pulmonary hypertension and improved following cytoreductive treatment. This case points to the importance of suspecting pulmonary EMH when unexplained progressive dyspnea occurs in a patient with MMM. Early recognition of pulmonary EMH may prevent PH and favor a better response to therapy.
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Affiliation(s)
- Elisa Rumi
- Division of Hematology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Tsao L, Siegel DS, Zeveloff S, Bhagat G, D'Agati VD, Markowitz GS. An Unusual Finding in the Renal Medulla. Am J Kidney Dis 2005; 46:780-6. [PMID: 16183437 DOI: 10.1053/j.ajkd.2005.04.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Accepted: 04/13/2005] [Indexed: 11/11/2022]
Affiliation(s)
- Lawrence Tsao
- Department of Pathology, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
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26
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Ziakas PD, Voulgarelis M, Felekouras E, Anagnostou D, Tzelepis GE. Myelofibrosis-associated massive splenomegaly: a cause of increased intra-abdominal pressure, pulmonary hypertension, and positional dyspnea. Am J Hematol 2005; 80:128-32. [PMID: 16184577 DOI: 10.1002/ajh.20388] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We describe a patient with myelofibrosis, giant splenomegaly, and pulmonary hypertension related to increased intra-abdominal pressure. Focusing on alterations in hemodynamic studies, we conclude that in patients with myelofibrosis, dyspnea, and hypoxemia, the measurement of intra-abdominal pressure should be included in the initial evaluation. It is an inexpensive, non-invasive diagnostic tool that can provide crucial information about the cause of dyspnea and disclose the pathogenetic link between massive splenomegaly and pulmonary compromise in myelofibrosis.
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Affiliation(s)
- Panayiotis D Ziakas
- University of Athens Medical School, Department of Pathophysiology, Athens, Greece
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Wong CC, Brown D, Howling SJ, Parker NE. Hydroxyurea-induced pneumonitis in a patient with chronic idiopathic myelofibrosis after prolonged drug exposure. Eur J Haematol 2003; 71:388-90. [PMID: 14667203 DOI: 10.1034/j.1600-0609.2003.00123.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We describe a 63-yr-old patient diagnosed with chronic idiopathic myelofibrosis whose disease was treated with hydroxyurea for 2 yr. He developed respiratory symptoms that were extensively investigated including lung biopsy. Clinical, radiological and histological features were compatible with a diagnosis of hydroxyurea-induced pneumonitis. Following drug withdrawal there was remarkable improvement in clinical and radiological findings.
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Affiliation(s)
- Chi C Wong
- Department of Haematology, The Whittington Hospital, London, UK.
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Koch CA, Li CY, Mesa RA, Tefferi A. Nonhepatosplenic extramedullary hematopoiesis: associated diseases, pathology, clinical course, and treatment. Mayo Clin Proc 2003; 78:1223-33. [PMID: 14531481 DOI: 10.4065/78.10.1223] [Citation(s) in RCA: 203] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To define associated clinical conditions, pathology, natural history, and treatment outcome of nonhepatosplenic extramedullary hematopoiesis (NHS-EMH). PATIENTS AND METHODS We retrospectively reviewed the medical charts of all patients identified as having NHS-EMH from 1975 to 2002. Diagnosis was made by tissue biopsy, fine-needle aspiration biopsy, or radionuclide bone marrow scanning. RESULTS We identified 27 patients with antemortem diagnosis of NHS-EMH. The most common associated condition and disease site were myelofibrosis with myeloid metaplasia (MMM) (in 18 patients [67%]) and the vertebral column (in 7 patients [26%]; all involving the thoracic region), respectively. At the time of diagnosis of NHS-EMH, concurrent splenic EMH (in 22 patients [82%]; 15 [56%] had undergone splenectomy) and red blood cell transfusion dependency (in 12 patients [44%]) were prevalent. Of the 27 patients, 9 (33%) required no specific therapy. Specific therapy was radiation (in 7 patients with a 71% response rate) and surgical excision (in 6 patients with a 67% response). Treatment-associated complications were limited to surgery. Radiation therapy was not used in the non-MMM group, but low-dose radiation therapy was used in the MMM group for paraspinal or intraspinal EMH (median dose, 1 Gy; range, 1-10 Gy), pleural or pulmonary disease (median dose, 1.25 Gy; range, 1.00-1.50 Gy), and abdominal or pelvic disease (median dose, 2.02 Gy; range, 150-4.50 Gy). Median survival after the diagnosis of NHS-EMH was 13 months in the MMM group and 21 months in the non-MMM group. CONCLUSIONS This retrospective study suggests that NHS-EMH is rare, is often associated with MMM, and preferentially affects the thoracic spinal region. Asymptomatic disease may require no specific treatment, whereas symptomatic disease is best managed with low-dose radiation therapy.
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Affiliation(s)
- Cody A Koch
- Mayo Medical School, Mayo Clinic, Rochester, Minn 55905, USA
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