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Luo M, Chen JW, Xie CM. Magnetic resonance imaging features of intrahepatic extramedullary hematopoiesis: Three case reports. World J Clin Cases 2022; 10:6626-6635. [PMID: 35979290 PMCID: PMC9294877 DOI: 10.12998/wjcc.v10.i19.6626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/18/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Extramedullary hematopoiesis rarely occurs within the liver alone, and is easily misdiagnosed. The radiological literature on this disease is exclusively case reports. There is a paucity of literature on the role of magnetic resonance imaging (MRI). The most common imaging modalities used are computed tomography and ultrasound. This report aims to provide more data on the appearance of extramedullary hematopoiesis using MRI to help radiologists establish the diagnosis.
CASE SUMMARY Three patients (one male and two females) were incidentally found to have a hepatic mass or nodule, without hepatomegaly or splenomegaly. Laboratory tests including liver function, serum hepatic tumor markers, and hepatitis serologic markers were normal. On MRI scans, all lesions showed lower signal intensity on in-phase images than on out-phase images. One case showed changes in signal intensity on T2 weighted images (WI) and diffusion WI, which shifted from hyperintensity to hypointensity with size enlargement between two rounds of imaging examination. These lesions exhibited different enhancement patterns on dynamic contrast enhancement series.
CONCLUSION The MRI signal change and in-/out-phase image might provide useful information and help radiologists establish the diagnosis of intrahepatic extramedullary hematopoiesis.
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Affiliation(s)
- Ma Luo
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Jia-Wen Chen
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
| | - Chuan-Miao Xie
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
- State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong Province, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong Province, China
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2
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Rafiee F, Haseli S, Jafari SH, Iranpour P. Extramedullary haematopoiesis presenting as a periportal mass. BMJ Case Rep 2020; 13:13/7/e235064. [PMID: 32699056 DOI: 10.1136/bcr-2020-235064] [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: 11/03/2022] Open
Abstract
Extramedullary haematopoiesis (EMH) is defined as haematopoiesis occurring in organs outside the bone marrow. The liver is one of the rare sites of EMH, and to the best of our knowledge, a few cases of adult EMH of the liver have been reported in the last 20 years. Here, we reported the case of a 68-year-old man with a known history of myelofibrosis presented with vague abdominal pain. An abdominal CT scan showed a hypoattenuating periportal mass encasing the portal vein. The final diagnosis of EMH was made through the histopathological examination. This is a rare presentation of EMH, which may be easily mistaken for other pathologies such as metastases. Familiarity with this type of presentation aids in correctly diagnosing it in an appropriate clinical setting.
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Affiliation(s)
- Faranak Rafiee
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Sara Haseli
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran.,Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Seyed Hamed Jafari
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Pooya Iranpour
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
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3
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Functional integration of acute myeloid leukemia into the vascular niche. Leukemia 2014; 28:1978-1987. [PMID: 24637335 PMCID: PMC4167983 DOI: 10.1038/leu.2014.109] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/06/2014] [Accepted: 03/13/2014] [Indexed: 12/15/2022]
Abstract
Vascular endothelial cells are a critical component of the hematopoietic microenvironment that regulates blood cell production. Recent studies suggest the existence of functional cross-talk between hematologic malignancies and vascular endothelium. Here, we show that human acute myeloid leukemia (AML) localizes to the vasculature in both patients and in a xenograft model. A significant number of vascular tissue-associated AML cells (V-AML) integrate into vasculature in vivo and can fuse with endothelial cells. V-AML cells acquire several endothelial cell-like characteristics, including the up-regulation of CD105, a receptor associated with activated endothelium. Remarkably, endothelial-integrated V-AML shows an almost 4-fold reduction in proliferative activity compared to non-vascular associated AML. Primary AML cells can be induced to down regulate the expression of their hematopoietic markers in vitro and differentiate into phenotypically and functionally-defined endothelial-like cells. After transplantation, these leukemia-derived endothelial cells are capable of giving rise to AML. Taken together, these novel functional interactions between AML cells and normal endothelium along with the reversible endothelial cell potential of AML suggest that vascular endothelium may serve as a previously unrecognized reservoir for acute myeloid leukemia.
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4
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Valentino M, Sabato M, Murrone S, Pavlica P, Barozzi L, Rossi C. Contrast-enhanced ultrasound findings in a case of renal extramedullary hematopoiesis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:171-174. [PMID: 22855431 DOI: 10.1002/jcu.21975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 06/22/2012] [Indexed: 06/01/2023]
Abstract
We present the case of an 80-year-old man with two renal solid masses found at sonography, which were imaged by contrast-enhanced ultrasound, CT, and MRI and confirmed histologically. Contrast-enhanced ultrasound findings suggested a benign mass and a CT-guided biopsy yielded a diagnosis of extramedullary hematopoiesis.
