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Bennett-Caso C, Srinath A, de la Roza G, Stock H, Damron TA. Extramedullary Hematopoiesis Adjacent to Vertebral Fracture in a Patient with Pernicious Anemia: Support for a Mechanical Extrusion Mechanism. JBJS Case Connect 2023; 13:01709767-202306000-00028. [PMID: 37172112 DOI: 10.2106/jbjs.cc.22.00716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
CASE A 68-year-old woman presented with a paraspinal mass of indeterminate imaging characteristics. Workup and computed tomography-guided Fine Needle Aspiration (FNA) aspiration revealed extramedullary hematopoiesis (EMH) adjacent to a prior compression fracture in the setting of pernicious anemia. CONCLUSION The combination of findings suggests a possible relationship of the compression fracture and the EMH because of traumatic extravasation of marrow contents, with the patient's underlying anemia possibly providing an underlying predisposition to EMH.
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Affiliation(s)
| | - Arjun Srinath
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Gustavo de la Roza
- Department of Orthopedics, SUNY Upstate Medical University, Syracuse, New York
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York
| | - Harlan Stock
- Department of Orthopedics, SUNY Upstate Medical University, Syracuse, New York
- Department of Radiology, SUNY Upstate Medical University, Syracuse, New York
| | - Timothy A Damron
- Department of Orthopedics, SUNY Upstate Medical University, Syracuse, New York
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Abbarh S, Al-Mashdali AF, Abdelrazek M, Gurusamy VM, Yassin MA. Recurrent spinal cord compression due to extramedullary hematopoiesis in thalassemia patient: Case report. Medicine (Baltimore) 2022; 101:e29334. [PMID: 35758362 PMCID: PMC9276436 DOI: 10.1097/md.0000000000029334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/01/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Spinal cord compression secondary to extramedullary hematopoiesis (EMH) is a rare condition. Variable treatment options have been reported with different efficacy and recurrence rate. Due to its rarity, no clear optimal management guidelines have been established yet. PATIENT CONCERNS AND DIAGNOSIS We report a recurrence of spinal cord compression secondary to EMH in a 19-year-old male, with a background of transfusion-dependent beta-thalassemia on luspatercept, who presented with weakness in both lower limbs. INTERVENTIONS AND OUTCOMES He was treated successfully both times with radiotherapy. CONCLUSION Early diagnosis and management of EMH compressing the spinal cord are essential to prevent permanent neurological damage. Diagnosis should be suspected based on the clinical presentation and magnetic resonance imaging findings in a patient with a history of ineffective hemopoiesis. Treatment option remains controversial. Radiotherapy option seems effective, even in recurrent cases, and valid, particularly for those at high risk of surgery or who do not prefer it.
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Affiliation(s)
- Shahem Abbarh
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Mohamed A. Yassin
- Hematology and Oncology Department, Hamad Medical Corporation, Doha, Qatar
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Tremblay D, Saberi S, Mascarenhas J, Schiano TD, Fiel MI. The Quantification and Significance of Extramedullary Hematopoiesis Seen on Liver Biopsy Specimens. Am J Clin Pathol 2022; 158:277-282. [PMID: 35511690 DOI: 10.1093/ajcp/aqac042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Extramedullary hematopoiesis (EMH) may occur in the liver and is often considered pathologic in adults. Many hematologic and nonhematologic disorders are associated with the development of EMH. However, it is unclear whether the presence of EMH is always pathologic. At present, no formal grading system for EMH in the liver exists. METHODS We reviewed 42 liver biopsy specimens with EMH and developed a novel grading system to quantify the degree of EMH from 1 to 3 based on the number of EMH foci in 10 high-power fields. RESULTS Most patients had nonhematologic conditions (n = 25). Seventeen patients had a hematologic condition, most frequently a myeloproliferative neoplasm (n = 9). Patients with an underlying hematologic condition had a significantly higher EMH grade compared with those without a hematologic condition (P < .0001). All patients with grade 3 EMH had an underlying hematologic diagnosis, and most (86%) patients with grade 1 EMH had a nonhematologic disorder. CONCLUSIONS Our data suggest that EMH grading in the liver is feasible and can identify patients who may have an underlying hematologic condition, which can guide further diagnostic workup.
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Affiliation(s)
- Douglas Tremblay
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, New York, NY, USA
| | - Shahram Saberi
- Department of Pathology, Molecular and Cell-Based Medicine, New York, NY, USA
| | - John Mascarenhas
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, New York, NY, USA
| | - Thomas D Schiano
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Isabel Fiel
- Department of Pathology, Molecular and Cell-Based Medicine, New York, NY, USA
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Trisolini R, Larghi A, Livi V, Paioli D, Cancellieri A. The bizarre appearance of intrathoracic extramedullary hematopoiesis during an endoscopic ultrasound examination. Endoscopy 2022; 54:E172-E173. [PMID: 33910255 DOI: 10.1055/a-1463-2527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Rocco Trisolini
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vanina Livi
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniela Paioli
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Extramedullary Hematopoiesis of the Liver and Spleen. J Clin Med 2021; 10:jcm10245831. [PMID: 34945127 PMCID: PMC8707658 DOI: 10.3390/jcm10245831] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 12/11/2022] Open
Abstract
Hematopoiesis is the formation of blood cellular components and, consequently, immune cells. In a more complete definition, this process refers to the formation, growth, maturation, and specialization of blood cells, from the hematopoietic stem cell, through the hematopoietic progenitor cells, to the s pecialized blood cells. This process is tightly regulated by several elements of the bone marrow microenvironment, such as growth factors, transcription factors, and cytokines. During embryonic and fetal development, hematopoiesis takes place in different organs: the yolk sac, the aorta–gonad mesonephros region, the lymph nodes, and not lastly, the fetal liver and the spleen. In the current review, we describe extramedullary hematopoiesis of the spleen and liver, with an emphasis on myeloproliferative conditions.