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Affiliation(s)
- Massimo Valentino
- Department of Diagnostic Imaging-Emergency Radiology Unit, University Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy
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5
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Intrathoracic extramedullary haematopoiesis: The advantages of hybrid imaging. Diagn Interv Imaging 2012; 93:897-902. [DOI: 10.1016/j.diii.2012.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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6
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La Fianza A, van der Byl G, Maccabelli G, Torretta L, Calliada F. CT and MR findings in extramedullary haematopoiesis with biliary system encasement: a case report. J Radiol Case Rep 2010; 4:1-8. [PMID: 22470696 DOI: 10.3941/jrcr.v4i11.462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Extramedullary haematopoiesis is the production of blood elements outside the bone marrow cavity. In our case computed tomography and magnetic resonance imaging revealed the presence of a rare localization of extramedullary haematopoiesis with encasement of the biliary system in a 59 years-old male Caucasian patient, with chronic myelofibrosis and hepatic failure's symptomatology. Computed tomography detected the presence of homogeneous hypodense tissue around intra-hepatic bile ducts with minimal contrast enhancement, strongly suggestive for extramedullary haematopoiesis. Magnetic resonance confirmed the presence of a solid tissue surrounding the biliary tree, showing late enhancement after gadolinium administration suggestive for non-active lesion of extramedullary haematopoiesis. Final diagnosis was established by percutaneous biopsy.
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7
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Role of the Spleen in Cyclophosphamide-induced Hematosuppression and Extramedullary Hematopoiesis in Mice. Arch Med Res 2009; 40:249-55. [DOI: 10.1016/j.arcmed.2009.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Accepted: 03/25/2009] [Indexed: 11/24/2022]
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8
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Lee IJ, Kim SH, Kim DS, Lee JM, Han JK, Choi BI. Intrahepatic extramedullary hematopoiesis mimicking a hypervascular hepatic neoplasm on dynamic- and SPIO-enhanced MRI. Korean J Radiol 2008; 9 Suppl:S34-8. [PMID: 18607123 PMCID: PMC2627188 DOI: 10.3348/kjr.2008.9.s.s34] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We present a rare case of a focal intrahepatic extramedullary hematopoiesis (EMH) that mimicked a hypervascular hepatic neoplasm in a 33-year-old woman with idiopathic myelofibrosis. The lesion showed homogeneous and persistent enhancement on both contrast-enhanced CT and gadolinium-enhanced dynamic MR imaging. The lesion did not demonstrate an apparent signal drop on a T2*-weighted sequence following administration of a superparamagnetic iron-oxide agent (SHU 555A). A hepatocellular adenoma was the initial radiological diagnosis. To the best of our knowledge, this is the first report of a histopathologically proven intrahepatic EMH evaluated with dynamic- and SPIO-enhanced MRI.
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Affiliation(s)
- In Joon Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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9
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Lee JW, Kim S, Kwack SW, Kim CW, Moon TY, Lee SH, Cho M, Kang DH, Kim GH. Hepatic Capsular and Subcapsular Pathologic Conditions: Demonstration with CT and MR Imaging. Radiographics 2008; 28:1307-23. [DOI: 10.1148/rg.285075089] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Jelali MA, Luciani A, Kobeiter H, Zafrani S, Anglade MC, Zegai B, Bachir D, Rahmouni A. MRI features of intrahepatic extramedullary haematopoiesis in sickle cell anaemia. Cancer Imaging 2006; 6:182-5. [PMID: 17208673 PMCID: PMC1766560 DOI: 10.1102/1470-7330.2006.0030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Extramedullary haematopoiesis (EMH) is a reactive mechanism by which blood cells are produced outside of the bone marrow to supplement insufficient production or increased destruction of erythrocytes. EMH is uncommon in sickle cell anaemia (SCA). We report the first case of focal intra-hepatic EMH in SCA depicted on MRI occurring in a 32-year-old woman with homozygote SCA and in view of previously published data, highlight the diagnostic features suggesting a differential diagnosis with other focal liver lesions including infectious, inflammatory or primary liver tumors.
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Affiliation(s)
- Mohamed Ali Jelali
- Department of Radiology, Centre Hospitalo-Universitaire Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Alain Luciani
- Department of Pathology, Centre Hospitalo-Universitaire Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Hicham Kobeiter
- Department of Radiology, Centre Hospitalo-Universitaire Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Serge Zafrani
- Department of Pathology, Centre Hospitalo-Universitaire Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Marie Christine Anglade
- Department of Radiology, Centre Hospitalo-Universitaire Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Benhalima Zegai
- Department of Radiology, Centre Hospitalo-Universitaire Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Dora Bachir
- Department of Haematology, Centre Hospitalo-Universitaire Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Alain Rahmouni
- Department of Radiology, Centre Hospitalo-Universitaire Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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11
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Galperin-Aizenberg M, Volchek Y, Even Sapir E, Vasserman M, Maizlin ZV, Cohenpour M, Gayer G. Renal extramedullary haematopoiesis mimicking renal lymphoma on computed tomography. Clin Radiol 2006; 61:896-8. [PMID: 16978988 DOI: 10.1016/j.crad.2006.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2006] [Revised: 05/15/2006] [Accepted: 05/17/2006] [Indexed: 11/28/2022]
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12
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König S, Krause P, Markus PM, Becker H. [Role of stem cells in adult hepatic regeneration]. Chirurg 2005; 76:445-52. [PMID: 15827705 DOI: 10.1007/s00104-005-1020-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Central to the successful surgically treatment numerous liver diseases is the ability of the organ to regenerate. The understanding of the process of self-renewal has both changed and progressed over the last few decades. For many years, the assumption was that the liver regenerates primarily through the division of mature liver cells. However, over the last few years there has been increasing evidence of the participation of stem cells. Intrahepatic stem cells, so-called oval cells, are activated under conditions of severe or chronic liver disease and originate from the canals of Hering. In addition, extrahepatic stem cells may migrate from the bone marrow into the liver when the regenerative capacity of the liver itself is depleted. It is not yet fully clear how the different stem cell populations interact with both each other and the mature liver cell population to achieve homeostatic cell and differentiation equilibrium in the diseased and/or regenerating organ. In any case, the outstanding growth potential of liver stem cells may become a clinically viable option in the field of cell transplantation.
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Affiliation(s)
- S König
- Klinik für Allgemeinchirurgie, Georg-August-Universität Göttingen.
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13
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Al-Nafussi A, Al-Okati D, Alsewan M. Extramedullary haematopoietic tumour of the breast: a case report in a woman with secondary myelofibrosis following essential thrombocythaemia. Histopathology 2004; 44:625-6. [PMID: 15186279 DOI: 10.1111/j.1365-2559.2004.01700.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Singer A, Maldjian P, Simmons MZ. Extramedullary hematopoiesis presenting as a focal splenic mass: a case report. ACTA ACUST UNITED AC 2004; 29:710-2. [PMID: 15162237 DOI: 10.1007/s00261-003-0164-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Accepted: 12/17/2003] [Indexed: 11/25/2022]
Abstract
We report the ultrasound, computed tomographic, and magnetic resonance imaging findings in a case of extramedullary hematopoiesis presenting as a focal splenic mass in a patient with myelodysplastic syndrome. Ultrasound demonstrated a well-circumscribed hyperechoic mass, whereas computed tomography showed a heterogeneous mass better visualized after administration of intravenous contrast. On magnetic resonance imaging, the lesion was hypointense to the spleen on T1-weighted images, with increased signal on T2-weighted images, and demonstrated enhancement after intravenous contrast administration. Extramedullary hematopoiesis should be considered in the differential diagnosis for a splenic mass in any patient with a hematologic disorder.
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Affiliation(s)
- A Singer
- Department of Radiology, UMD-New Jersey Medical School University Hospital, C320 Newark, NJ 07103, USA.
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15
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Tzankov A, Krugmann J, Steurer M, Dirnhofer S. Idiopathic myelofibrosis with nodal, serosal and parenchymatous infiltration. Case report and review of the literature. Acta Haematol 2002; 107:173-6. [PMID: 11978939 DOI: 10.1159/000057636] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Idiopathic myelofibrosis (IMF) is a breakpoint cluster region rearrangement-negative chronic myeloproliferative disease with progressive bone marrow fibrosis. We report a female patient (65 years old) who was admitted to our hospital in 1996. Trephine bone marrow biopsy revealed diffuse fibrosis with atypical multilobulated megakaryocytes. A cellular phase of IMF was diagnosed. Three years later, despite being at intermediate risk, the patient developed generalized lymphadenopathy and multiple sclerosing tumors throughout the peritoneum and retroperitoneum. Biopsy specimens from these tumors revealed sclerosing hematopoietic infiltrates. The present case demonstrates that IMF not only can progress to acute leukemia but can also spread uncontrollably, or 'metastasize' with extensive sclerosing hematopoietic tumors throughout the body.
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