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Noguchi H, Higashi M, Desaki R, Tasaki T, Kirishima M, Kitazono I, Tabata K, Tanimoto A. Adult Hepatocellular Carcinoma Coexisting with Extramedullary Hematopoiesis. Int J Surg Pathol 2021; 30:339-345. [PMID: 34665056 DOI: 10.1177/10668969211050904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Extramedullary hematopoiesis (EMH) in adults usually occurs in the liver, spleen, and lymph nodes when bone marrow hematopoiesis fails. EMH has also been recognized in benign or malignant hepatic tumors, such as hepatoblastoma, hepatocellular adenoma, and vascular tumors. However, it is rarely encountered in hepatocellular carcinoma (HCC) in elderly adults, and the molecular mechanism of EMH in hepatic tumors remains unclear. We present a case of a 74-year-old man without any hematopoietic disorders and hepatitis viral infection who underwent hepatic resection for HCC. Histological examination revealed a well-differentiated HCC with trilineage hematopoiesis in the tumor and non-neoplastic liver. The coexistence of HCC and EMH in adult patients with no hematopoietic disorders is very rare and must be distinguished from poorly differentiated or dedifferentiated HCC and hepatoblastoma.
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Affiliation(s)
- Hirotsugu Noguchi
- 208512Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - Michiyo Higashi
- 208512Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - Ryo Desaki
- Tanegashima Medical Center, Kagoshima 891-3198, Japan
| | - Takashi Tasaki
- 208512Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - Mari Kirishima
- 208512Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - Ikumi Kitazono
- 208512Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - Kazuhiro Tabata
- 208512Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
| | - Akihide Tanimoto
- 208512Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan
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Liu J, Sui J, Sun D, Guo K, Gao Z, Bian J, Yan J, Wang L. Case Report: An Undefined Liver Lesion in a Young Man With Severe Aplastic Anemia: A Teachable Moment. Front Surg 2021; 8:665367. [PMID: 34336914 PMCID: PMC8317259 DOI: 10.3389/fsurg.2021.665367] [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] [Received: 02/08/2021] [Accepted: 05/21/2021] [Indexed: 11/20/2022] Open
Abstract
In this work, we reported a young man complaining of asthenia and intermittent fever for 10 days, and an ultrasound showed an undefined lesion on his liver. Facing the patient's situation with severe agranulocytosis, anemia, and thrombocytopenia, we passed through a tough diagnostic process for choosing an appropriate treatment for him with an ambiguous result of pathological biopsy. The undefined liver lesion was successfully solved by withdrawing the androgen for observation, without lobectomy. The lesion gradually diminished over 2 years of follow-up.
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Affiliation(s)
- Jin Liu
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jidong Sui
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Deguang Sun
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Kun Guo
- Department of Pathology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhenming Gao
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jie Bian
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jinsong Yan
- Department of Hematopathology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Liming Wang
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Kushwaha P, Singh M, Jain S, Neogi S. Extramedullary Hematopoiesis in Lymphangioma - A Cytological Study. J Cytol 2021; 38:109-110. [PMID: 34321780 PMCID: PMC8280854 DOI: 10.4103/joc.joc_206_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pritika Kushwaha
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Meeta Singh
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Shyama Jain
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Sujoy Neogi
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
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Boussaa H, Kaffel D, Maatallah K, Lassoued Ferjani H, Hamdi W. A rare cause of lumbar nerve root compression: Extramedullary hematopoiesis in a patient with thalassemia major. Clin Case Rep 2021; 9:e04119. [PMID: 34026159 PMCID: PMC8123554 DOI: 10.1002/ccr3.4119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/08/2022] Open
Abstract
Extramedullary hematopoiesis (EMH) can rarely involve the epidural space, leading to spinal cord compression syndrome. No treatment guidelines have been established yet.
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Affiliation(s)
- Hiba Boussaa
- University of Tunis El ManarFaculty of Medicine of TunisTunisia
- Department of RheumatologyMohamed Kassab Institute of OrthopedicsLa ManoubaTunisia
| | - Dhia Kaffel
- University of Tunis El ManarFaculty of Medicine of TunisTunisia
- Department of RheumatologyMohamed Kassab Institute of OrthopedicsLa ManoubaTunisia
| | - Kaouther Maatallah
- University of Tunis El ManarFaculty of Medicine of TunisTunisia
- Department of RheumatologyMohamed Kassab Institute of OrthopedicsLa ManoubaTunisia
| | - Hanene Lassoued Ferjani
- University of Tunis El ManarFaculty of Medicine of TunisTunisia
- Department of RheumatologyMohamed Kassab Institute of OrthopedicsLa ManoubaTunisia
| | - Wafa Hamdi
- University of Tunis El ManarFaculty of Medicine of TunisTunisia
- Department of RheumatologyMohamed Kassab Institute of OrthopedicsLa ManoubaTunisia
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Lentini M, Cardia R. Unusual pleomorphic cells in axillary lymph node. J Clin Pathol 2021; 74:jclinpath-2020-206782. [PMID: 33558395 DOI: 10.1136/jclinpath-2020-206782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 12/23/2020] [Accepted: 01/24/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Maria Lentini
- Department of Human Pathology of adult and developmental age, School of Medicine, University of Messina, Messina, Italy
| | - Roberta Cardia
- Department of Human Pathology of adult and developmental age, School of Medicine, University of Messina, Messina, Italy
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